Title Neurokirurško liječenje Parkinsonove bolesti Title (english) Neurosurgical treatment of Parkinson's disease Author Mihaela Kešelj Mentor Srđana Telarović (mentor)Committee member Zdravka Poljaković (predsjednik povjerenstva)Committee member Mario Habek (član povjerenstva)Committee member Srđana Telarović (član povjerenstva)Granter University of Zagreb Defense date and country 2014-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Parkinsonova bolest (PB) je progresivni neurodegenerativni poremećaj uzrokovan degeneracijom dopaminergičkih neurona supstancije nigre. Glavni je predstavnik poremećaja pokreta karakteriziranih osiromašenjem kretnji. PB karakterizira niz simptoma: ukočenost mišića zbog povišenog mišićnog tonusarigidnost, usporenost (bradikinezija) i blokiranje kretanja, tremor u mirovanju, gubitak posturalnih refleksa i fleksijsko držanje tijela. Dijagnoza PB je tipično klinička i bazira se na kriterijima koji uključuju prisutnost bradikinezije i/ili rigora, akinetički tremor, odsutnost atipičnih znakova. Potrebna je i prisutnost dva od sljedeća tri znaka: dobar odgovor na levodopu, levodopom inducirani nevoljni pokreti, tj.diskinezije i asimetričan početak bolesti.
Liječenje PB je simptomatsko. Usmjereno je na kontrolu motoričkih simptoma i poboljšanje kvalitete života. U liječenju PB se koriste dopaminomimetici (levodopa, agonsiti dopaminergičkih receptora), inhibitori razgradnih enzima dopamina - inhibitori
enzima monoaminoksidaze tipa B (MAO-B), inhibitori enzima katehol-O-metiltransferaze, (COMT), antiglutamatergici te iznimno rijetko antikolinergici. Levodopa je zlatni standard. Osim farmakološkog valja naglasiti da postoji i neurokirurško liječenje PB. Ono je indicirano u bolesnika koji reagiraju na levodopu, ali je više ne toleriraju zbog nuspojava kao što su motoričke fluktuacije ili diskinezije, ili u kojih je liječenje podnošljivim dozama levodope postalo neučinkovito. Primjenjuju se ireverzibilne metode: palidotomija i talamotomija. Pronalazak stimulacije bazalnih ganglija implantacijom elektroda (engl. deep brain stimulation – DBS) predstavlja revoluciju neurokirurškog liječenja razvijenih oblika PB. Za razliku od palidotomije i talamotomije, primjena DBS-a je reverzibilna. Iako ima znatno pozitivan učinak, ovaj način liječenja ipak ne sprječava daljnji razvoj PB.
Abstract (english) Parkinsons disease (PD) is a progressive neurodegenerative disorder caused by the degeneration of dopaminergic neurons in the substantia nigra. It is the main representative of the movement disorder characterized by impoverishment movements. PD is characterized by a variety of symptoms: muscle stiffness due to increased muscle tone-rigidity, slowness (bradykinesia) and blocking movement, resting tremors, loss of postural reflexes and flexion posture. Diagnosis of PD is typically clinical and is based on criteria that include the presence of bradykinesia and / or rigidity, akinetic tremor, absence
of atypical signals. Presence of two of the following three signals is required: a good response to levodopa, levodopa-induced involuntary movements, that is dyskinesia, and asymmetrical beginning of disease. Treatment of PD is symptomatic. It is focused on the control of motor symptoms and on the improvement of the quality of life. In the treatment of PD dopaminomimetics (levodopa, dopaminergic receptor agonists), inhibitors of the degradation enzyme dopamine-inhibitors of the enzyme monoamino oxidasa type B (MAO-B), inhibitors of the enzyme catechol-o-methyltransferase (COMT), antiglutamatergics and extremely rarely anticholinergics are being used. Levodopa is the golden standard.
Besides pharmacological, there is also neurosurgical treatment of PD. It is indicated in patients who respond to levodopa, but no longer tolerate it because of the side effects such as motoric fluctuations or dyskinesias, or in which the treatment with tolerable doses of levodopa became ineffective. Irreversible methods are applied: palitodomy and thalamotomy. The discovery of stimulation of the basal ganglia by implantation of electrodes (deep brain stimulation - DBS) represents a revolution of neurosurgical treatment of developed forms of PD. Unlike palidotomy and thalamotomy, application of DBS is reversible. Although it has significantly positive effect, this form of treatment unfortunately does not preclude further development of PD.
Keywords
Parkinsonova bolest
farmakološko liječenje
neurokirurško liječenje
palidotomija
talamotomija
duboka stimulacija bazalnih ganglija
Keywords (english)
Parkinsons disease
pharmacological treatment
neurosurgical treatment
pallidotomy
thalamotomy
stimulation of basal ganglia.
Language croatian URN:NBN urn:nbn:hr:105:040265 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2015-09-28 09:45:18
