Rehabilitation von Parkinson-Patienten mit Tiefenhirnstimulation

Median-Klinik Berlin-Kladow, Berlin, Deutschland; Rhein-Mosel-Fachklinik Andernach, Andernach, Deutschland; RehaNova Köln, Köln, Deutschland; MediClin Reha-Zentrum Reichshof, Reichshof-Eckenhagen, Deutschland
Der Nervenarzt (Impact Factor: 0.8). 01/2011; 82(4):462-467. DOI: 10.1007/s00115-010-3092-7

ABSTRACT HintergrundDie Tiefenhirnstimulation des Nucleus subthalamicus stellt eine wirksame Therapieoption für Patienten mit fortgeschrittener
Parkinson-Krankheit dar. Eine wachsende Zahl von Patienten wird nach der Ersteinstellung stationär rehabilitativ behandelt.
Die Bedeutung einer weiteren Stimulator- und Medikamenteneinstellung für diese Rehabilitationsbehandlung ist unklar.

Patienten und MethodenDiese retrospektive Analyse schloss Parkinson-Patienten ein, die innerhalb von 3 Monaten nach Elektrodenimplantation eine
stationäre Rehabilitationsbehandlung mit systematischem Algorithmus zur Verbesserung der Stimulationswirkung durchliefen.
Untersucht wurden (1) die vorgenommenen Änderungen der Stimulationsparameter und der Medikation sowie (2) der Einfluss auf
die mit dem Barthel-Index bestimmte Alltagskompetenz.

ErgebnisseInsgesamt 95Patienten wurden 20,4±10,7Tage nach der Operation über 29,0±11,2Tage rehabilitativ behandelt. Technische Dysfunktionen
fanden sich bei 3 (3,1%) Patienten und eine Elektrodendislokation bei einer Patientin (1,1%). An 7,3±4,0 Tagen erfolgten teils
mehrfache Änderungen der Stimulationsparameter. Bis zur Entlassung wurden die Stimulationsamplituden signifikant von 2,1±0,8V
auf 3,0±0,8V erhöht. Zudem wurden bei 70 (73,7%) Patienten aktive Stimulationskontakte gegenüber der Aufnahmeeinstellung
geändert. Die mittlere L-Dopa-Äquivalenzdosis sank von 529±290mg/Tag auf 300±277mg/Tag. Der Barthel-Index stieg signifikant
um 10,3±12,4 Punkte.

SchlussfolgerungEine weitere Stimulator- und Medikamenteneinstellung nach der Ersteinstellung im primären Zentrum stellt einen wichtigen Bestandteil
der stationären Rehabilitationsbehandlung von Parkinson-Patienten mit Tiefenhirnstimulation dar.

BackgroundDeep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an important therapeutic option in patients with
advanced Parkinson’s disease (PD). An increasing number of patients are referred for hospital rehabilitation after initial
programming. The role of further DBS and medication adjustments for this rehabilitation therapy is uncertain.

MethodsThis study was a retrospective analysis of a hospital rehabilitation program with a systematic algorithm to improve DBS efficacy
in PD patients referred within 3 months after electrode implantation. This study analyzed (1) changes of stimulation parameters
and medication and (2) changes in the performance of activities of daily living as measured by the Barthel index.

ResultsAfter an average of 20.4±10.7 days following surgery 95 PD patients were hospitalized for an average rehabilitation period
of 29.0±11.2 days. Technical dysfunctions were found in 3 (3.1%) patients and a bilateral electrode dislocation in 1 (1.1%)
patient. Stimulation parameters were adjusted on 7.3±4.0 days, sometimes with several adjustments on the same day. Until discharge
the stimulation amplitude was significantly increased from 2.1±0.8V to 3.0±0.8V. Moreover, in 70 (73.7%) patients active
stimulation contacts were changed. The mean levodopa equivalent dosage decreased from 529±290mg/die to 300±277mg/die. The
Barthel index increased significantly by 10.3±12.4 points.

ConclusionFurther DBS and medication adjustments play an important role for hospital rehabilitation of PD patients after initial DBS
programming in DBS centers.

SchlüsselwörterTiefenhirnstimulation–Nucleus subthalamicus–Morbus Parkinson–Rehabilitation–Alltagskompetenz
KeywordsDeep brain stimulation–Nucleus subthalamicus–Parkinson disease–Rehabilitation–Activities of daily living

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