Aktuelle Neurologie 2011; 38(09): 488-493
DOI: 10.1055/s-0031-1298006
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Pumpentherapien für fluktuierende Patienten mit Morbus Parkinson

Pump Therapies for Patients with Parkinson’s Disease and Motor Fluctuations
F. Klostermann
1   Charité – Universitätsmedizin Berlin, Neurologie, Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
21 December 2011 (online)

Zusammenfassung

Behandlungsmöglichkeiten des Morbus Parkinson haben sich in jüngerer Vergangenheit wesentlich erweitert, insbesondere für Patienten, die unter komplexen Fluktuationen ihres Bewegungszustands leiden. Sind wechselnde hypo- und dyskinetische Phasen mit konventionellen medikamentösen Strategien nicht zu kontrollieren, können heutzutage Pumpen zur kontinuierlichen Applikation von Apomorphin oder Levodopa eingesetzt werden. Obgleich diese Eskala­tionstherapien wie auch die Tiefenhirnstimulation prinzipiell das gleiche Behandlungsproblem adressieren, richten sich die einzelnen Methoden an zumindest teilweise unterschiedliche Patientengruppen. Der folgende Überblick stellt die wichtigsten Eigenschaften der verschiedenen Pumpentherapien und Kriterien für deren Einsatz dar.

Abstract

Treatment options for Parkinson’s disease (PD) have greatly increased during the last decades, mostly for patients with severe motor fluctuations. Next to deep brain stimulation (DBS), different pump systems for the continuous infusion of apomorphine and levodopa can provide decisive benefits, if optimised conventional drug therapy proceeds along with oscillations of the motor condition. Although drug pumps and DBS are principally indicated for similar long-term treatment problems in PD, these escalation therapies address at least partially distinct patient profiles. In the following survey the most relevant properties and application criteria of apomorphine and levodopa pump therapies are described.

 
  • Literatur

  • 1 Forno L. Neuropathology of Parkinson’s disease. J Neuropathol Exp Neurol 1996; 55: 259-272
  • 2 Olanow CW, Rascol O, Hauser R et al. A double-blind, delayed-start trial of rasagiline in Parkinson’s disease. N Engl J Med 2009; 361: 1268-1278
  • 3 Birkmayer W, Hornykiewicz O. Der L-Dioxyphenylalanin (4DOPA)-Effekt bei der Parkinson-Akinese. Wien Klin Wschr 1961; 73: 787-788
  • 4 Poewe WH, Wenning GK. The natural history of Parkinson’s disease. Ann Neurol 1998; 44: S1-S9
  • 5 Schrag A, Quinn N. Dyskinesias and motor fluctuations in Parkinson’s disease. A community-based study. Brain 2000; 123: 2297-2305
  • 6 Fahn S, Oakes D, Shoulson I et al. Levodopa and the progression of Parkinson’s disease. N Engl J Med 2004; 351: 2498-2508
  • 7 Nutt JG, Holford NH. The response to levodopa in Parkinson’s disease: imposing pharmacological law and order. Ann Neurol 1996; 39: 561-573
  • 8 Mouradian MM, Juncos JL, Fabbrini G et al. Motor fluctuations in Parkinson’s disease: pathogenetic and therapeutic studies. Ann Neurol 1987; 22: 475-479
  • 9 Olanow CW, Obeso JA, Stocchi F. Continuous dopamine-receptor treatment of Parkinson’s disease: scientific rationale and clinical implications. Lancet Neurol 2006; 5: 677-687
  • 10 Whone AL, Watts RL, Stoessl AJ et al. Slower progression of Parkinson’s disease with ropinirole versus levodopa: The REAL-PET study. Ann Neurol 2003; 54: 93-101
  • 11 Holloway RG, Shoulson I, Fahn S et al. Pramipexole vs levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial. Arch Neurol 2004; 61: 1044-1053
  • 12 Hely MA, Morris JG, Reid WG et al. The Sydney Multicentre Study of Parkinson’s disease: a randomised, prospective five year study comparing low dose bromocriptine with low dose levodopa-carbidopa. J Neurol Neurosurg Psychiatry 1994; 57: 903-910
  • 13 Van Gerpen JA, Kumar N, Bower JH et al. Levodopa-associated dyskinesia risk among Parkinson disease patients in Olmsted County, Minnesota, 1976–1990. Arch Neurol 2006; 63: 205-209
  • 14 Gervason CL, Pollak PR, Limousin P et al. Reproducibility of motor effects induced by successive subcutaneous apomorphine injections in Parkinson’s disease. Clin Neuropharmacol 1993; 16: 113-119
  • 15 Pfeifer RF, Gutman L, Hull KL et al. Continued efficacy and safety of subcutaneous apomorphine in patients with advanced Parkinson’s disease. Parkinsonism Relat Disord 2007; 13: 93-100
  • 16 Trosch R. Decrease in UPDRS motor scores following intermittent subcutaneous apomorphine for 6 months in patients with advanced Parkinson’s disease. Mov Disord 2004; 19: S217 (S9)
  • 17 Swope DM. Rapid treatment of “wearing off” in Parkinson’s disease. Neurology 2004; 62: S27-S31 (S4)
  • 18 Vaamonde J, Luquin MR, Obeso JA. Subcutaneous lisuride infusion in Parkinson’s disease. Response to chronic administration in 34 patients. Brain 1991; 114: 601-617
  • 19 Sam E, Jeanjean AP, Maloteaux JM et al. Apomorphine pharmacokinetics in parkinsonism after intranasal and subcutaneous application. Eur J Drug Metab Pharmacokinet 1995; 20: 27-33
  • 20 Manson AJ, Turner K, Lees AJ. Apomorphine monotherapy in the treatment of refractory motor complications of Parkinson’s disease: long-term follow-up study of 64 patients. Mov Disord 2002; 17: 1235-1241
  • 21 Chaudhuri KR, Critchley P, Abbott RJ et al. Subcutaneous apomorphine for on-off oscillations in Parkinson’s disease. Lancet 1988; 2: 1260
  • 22 Drapier S, Gillioz AS, Leray E et al. Apomorphine infusion in advanced Parkinson’s patients with subthalamic stimulation contraindications. Parkinsonism Relat Disord 2011; [Epub ahead of print]
  • 23 Colzi A, Turner K, Lees AJ. Continuous subcutaneous waking day apomorphine in the long term treatment of levodopa induced interdose dyskinesias in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1998; 64: 573-576
  • 24 Stibe CM, Lees AJ, Kempster PA et al. Subcutaneous apomorphine in parkinsonian on-off oscillations. Lancet 1988; 1: 403-406
  • 25 Katzenschlager R, Hughes A, Evans A et al. Continuous subcutaneous apomorphine therapy improves dyskinesias in Parkinson’s disease: a prospective study using single-dose challenges. Mov Disord 2005; 20: 151-157
  • 26 Poewe W, Wenning GK. Apomorphine: an underutilized therapy for Parkinson’s disease. Mov Disord 2000; 15: 789-794
  • 27 Antonini A, Isaias IU, Rodolfi G et al. A 5-year prospective assessment of advanced Parkinson disease patients treated with subcutaneous apomorphine infusion or deep brain stimulation. J Neurol 2011; 258: 579-585
  • 28 Nilsson D, Nyholm D, Aquilonius SM. Duodenal levodopa infusion in Parkinson’s disease – long-term experience. Acta Neurol Scand 2001; 104: 343-348
  • 29 Contin M, Riva R, Martinelli P et al. Pharmacodynamic modeling of oral levodopa: clinical application in Parkinson’s disease. Neurology 1993; 43: 367-371
  • 30 Shoulson I, Glaubiger GA, Chase TN. On-off response. Clinical and biochemical correlations during oral and intravenous levodopa administration in parkinsonian patients. Neurology 1975; 25: 1144-1148
  • 31 Quinn N, Parkes JD, Marsden CD. Control of on/off phenomenon by continuous intravenous infusion of levodopa. Neurology 1984; 34: 1131-1136
  • 32 Syed N, Murphy J, Zimmerman Jr T et al. Ten years’ experience with enteral levodopa infusions for motor fluctuations in Parkinson’s disease. Mov Disord 1998; 13: 336-338
  • 33 Nyholm D, Nilsson Remahl AI, Dizdar N et al. Duodenal levodopa in­fusion monotherapy vs oral polypharmacy in advanced Parkinson disease. Neurology 2005; 64: 216-223
  • 34 Antonini A, Isaias IU, Canesi M et al. Duodenal levodopa infusion for advanced Parkinson’s disease: 12-month treatment outcome. Mov Disord 2007; 22: 1145-1149
  • 35 Eggert K, Schrader C, Hahn M et al. Continuous jejunal levodopa infusion in patients with advanced Parkinson disease: practical aspects and outcome of motor and non-motor complications. Clin Neuropharmacol 2008; 31: 151-166
  • 36 Antonini A, Mancini F, Canesi M et al. Duodenal levodopa infusion improves quality of life in advanced Parkinson’s disease. Neurodegener Dis 2008; 5: 244-246
  • 37 Honig H, Antonini A, Martinez-Martin P et al. Intrajejunal levodopa infusion in Parkinson’s disease: a pilot multicenter study of effects on nonmotor symptoms and quality of life. Mov Disord 2009; 24: 1468-1474
  • 38 Elia AE, Dollenz C, Soliveri P et al. Motor features and response to oral levodopa in patients with Parkinson’s disease under continuous dopaminergic infusion or deep brain stimulation. Eur J Neurol 2011; [Epub ahead of print]
  • 39 Devos D. French DUODOPA Study Group. Patient profile, indications, efficacy and safety of duodenal levodopa infusion in advanced Parkinson’s disease. Mov Disord 2009; 24: 993-1000
  • 40 Manca D, Cossu G, Murgia D et al. Reversible encephalopathy and axonal neuropathy in parkinson’s disease during duodopa therapy. Mov Disord 2009; 24: 2293-2294
  • 41 Urban PP, Wellach I, Faiss S et al. Subacute axonal neuropathy in Parkinson’s disease with cobalamin and vitamin B6 deficiency under duodopa therapy. Mov Disord 2010; 25: 1748-1752
  • 42 Klostermann F, Jugel C, Müller T et al. Malnutritional neuropathy under intestinal levodopa infusion. J Neural Transm 2011; [Epub ahead of print]
  • 43 Toth C, Breithaupt K, Ge S et al. Levodopa, methylmalonic acid, and neuropathy in idiopathic Parkinson disease. Ann Neurol 2010; 68: 28-36
  • 44 Müller T, Jugel C, Ehret R et al. Elevation of total homocysteine levels in patients with Parkinson’s disease treated with duodenal levodopa/carbidopa gel. J Neural Transm 2011; 118: 1329-1333
  • 45 Antonini A, Odin P. Pros and cons of apomorphine and L-dopa continuous infusion in advanced Parkinson’s disease. Parkinsonism Relat Disord 2009; 15: S97-S100 (S4)
  • 46 Raudino F, Garavaglia P, Pianezzola C et al. Long-term experience with continuous duodenal levodopa-carbidopa infusion (Duodopa): report of six patients. Neurol Sci 2009; 30: 85-86
  • 47 Deuschl G, Schade-Brittinger C, Krack P et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 2006; 355: 896-908
  • 48 Russmann H, Ghika J, Villemure JG et al. Subthalamic nucleus deep brain stimulation in Parkinson disease patients over age 70 years. Neurology 2004; 63: 1952-1954
  • 49 Weaver FM, Follett K, Stern M et al. Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson’s disease: a randomized trial. JAMA 2009; 301: 63-73
  • 50 Hilker R, Antonini A, Odin P. What is the best treatment for fluctuating Parkinson’s disease: continuous drug delivery or deep brain stimula­tion of the subthalamic nucleus?. J Neural Transm 2011; 118: 907-914