Moderne Therapie des idiopathischen Parkinson-Syndroms

Das idiopathische Parkinson-Syndrom ist eine der häufigsten neurologischen Erkrankungen in Deutschland, deren Prävalenz mit zunehmendem Lebensalter ansteigt. Die klassische Behandlung mit oral verabreichtem L-Dopa zeichnet sich zwar initial durch eine gute Wirksamkeit aus, geht jedoch aufgrund des zunehmenden Absterbens nigrostriataler Neurone im Krankheitsverlauf und der damit zunehmend unregelmäßig erfolgenden Dopaminfreisetzung im Striatum mit einer Reihe von Komplikationen einher, zu denen vor allem Dyskinesien und motorische Fluktuationen zählen. Erkenntnisse aus der klinischen Forschung legen die Vermutung nahe, dass sich diese Spätkomplikationen der Erkrankung am ehesten durch eine Medikation verhindern oder zumindest verzögern lassen, die eine kontinuierliche dopaminerge Stimulation im Striatum gewährleistet. Im Zentrum der modernen Parkinson-Therapie steht daher das Bestreben, insbesondere jüngere Patienten zunächst mit Dopaminagonisten und anderen Substanzklassen zu behandeln und L-Dopa erst spät im Verlauf und in einer möglichst niedrigen Dosierung einzusetzen. Bei älteren Patienten mit Komorbidität kann hingegen L-Dopa auch primär verabreicht werden, da es bei guter Wirksamkeit über ein günstiges Nebenwirkungsprofil verfügt. Auch für fortgeschrittene Erkrankungsstadien bietet die moderne medikamentöse Therapie des idiopathischen Parkinson-Syndroms zusammen mit innovativen, operativen Verfahren eine Vielzahl von Behandlungsansätzen, so dass die Lebensqualität für Parkinson-Patienten lange aufrechterhalten werden kann.

Idiopathic Parkinson's disease is one of the most common neurological diseases in Germany whose prevalence is increasing with rising age. Classical treatment with orally administered levodopa is able to treat the symptoms of this disease with high efficacy but is also associated with marked long-term sequelae for the patient, such as dyskinesia and motor fluctuations, which are due to the progressive loss of nigrostriatal neurons during the course of the disease leading to an unsteady release of dopamine in the striatum. Results from clinical studies suggest that these long-term complications can be avoided or at least postponed by a medication that guarantees a continuous dopaminergic stimulation in the striatum. Thus, the modern concept of Parkinson's disease is focussed to initiate treatment with dopamine agonists and substances other than levodopa, and to use levodopa preferably late in the course of the disease and at the lowest doses possible. Due to its high efficacy and low adverse effects, levodopa can however still be recommended for the initial treatment in older patients with comorbidity. Modern drug therapy of idiopathic Parkinson's disease together with innovative surgical methods offers a wide variety of treatment options even in advanced disease stages and is able to maintain the quality of life for Parkinson's patients for a very long time.

Key Words

Parkinson's disease - PD therapy - continuous dopaminergic stimulation - levodopa - dopamine agonists

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