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Tiefe Hirnstimulation bei idiopathischem Parkinson-Syndrom

Empfehlungen der Deutschen Arbeitsgemeinschaft Tiefe Hirnstimulation

Deep brain stimulation for Parkinson’s disease

Consensus recommendations of the German Deep Brain Stimulation Association

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Zusammenfassung

Die tiefe Hirnstimulation (THS) bessert bei idiopathischem Parkinson-Syndrom prinzipiell Levodopa-responsive Symptome und Tremor. Die Stimulation des Nucleus subthalamicus (STN) ist in Bezug auf die Kontrolle von Fluktuationen und die Off-Zeit-Reduktion der rein medikamentösen Therapie überlegen. Verlaufsuntersuchungen zeigen eine langfristig anhaltende Wirksamkeit der STN-Stimulation, auch wenn die Erkrankung selbst weiter progredient ist. Die STN-THS erlaubt im Gegensatz zur Stimulation des Globus pallidus internus (GPi) zumeist die Reduktion der dopaminergen Medikation. Die Stimulation im Nucleus ventralis intermedius thalami (VIM) stellt eine Alternative bei älteren Patienten mit medikamentös nicht beherrschbarem Tremor dar. Eine konsequente und sorgfältige Indikationsstellung ist besonders bei Parkinson-Patienten zur Minimierung möglicher Operationsrisiken und unerwünschter Wirkungen der THS unabdingbar. Diese Arbeit fasst die aktuelle Datenlage zu dieser Thematik in Form von Empfehlungen zusammen, welche innerhalb der Arbeitsgemeinschaft Tiefe Hirnstimulation erarbeitet wurden.

Summary

Deep brain stimulation (DBS) has been shown to be effective for levodopa-responsive symptoms and tremor in Parkinson’s disease (PD). The subthalamic nucleus (STN) is the preferred target for most patients suffering from late stage motor complications of the disorder. STN DBS is superior to best medical treatment concerning the control of motor fluctuations and the increase of on-time without dyskinesias. In contrast to DBS of the internal pallidum (GPi), STN stimulation also permits a reduction of the dopaminergic medication. Long-term data demonstrated sustained effectiveness of STN DBS despite progressive disease. DBS of the thalamic ventral intermediate nucleus (VIM) is an alternative target in older PD patients with severe PD tremor refractory to medication. In order to minimize potential risks and side effects, the use of DBS needs careful adherence to inclusion and exclusion criteria for eligible PD patients. This paper summarizes the current consensus recommendations of the German Deep Brain Stimulation Association for DBS in PD.

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Hilker, R., Benecke, R., Deuschl, G. et al. Tiefe Hirnstimulation bei idiopathischem Parkinson-Syndrom. Nervenarzt 80, 646–655 (2009). https://doi.org/10.1007/s00115-009-2695-3

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