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Pharmakologische Zusatzbehandlung in der Aphasietherapie

Status quo und Perspektiven

Present status and future possibilities of adjuvant pharmacotherapy for aphasia

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Zusammenfassung

Eine Aphasie zählt zu den häufigsten und subjektiv schwerwiegendsten Folgen eines Schlaganfalls. Angesichts einer geringen Spontanerholung und der beschränkten Wirksamkeit konventioneller Sprachtherapie stellt sich die Frage nach Möglichkeiten der Therapieverbesserung. Neben einer Steigerung der Trainingsfrequenz — mit täglichen, mehrstündigen Einheiten und einer hohen Wiederholungsrate des Sprachmaterials („massiertes Training“) — bietet sich die Möglichkeit einer adjuvanten Pharmakotherapie. Hier beleuchten wir das Potenzial monoaminerger (Bromocriptin, Levodopa, d-Amphetamin) und cholinerger (Donepezil) Medikamente bei Aphasie. Eine abschließende Wirksamkeitsbewertung einer Kombinationsbehandlung aus massiertem Sprachtraining und pharmakologischer Zusatzbehandlung kann jedoch erst durch Etablierung von Verbundstrukturen und Durchführung hinreichend großer randomisierter, plazebokontrollierter klinischer Studien erfolgen. Neben diesen medikamentösen Strategien erwecken tierexperimentelle Ergebnisse zur Funktionserholung nach Gehirnschädigungen die Hoffnung, dass mittelfristig auch neurotrophe Faktoren oder Stammzellen in der adjuvanten Therapie von Aphasie einen Platz finden werden.

Summary

Aphasia is one of the most frequent and disabling consequences of stroke. Poor spontaneous recovery and the limited success of conventional speech therapy bring up the question of how current treatment approaches can be improved. Besides increasing training frequency—with daily sessions lasting several hours and high repetition rates of language materials (“massed training”)—adjuvant drug therapy may help to increase therapy efficacy. In this article, we illuminate the potential of monoaminergic (bromocriptine, levodopa, d-amphetamine) and cholinergic (donepezil) substances for treating aphasia. For a final evaluation of combined massed training and adjuvant pharmacotherapy, randomized, placebo-controlled (multicenter) clinical trials with sufficient numbers of patients are needed. Furthermore, results of experimental animal studies of functional recovery in brain damage raise hopes that neurotrophic factors or stem cells might find a place in recovery from aphasia in the intermediate future.

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Notes

  1. VAT = visuelle Aktionstherapie, MODAK = Modalitätenaktivierung in der Aphasietherapie, REST = Reduzierte Syntaxtherapie, PAKT = Partner Aphasiker Kommunikationstraining, MIT = melodische Intonationstherapie, PACE = Förderung der kommunikativen Fähigkeiten von Aphasikern (s. auch [16, 17]).

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Danksagung

Diese Arbeit wurde unterstützt durch die NRW-Nachwuchsgruppe Kn2000 des Ministeriums für Bildung und Forschung Nordrhein-Westfalen (Fö.1KS9604/0), das Interdisziplinäre Zentrum für Klinische Forschung Münster (IZKF Projekte FG2 und Kne3/074/04), die Volkswagen-Stiftung (Az.: I/80 708) sowie die Stiftung Neuromedizin Münster.

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  1. Klinik und Poliklinik für Neurologie, Universität Münster

    C. Korsukewitz, C. Breitenstein, M. Schomacher & S. Knecht

  2. IZKF Münster, Universität Münster

    C. Breitenstein & S. Knecht

  3. Klinik und Poliklinik für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Straße 33, 48149, Münster, Deutschland

    C. Korsukewitz

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  1. C. Korsukewitz
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Correspondence to C. Korsukewitz.

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Catharina Korsukewitz und Caterina Breitenstein haben zu gleichen Teilen zum Manuskript beigetragen.

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Korsukewitz, C., Breitenstein, C., Schomacher, M. et al. Pharmakologische Zusatzbehandlung in der Aphasietherapie. Nervenarzt 77, 403–415 (2006). https://doi.org/10.1007/s00115-005-2006-6

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