Nervenheilkunde 2013; 32(04): 185-191
DOI: 10.1055/s-0038-1628502
Autonomes Nervensystem
Schattauer GmbH

Neurovegetative Funktionsstörungen bei extrapyramidalmotorischen Erkrankungen

Autonomic dysfunction in patients with extrapyramidal disorders
T. Ziemssen
1   Zentrum für klinische Neurowissenschaften, Autonomes und neuroendokrinologisches Funktionslabor (ANF), Neurologische Klinik, Universitätsklinikum Carl-Gustav Carus, Technische Universität Dresden
› Author Affiliations
Further Information

Publication History

eingegangen am: 18 October 2012

angenommen am: 20 October 2012

Publication Date:
24 January 2018 (online)

Zusammenfassung

Bei extrapyramidal-motorischen Erkrankungen werden häufig nicht motorische Symptome z. B. Verhaltensauffälligkeiten, Dysautonomien, Schlafstörungen und sensorische Störungen beobachtet, die deutliche Implikationen auf die Lebensqualität haben können. Obwohl autonome Dysfunktionen wichtiger Bestandteil extrapyramidaler Erkrankungen (wie idiopathisches Parkinson-Syndrom, Multisystematrophie, progressive supranukleäre Blickparese, Lewy-Body-Demenz) sind, werden sie oft formal nicht mit untersucht und häufig nicht diagnostiziert. Eine geeignete symptomorientierte Diagnostik der unterschiedlichen Funktionssysteme des autonomen Nervensystems und eine symptomatische Therapie im Rahmen eines interdisziplinären Konzepts können von größtem Nutzen für die betroffenen Patienten sein. Leider sind doppelblinde, randomisierte, kontrollierte Studien selten, was zur Folge hat, dass die meisten Empfehlungen nicht evidenzbasiert sind. Im Folgenden sollen die wesentlichen pathophysiologischen Erkenntnisse neben der jeweiligen Diagnostik und Therapie dargestellt werden, wobei der Schwerpunkt auf den kardiovaskulären Funktionsstörungen liegt.

Summary

Although extrapyramidal diseases are commonly thought to solely affect the (extrapyramidal) motor system, non-motor symptoms such as behavioural abnormalities, dysautonomia, sleep disturbances and sensory dysfunctions are also frequently observed. Autonomic dysfunction as an important clinical component of extrapyramidal diseases (idiopathic Parkinson’s disease, multiple system atrophy, progressive supranuclear palsy, dementia with Lewy bodies) is often not formally assessed and thus frequently underdiagnosed. Symptoms of autonomic dysfunction can have more impact on quality of life than mild motor symptoms. Appropriate symptom-oriented diagnosis and symptomatic treatment as part of an interdisciplinary approach can provide a great benefit for the patient. Unfortunately, double-blind, randomised, controlled studies are scarce with the consequence that most recommendations are not based on the highest level of evidence. This review presents a limited overview on the treatment of cardiovascular, gastrointestinal, and sudomotor autonomic dysfunctions in various extrapyramidal syndromes.

 
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