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Funktionelle Bildgebung der tiefen Hirnstimulation bei idiopathischem Parkinson-Syndrom

Functional imaging of deep brain stimulation in idiopathic Parkinson’s disease

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Zusammenfassung

Mit funktionell-bildgebenden Untersuchungen können die Auswirkungen der tiefen Hirnstimulation (THS) auf das neuronale Netzwerk am lebenden Menschen untersucht werden. Bei Patienten mit idiopathischem Parkinson-Syndrom (IPS) und THS wurden Studien vorwiegend mit Positronenemissionstomographie (PET) in Ruhe sowie unter motorischen, kognitiven oder emotionalen Aktivierungsbedingungen durchgeführt. Im motorischen System führt die Stimulation zu einer Reduktion abnormaler neuronaler Aktivitätsmuster, welche teilweise mit der Besserung motorischer Kardinalsymptome korreliert. Ein gesteigerter Energieumsatz im Zielgebiet der Elektroden weist auf einen exzitatorischen Effekt der THS in der unmittelbaren Umgebung des elektrischen Feldes hin. Fernwirkungen der Nucleus-subthalamicus (STN)-Stimulation auf frontale kortikale Assoziationsareale bieten Erklärungen für Veränderungen von Affekt, Verhalten und Kognition bei einzelnen Patienten, die vermutlich durch eine Interferenz der THS mit assoziativen und limbischen Basalganglienschleifen verursacht werden. Zusammenfassend erbringen die Ergebnisse von Bildgebungsstudien wichtige Erkenntnisse, die zur Optimierung und Weiterentwicklung der THS überaus wertvoll sind.

Summary

Functional brain imaging allows the effects of deep brain stimulation (DBS) on the living human brain to be investigated. In patients with advanced Parkinson’s disease (PD), positron emission tomography (PET) studies were undertaken at rest as well as under motor, cognitive or behavioral activation. DBS leads to a reduction of abnormal PD-related network activity in the motor system, which partly correlates with the improvement of motor symptoms. The local increase of energy consumption within the direct target area suggests a predominant excitatory influence of the stimulation current on neuronal tissue. Remote effects of DBS of the subthalamic nucleus (STN) on frontal association cortices indicate an interference of stimulation energy with associative and limbic basal ganglia loops. Taken together, functional brain imaging provides very valuable data for advancement of the DBS technique in PD therapy.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Prof. Dr. R. Hilker ist als Referent für die Firma Medtronic GmbH tätig.

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  1. Zentrum der Neurologie und Neurochirurgie, Klinik für Neurologie, Goethe-Universität, Schleusenweg 2–16, 60528, Frankfurt am Main, Deutschland

    R. Hilker

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Correspondence to R. Hilker.

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Hilker, R. Funktionelle Bildgebung der tiefen Hirnstimulation bei idiopathischem Parkinson-Syndrom. Nervenarzt 81, 1204–1207 (2010). https://doi.org/10.1007/s00115-010-3027-3

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  • DOI: https://doi.org/10.1007/s00115-010-3027-3

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