Tiefe Hirnstimulation beim idiopathischen Parkinson-Syndrom

ZUSAMMENFASSUNG

Indikationen für die tiefe Hirnstimulation beim idiopathischen Parkinson-Syndrom sind medikamentös therapieresistenter Tremor oder medikamentös nicht ausreichend beherrschbare Wirkfluktuationen, Dyskinesien und schwere Nebenwirkungen der Medikation. Die sorgfältige präoperative Beratung der Patienten bezüglich der realistischen Therapieziele ist wesentlich für die postoperative Therapiezufriedenheit. Tremor sowie alle Off-Phasen-gebundenen motorischen und nicht motorischen Symptome sind der Therapie der tiefen Hirnstimulation gut zugänglich, dagegen sind Symptome, die präoperativ auch im medikamentösen On persistieren (On-Phasen-Freezing, Gleichgewichtsstörungen), durch die tiefe Hirnstimulation nicht zu bessern. Einige vegetative Symptome (Blasenstörungen, Schlafstörungen) können sich bessern, andere (orthostatische Dysregulation) nicht. In der postoperativen Phase können – meist transiente – psychische Störungen wie Depressivität, erhöhte Impulsivität oder Hypomanie auftreten. Die Wirkung der tiefen Hirnstimulation auf die Zielsymptome Rigor, Tremor und Hypokinese hält an, die Progredienz der neurodegenerativen Erkrankung wird aber nicht aufgehalten.

ABSTRACT

Deep brain stimulation is indicated in Parkinson‘s tremor that doesn‘t respond to medication or in Parkinson‘s disease with on-off fluctuations which cannot be sufficiently controlled by medical treatment. Patients should be thoroughly counseled preoperatively about reasonable aims to provide good postoperative treatment satisfaction. Tremor and those symptoms which are linked to the medical off-phases such as rigor, hypokinesia, off-linked freezing and painful dystonia will be ameliorated by deep brain stimulation, whilst symptoms which preoperatively persist during the medical on-phase such as on- phase- freezing and imbalance will not respond to deep brain stimulation. Some vegetative symptoms may be ameliorated by deep brain stimulation, such as sleep disturbances or bladder function, other vegetative symptoms will not be altered, such as orthostatic dysregulation. During the postoperative phase psychiatric symptoms such as depression, mania or impulsiveness may occur which usually are transient. Treatment effects of deep brain stimulation will permanently persist. However, the natural progression of the disease cannot be stopped.

Schlüsselwörter

Idiopathisches Parkinson-Syndrom - tiefe Hirnstimulation - Indikationen - postoperative Nachsorge

Key words

Parkinson‘s disease - deep brain stimulation - indication - postoperative management

• Literatur

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