Kontinuierliche intestinale L-Dopa-Gabe und B-Vitamine: was ist zu beachten?^[*]

Zusammenfassung

Ein Vitamin B12- sowie Vitamin B6-Mangel muss als mögliche Folge einer L-Dopa Therapie angesehen werden, wobei der genaue Pathomechanismus nicht sicher bekannt ist. Insbesondere eine kontinuierliche intestinale L-Dopa Gabe bedingt offenbar häufiger einen Mangel der B-Vitamine, der sich dann mit einer axonal senso-motorischen Polyneuropathie bis hin zu einer Polyradikulitis klinisch manifestieren kann. Dabei spielen vermutlich Resorptionsstörungen eine wichtige Rolle. Unter einer oralen L-Dopa Therapie bei Patienten mit Parkinsonerkran­k­ung sollte daher insbesondere bei Auftreten kognitiver Einschränkungen oder bei Auftreten einer Gangstörung ein Mangel an B-Vitaminen in die differenzialdiagnostischen Erwägungen einbezogen werden. Bei einer kontinuierlichen L-DOPA Gabe hingegen sind Kontrollen des Vitamin B12-/B6-Spiegelsbereits vor Beginn der Therapie und regelmäßig im Verlauf zu empfehlen. Bei grenzwertigen Befunden sollte eine differenzierte Diagnostik und Substitutionsbehandlung erfolgen. Bei fulminanten Verläufen ist meist ein Absetzen der intrajejunalen Gabe unter stationären Bedingungen erforderlich.

Abstract

Deficiency of both vitamin B12 and vitamin B6 may be a secondary effect of treatment with levodopa. Its pathomechanism has not yet clearly been elucidated. The continuous administration of intestinal levodopa seems to be particularly contributory to the development of vitamin B deficiencies, which apparently often times manifest themselves in the form of axonal sensomotor polyneuropathy and/or of polyradiculitis with clinical symptoms. Disordered resorption is most probably involved. In terms of differential diagnosis, we should thus take into consideration deficiencies of B vitamins in patients con­tinuously managed with levodopa when they are presenting with cognitive restrictions or notable ataxia. If patients are going to be started on continuous levodopa therapy, they should have their levels of vitamins B12 and B6 checked prior to treatment with regular laboratory follow-up in the further course. In the event of borderline results, the patients will need more differentiated diagnostic work-up and replacement therapy. An acute, fulminating course usually requires the withdrawal of intrajejunal therapy under inpatient conditions.

Schlüsselwörter

idiopathisches Parkinson­syndrom - L-Dopa - kontinuierliche intestinale LDOPA Gabe - Polyneuropathie - B-Vitamine

Keywords

parkinson’s disease - levodopa - continuous intestinal ­administration of levodopa - polyneuropathy - B vitamins

^* Das Manuskript ist Ergebnis des Parkinson Experten Meetings in Dresden. Die weiteren Teilnehmer waren (in alphabetischer Reihenfolge): Horst Baas, Oliver Bandmann, Anja Bilsing, Carsten Buhmann, Ilona Csoti, Gerd Fuchs, Johann Hagenah, Matthias Hahne, Jochen Klucken, Martina Müngersdorf, Christoph Redecker, Heinz Reichmann, Alfons Schnitzler, Jörg Schulz, Peter Vieregge, Tobias Warnecke, Jürgen Winkler, Martin Wolz, Ullrich Wüllner.

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