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Erschienen in: Der Nervenarzt 8/2003

01.08.2003

Die tiefe Hirnstimulation zur Behandlung von M. Parkinson, Tremor und Dystonie

verfasst von: F. Kopper, J. Volkmann, D. Müller, M. Mehdorn, G. Deuschl

Erschienen in: Der Nervenarzt | Ausgabe 8/2003

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Zusammenfassung

Die tiefe Hirnstimulation stellt eine wirkungsvolle Erweiterung der medikamentösen Behandlung von behindernden motorischen Symptomen bei neurologischen Bewegungsstörungen dar. Die Vorteile gegenüber ablativen stereotaktischen Verfahren liegen in der nur geringen Gewebsschädigung durch das Einbringen der Stimulationselektroden und der damit prinzipiell gegebenen Reversibilität von unerwünschten Therapieeffekten. Weiterhin kann die Therapie durch Änderung der Stimulationsparameter an den Verlauf der Erkrankung angepaßt werden, so daß über Jahre hinaus die Möglichkeit der Therapieoptimierung gegeben ist. Die Hochfrequenzstimulation des Nucleus subthalamicus (STN) und Globus pallidus internus (GPi) bei M. Parkinson, des Nucleus ventralis intermedius thalami (VIM) bei essenziellem Tremor und des GPi bei Dystonien gelten als etablierte Therapieverfahren und führen zu einer messbaren Verbesserung der motorischen Symptome der betroffenen Patienten. Studien zur Erfassung der Einflüsse auf die Lebensqualität sind dringend erforderlich und werden aktuell für M. Parkinson und Dystonien durchgeführt.
Die Behandlung des zerebellären Tremors bei multipler Sklerose (MS) durch die tiefe Hirnstimulation gestaltet sich schwieriger, wobei durch strenge Patientenselektion in Einzelfällen eine weitreichende Linderung der motorischen Behinderung erreicht werden kann. Die Datenlage lässt zum gegenwärtigen Zeitpunkt keine Beurteilung des Langzeiteffektes bei MS-Tremor zu, Studien zur Evaluation der chronischen VIM-Stimulation bei dieser Indikation werden dringend benötigt.
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Metadaten
Titel
Die tiefe Hirnstimulation zur Behandlung von M. Parkinson, Tremor und Dystonie
verfasst von
F. Kopper
J. Volkmann
D. Müller
M. Mehdorn
G. Deuschl
Publikationsdatum
01.08.2003
Verlag
Springer-Verlag
Erschienen in
Der Nervenarzt / Ausgabe 8/2003
Print ISSN: 0028-2804
Elektronische ISSN: 1433-0407
DOI
https://doi.org/10.1007/s00115-003-1555-9

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