Therapie des Parkinson-Syndroms

Durch das Absterben dopaminerger Neurone kommt es in den betroffenen Gehirnbereichen zu einem Mangel an Dopamin und damit zu einem Ungleichgewicht zwischen dem dopaminergen und cholinergen System (18, 23, 30).

Daher versuchen medikamentöse Therapien dieses Defizit an Dopamin wieder auszugleichen. Dies wird entweder durch den Ersatz des fehlenden Neurotransmitters oder durch eine lokale Hemmung des cholinergen Systems erreicht (1, 11, 14, 19).

Neben der medikamentösen Therapie kommen verschiedene operative Eingriffe zum Einsatz, die gegenüber den massiven Lessionen in der Geschichte der Parkinsonbehandlung enorm verfeinert wurden und äußerst wirkungsvoll sowohl die Bradykinese als auch den Tremor von Parkinsonpatienten verbessern. Bei der Pallidotomie werden Teile des Globus pallidus entfernt, während eine Thalamotomie ein Kerngebiet des Thalamus thermisch koaguliert (2, 11, 15, 20). Eine weitere operative Therapie ist die hochfrequente Stimulation thalamischer oder subthalamischer Kerne sowie des Globus pallidus (3, 20). Die Transplantation gesunder dopaminerger Zellen befindet sich noch in der Entwicklung, erscheint jedoch vielversprechend (5, 9, 12, 22). Weitere experimentelle Therapien beinhalten den Einsatz geeigneter Vektoren für einen Gentransfer (16, 21, 25, 28) und die Behandlung degenerierter Neurone mit neurotrophen Faktoren (z.B. GDNF: "glia cell line-derived neurotrophic factor"; 4, 24, 32).

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