Fortschr Neurol Psychiatr 2017; 85(09): 516-535
DOI: 10.1055/s-0043-110095
Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Praktische Anwendung der kontinuierlichen Apomorphin-Pumpentherapie

Practical use of continuous apomorphine infusion via pump
Lars Tönges
1   Ruhr-Universität Bochum, St. Josef-Hospital, Klinik für Neurologie
,
Andrés Ceballos-Baumann
2   Schön Klinik München-Schwabing, Neurologie und klinische Neurophysiologie
,
Holger Honig
3   Klinikum Bremerhaven Reinkenheide, Neurologie
,
Alexander Storch
4   Universitätsmedizin Rostock, Neurologie; DZNE Rostock
,
Wolfgang H. Jost
5   Parkinson-Klinik Ortenau; Universitätsklinikum Freiburg
› Author Affiliations
Further Information

Publication History

Publication Date:
17 August 2017 (online)

Zusammenfassung

Das idiopathische Parkinson-Syndrom ist nach der Alzheimer Erkrankung die zweithäufigste neurodegenerative Erkrankung und im fortgeschrittenen Stadium durch zahlreiche Besonderheiten gekennzeichnet. Neben nicht-motorischen Symptomen stehen oft motorische Komplikationen im Vordergrund, die mit pulsatilen oralen Therapien nur unzureichend verbessert werden können. Mithilfe der kontinuierlichen dopaminergen Stimulation lassen sich jedoch auch im fortgeschrittenen Stadium Optimierungen vornehmen, die neben der Verbesserung motorischer und nicht-motorischer Symptome auch eine höhere Lebensqualität erzielen können. Etabliert hat sich in diesem Zusammenhang die kontinuierliche subkutane Gabe von Apomorphin mittels Medikamentenpumpe, deren Nutzen, Indikationen, Anwendungsbeschränkungen und praktische Umsetzung in dieser Expertenempfehlung ausführlich dargestellt werden. Besonders hervorzuheben ist das vorteilhafte therapeutische Fenster der Apomorphin-Pumpentherapie, das durch einfache medikamentöse Titration bei einem schnell reversiblen Verfahren optimal ausgenutzt werden kann. Im vorliegenden Artikel werden die Ergebnisse eines Experten-Meetings zur Apomorphin-Therapie vorgestellt, das am 6. Juli 2016 in Frankfurt am Main stattgefunden hat.

Abstract

Parkinson’s disease is the second most common neurodegenerative illness after Alzheimer’s disease. In its advanced stages, it is characterized by various special symptoms. In addition to non-motor signs, motor complications are most prominent and most often can only be inadequately improved with pulsatile oral therapies. However, with the aid of continuous dopaminergic stimulation, improvements can be achieved even in advanced stages of the disease. This will not only alleviate motor and non-motor symptoms, but will also lead to a better quality of life. In this context, continuous subcutaneous apomorphine administration by means of a pump has been well established. Its benefits, indications, limitations and practical implementation will be thoroughly described in the expert recommendation. Particularly noteworthy is the rather broad therapeutic window of apomorphine pump treatment, which can be optimally utilized by simple drug titration in a rapidly reversible process. This article presents the results of an expert meeting on apomorphine therapy which took place on July 6, 2016, in Frankfurt (M), Germany.

 
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