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Nervenheilkunde 2005; 24(10): 884-902
DOI: 10.1055/s-0038-1630033
Original Article
Schattauer GmbH

Tiefe Hirnstimulation bei idiopathischem Parkinson-Syndrom und essenziellem Tremor

Grundlagen, Indikationsstellung, peri- und intraoperatives Vorgehen, Psychosomatik und RehabilitationDeep brain stimulation in Parkinson’s disease and essential tremorRationale, indication, pre-, intra- and postoperative management, psychosomatics and rehabilitation
A. M. Frank
1   Neurochirurgische Klinik und Poliklinik der Technischen Universität München (Direktorin: Univ. Prof. Dr. A. E. Trappe)
,
A. Ceballos-Baumann
2   Abteilung Neurologie und klinische Neurophysiologie, Neurologisches Krankenhaus München, Zentrum für Parkinson und Bewegungsstörungen
› Author Affiliations
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Publication History

Publication Date:
30 January 2018 (online)

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Zusammenfassung

Die tiefe Hirnstimulation als stereotaktisches Verfahren hat in kurzer Zeit einen festen Platz in der Therapie des fortgeschrittenen idiopathischen Parkinson-Syndroms (IPS) und der funktionell beeinträchtigenden Tremor-Formen erhalten. Trotz differenzierter medikamentöser Therapie und der Entwicklung neuer Medikamente kommt es im Verlauf des IPS zu Wirkfluktuationen und Nebenwirkungen, die durch die tiefe Hirnstimulation bei eindeutig L-DOPA-responsiven Patienten wirksam gebessert werden können. Auch ist die tiefe Hirnstimulation wirksam bei essenziellem Tremor. Ziel dieser Übersicht ist es, die wesentlichen Grundlagen und die Rationale der tiefen Hirnstimulation sowie die Indikationsstellung für dieses aufwendige und invasive therapeutische Verfahren zu erklären und das peri-, intraund postoperative Vorgehen sowie psychiatrische, psychosomatische und rehabilitative Aspekte zu skizzieren.

Summary

Deep brain stimulation (DBS), the stereotactic guided implantation of electrodes in deep brain structures and chronic stimulation has become an established option in the treatment of advanced Parkinson’s disease and essential tremor. Despite new anti-parkinsonian drugs levodopa fluctuations and long term complications such as on-offphenomena and dyskinesias continue to represent a challenge. In those patients who are clearly responsive to levodopa, DBS can alleviate the symptoms effectively. DBS is also effective in treatment of essential tremor. This review discusses the rationale of DBS and patient selection and describes pre-, intra- and postoperative management and psychiatric, psychosomatic and rehabilitative aspects.

Schlüsselwörter

Tiefe Hirnstimulation - Stereotaxie - idiopathisches Parkinson-Syndrom - Dopaminergika - Tremor

Keywords

Deep brain stimulation - stereotactic surgery - Parkinson’s disease - dopamine agonists - tremor
 

  • Literatur

  • 1 Acland KM, Churchyard A, Fletcher CL, Turner K, Lees A, Dowd PM. Panniculitis in association with apomorphine infusion. Br J Dermatol 1998; 138: 480-2.
    CrossrefPubMedGoogle Scholar
  • 2 Agid Y. et al. Levodopa in the treatment of Parkinson’s disease: a consensus meeting. Mov Disord 1999; 14: 911-3.
    CrossrefPubMedGoogle Scholar
  • 3 Ahlskog JE, Muenter MD. Frequency of levodopa-related dyskinesias and motor fluctuations as estimated from the cumulative literature. Mov Disord 2001; 16: 448-58.
    CrossrefPubMedGoogle Scholar
  • 4 Ardouin C, Pillon B, Peiffer E, Bejjani P, Limousin P, Damier P, Arnulf I, Benabid AL, Agid Y, Pollak P. Bilateral subthalamic or pallidal stimulation for Parkinson’s disease affects neither memory nor executive functions: a consecutive series of 62 patients. Ann Neurol 1999; 46: 217-23.
    CrossrefPubMedGoogle Scholar
  • 5 Bejjani BP, Damier P, Arnulf I, Thivard L, Bonnet AM, Dormont D, Cornu P, Pidoux B, Samson Y, Agid Y. Transient acute depression induced by high-frequency deep-brain stimulation. N Engl J Med 1999; 340: 1476-80.
    CrossrefPubMedGoogle Scholar
  • 6 Benabid AL, Pollak P, Gervason C, Hoffman D, Gao DM, Hommel M, Perret JE, De RJ. Longterm suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus. Lancet 1991; 337: 403-6.
    CrossrefPubMedGoogle Scholar
  • 7 Benabid AL, Pollak P, Gao D, Hoffmann D, Limousin P, Gay E, Payen I, Benazzouz A. Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders. J Neurosurg 1996; 84: 203-14.
    CrossrefPubMedGoogle Scholar
  • 8 Bergman H, Wichmann T, DeLong MR. Reversal of experimental parkinsonism by lesions of the subthalamic nucleus. Science 1990; 249: 1436-8.
    CrossrefPubMedGoogle Scholar
  • 9 Berney A, Vingerhoets F, Perrin A, Guex P, Villemure JG, Burkhard PR, Benkelfat C, Ghika J. Effect on mood of subthalamic DBS for Parkinson’s disease: a consecutive series of 24 patients. Neurology 2002; 59: 1427-9.
    CrossrefPubMedGoogle Scholar
  • 10 Burkhard PR, Vingerhoets FJ, Berney A, Bogousslavsky J, Villemure JG, Ghika J. Suicide after successful deep brain stimulation for movement disorders. Neurology 2004; 63: 2170-2.
    CrossrefPubMedGoogle Scholar
  • 11 Castelli L, Perozzo P, Genesia ML, Torre E, Pesare M, Cinquepalmi A, Lanotte M, Bergamasco B, Lopiano L. Sexual well being in parkinsonian patients after deep brain stimulation of the subthalamic nucleus. J Neurol Neurosurg Psychiatry 2004; 75: 1260-4.
    CrossrefPubMedGoogle Scholar
  • 12 Ceballos-Baumann AO. Idiopathisches Parkinson-Syndrom: Grundlagen, Medikamente, Therapieeinleitung. In: Ceballos-Baumann AO, Conrad B. (eds) Bewegungsstörungen in der Neurologie. 2. überarbeitete Auflage. Stuttgart, New York: Thieme; 2005
    Google Scholar
  • 13 Ceballos-Baumann AO, Boecker H. Tremor – new therapy options. Internist 2000; 41: 1353-62.
    CrossrefPubMedGoogle Scholar
  • 14 Ceballos-Baumann AO, Boecker H, Bartenstein P, von Falkenhayn I, Riescher H, Conrad B, Moringlane JR, Alesch F. A positron emission tomographic study of subthalamic nucleus stimulation in Parkinson disease: enhanced movement-related activity of motor-association cortex and decreased motor cortex resting activity. Arch Neurol 1999; 56: 997-1003.
    CrossrefPubMedGoogle Scholar
  • 15 Ceballos-Baumann AO, Boecker H, Fogel W, Alesch F, Bartenstein P, Conrad B, Diederich N, von Falkenhayn I, Moringlane JR, Schwaiger M, Tronnier VM. Thalamic stimulation for essential tremor activates motor and deactivates vestibular cortex. Neurology 2001; 56: 1347-54.
    CrossrefPubMedGoogle Scholar
  • 16 Charles PD, Van Blercom N, Krack P, Lee SL, Xie J, Besson G, Benabid AL, Pollak P. Predictors of effective bilateral subthalamic nucleus stimulation for PD. Neurology 2002; 59: 932-4.
    CrossrefPubMedGoogle Scholar
  • 17 Deep-Brain-Stimulation-Study-Group. Deepbrain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease. N Engl J Med 2001; 345: 956-63.
    CrossrefPubMedGoogle Scholar
  • 18 Deutsche Gesellschaft für Neurochirurgie. Empfehlungen zur Durchführung funktionell Neurochirurgischer Eingriffe. In: www.dncg.de 2005
    PubMedGoogle Scholar
  • 19 Doshi PK, Chhaya N, Bhatt MH. Depression leading to attempted suicide after bilateral subthalamic nucleus stimulation for Parkinson’s disease. Mov Disord 2002; 17: 1084-5.
    CrossrefPubMedGoogle Scholar
  • 20 Friedman JH, Koller WC, Lannon MC, Busenbark K, Swanson-Hyland E, Smith D. Benztropine versus clozapine for the treatment of tremor in Parkinson’s disease. Neurology 1997; 48: 1077-81.
    CrossrefPubMedGoogle Scholar
  • 21 Funkiewiez A, Ardouin C, Krack P, Fraix V, Van Blercom N, Xie J, Moro E, Benabid AL, Pollak P. Acute psychotropic effects of bilateral subthalamic nucleus stimulation and levodopa in Parkinson’s disease. Mov Disord 2003; 18: 524-30.
    CrossrefPubMedGoogle Scholar
  • 22 Funkiewiez A, Ardouin C, Caputo E, Krack P, Fraix V, Klinger H, Chabardes S, Foote K, Benabid AL, Pollak P. Long term effects of bilateral subthalamic nucleus stimulation on cognitive function, mood, and behaviour in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2004; 75: 834-9.
    CrossrefPubMedGoogle Scholar
  • 23 Haslinger B. Kalteis Boecker H, Alesch F, Ceballos-Baumann AO. STN stimulation reduces motor cortex activity. Neuroimage. 2005 (in press)
    PubMedGoogle Scholar
  • 24 Haslinger B, Boecker H, Buchel C, Vesper J, Tronnier VM, Pfister R, Alesch F, Moringlane JR, Krauss JK, Conrad B, Schwaiger M, Ceballos-Baumann AO. Differential modulation of subcortical target and cortex during deep brain stimulation. Neuroimage 2003; 18: 517-24.
    CrossrefPubMedGoogle Scholar
  • 25 Houeto JL, Mesnage V, Mallet L, Pillon B, Gargiulo M, du Moncel ST, Bonnet AM, Pidoux B, Dormont D, Cornu P, Agid Y. Behavioural disorders, Parkinson’s disease and subthalamic stimulation. J Neurol Neurosurg Psychiatry 2002; 72: 701-7.
    CrossrefPubMedGoogle Scholar
  • 26 Krack P, Pollak P, Limousin P, Benazzouz A, Benabid AL. Stimulation of subthalamic nucleus alleviates tremor in Parkinson’s disease [letter]. Lancet 1997; 350: 1675.
    CrossrefPubMedGoogle Scholar
  • 27 Krack P, Kumar R, Ardouin C, Dowsey PL, McVicker JM, Benabid AL, Pollak P. Mirthful laughter induced by subthalamic nucleus stimulation. Mov Disord 2001; 16: 867-75.
    CrossrefPubMedGoogle Scholar
  • 28 Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, Koudsie A, Limousin PD, Benazzouz A, LeBas JF, Benabid AL, Pollak P. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 2003; 349: 1925-34.
    CrossrefPubMedGoogle Scholar
  • 29 Kuehler A, Henrich G, Schroeder U, Conrad B, Herschbach P, Ceballos-Baumann A. A novel quality of life instrument for deep brain stimulation in movement disorders. J Neurol Neurosurg Psychiatry 2003; 74: 1023-30.
    CrossrefPubMedGoogle Scholar
  • 30 Kuehler A, Henrich G, Schroeder U, Conrad B, Herschbach P, Ceballos-Baumann A. A new perspective: subjectively perceived Quality of Life in patients with Deep Brain Stimulation for Parkinson’s Disease. Mov Disord. (in review).
    Google Scholar
  • 31 Kulisevsky J, Berthier ML, Gironell A, Pascual-Sedano B, Molet J, Pares P. Mania following deep brain stimulation for Parkinson’s disease. Neurology 2002; 59: 1421-4.
    CrossrefPubMedGoogle Scholar
  • 32 Kumar R, Krack P, Pollak P. Transient acute depression induced by high-frequency deep-brain stimulation. N Engl J Med 1999; 341: 1003-4 discussion 1004.
    CrossrefPubMedGoogle Scholar
  • 33 Kurlan R, Rubin AJ, Miller C, Rivera-Calimlim L, Clarke A, Shoulson I. Duodenal delivery of levodopa for on-off fluctuations in parkinsonism: preliminary observations. Ann Neurol 1986; 20: 262-5.
    CrossrefPubMedGoogle Scholar
  • 34 Kurlan R, Nutt JG, Woodward WR, Rothfield K, Lichter D, Miller C, Carter JH, Shoulson I. Duodenal and gastric delivery of levodopa in parkinsonism. Ann Neurol 1988; 23: 589-95.
    CrossrefPubMedGoogle Scholar
  • 35 Kurth MC, Tetrud JW, Tanner CM, Irwin I, Stebbins GT, Goetz CG, Langston JW. Double-blind, placebo-controlled, crossover study of duodenal infusion of levodopa/carbidopa in Parkinson’s disease patients with ‘on-off’ fluctuations. Neurology 1993; 43: 1698-703.
    CrossrefPubMedGoogle Scholar
  • 36 Limousin P, Pollack P, Benazzouz A, Hoffmann D, Le Bas JF, Brousolle E, Perret JE, Benabid AL. Effect on parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet 1995; 345: 91-5.
    CrossrefPubMedGoogle Scholar
  • 37 Nilsson D, Nyholm D, Aquilonius SM. Duodenal levodopa infusion in Parkinson’s disease – longterm experience. Acta Neurol Scand 2001; 104: 343-8.
    CrossrefPubMedGoogle Scholar
  • 38 Perozzo P, Rizzone M, Bergamasco B, Castelli L, Lanotte M, Tavella A, Torre E, Lopiano L. Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: comparison of pre- and postoperative neuropsychological evaluation. J Neurol Sci 2001; 192: 9-15.
    CrossrefPubMedGoogle Scholar
  • 39 Sage JI, Trooskin S, Sonsalla PK, Heikkila R, Duvoisin RC. Long-term duodenal infusion of levodopa for motor fluctuations in parkinsonism. Ann Neurol 1988; 24: 87-9.
    CrossrefPubMedGoogle Scholar
  • 40 Saint-Cyr JA, Trepanier LL, Kumar R, Lozano AM, Lang AE. Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson’s disease. Brain 2000; 123 (Pt 10): 2091-108.
    CrossrefPubMedGoogle Scholar
  • 41 Schneider F, Habel U, Volkmann J, Regel S, Kornischka J, Sturm V, Freund HJ. Deep brain stimulation of the subthalamic nucleus enhances emotional processing in Parkinson disease. Arch Gen Psychiatry 2003; 60: 296-302.
    CrossrefPubMedGoogle Scholar
  • 42 Schroeder U, Kuehler A, Haslinger B, Erhard P, Fogel W, Tronnier VM, Lange KW, Boecker H, Ceballos-Baumann AO. Subthalamic nucleus stimulation affects striato-anterior cingulate cortex circuit in a response conflict task: a PET study. Brain 2002; 125 (Pt 9): 1995-2004.
    CrossrefPubMedGoogle Scholar
  • 43 Schroeder U, Kuehler A, Lange KW, Haslinger B, Tronnier VM, Krause M, Pfister R, Boecker H, Ceballos-Baumann AO. Subthalamic nucleus stimulation affects a frontotemporal network: a PET study. Ann Neurol 2003; 54: 445-50.
    CrossrefPubMedGoogle Scholar
  • 44 Schroeder U, Kuehler A, Hennenlotter A, Haslinger B, Tronnier VM, Krause M, Pfister R, Sprengelmeyer R, Lange KW, Ceballos-Baumann AO. Facial expression recognition and subthalamic nucleus stimulation. J Neurol Neurosurg Psychiatry 2004; 75: 648-50.
    CrossrefPubMedGoogle Scholar
  • 45 Schuurman PR, Bosch DA, Bossuyt PM, Bonsel GJ, van Someren EJ, de Bie RM, Merkus MP, Speelman JD. A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor [see comments]. N Engl J Med 2000; 342: 461-8.
    CrossrefPubMedGoogle Scholar
  • 46 Umemura A, Jaggi JL, Hurtig HI, Siderowf AD, Colcher A, Stern MB, Baltuch GH. Deep brain stimulation for movement disorders: morbidity and mortality in 109 patients. J Neurosurg 2003; 98: 779-84.
    CrossrefPubMedGoogle Scholar
  • 47 Koller W. et al. High-frequency unilateral thalamic stimulation in the treatment of essential and parkinsonian tremor. Ann Neurol 1997; 42: 292-9.
    CrossrefPubMedGoogle Scholar
  • 48 Ondo W. et al. Unilateral thalamic deep brain stimulation for refractory essential tremor and Parkinson’s disease tremor. Neurology 1998; 51: 1063-9.
    CrossrefPubMedGoogle Scholar