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Systeme zur tiefen Hirnstimulation

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Tiefe Hirnstimulation

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Zusammenfassung

In den späten 1960er Jahren wurden erstmals Elektroden entwickelt, die eine kontinuierliche Stimulation neuraler Strukturen erlaubten [16, 17, 30, 32, 36]. Zunächst wurden diese halbimplantierbaren Radiofrequenzsysteme (implantierte Empfängerspule mit Elektrode, externer Stimulator/Impulsgenerator mit Antenne) zur Behandlung chronischer Schmerzen durch kontinuierliche elektrische Stimulation des Rückenmarks eingesetzt. Bechtereva et al., Mundinger und Siegfried [35] gehörten zu den ersten, die Bewegungsstörungen mittels Implantation permanenter Elektroden in tief liegenden Hirnarealen behandelten. Die ersten programmierbaren und vollimplantierbaren Impulsgeneratoren (Itrel®, Medtronic Inc., Minneapolis, MN, USA) wurden Anfang der 1980er Jahre entwickelt. Benabid [9–12] und Siegfried [37] begannen 1986 unabhängig voneinander Stimulationen im Nucleus ventralis intermedius (Vim) des Thalamus vorzunehmen, um den medikamentös therapierefraktären Tremor zu behandeln. Anfang der 1990er Jahre wurden erstmals Elektroden im Nucleus subthalamicus (STN) [6–8] und Globus pallidus internus (Gpi) [38, 39] zur Behandlung der akinetisch-rigiden Symptome der Parkinsonkrankheit eingesetzt. Die chronische tiefe Hirnstimulation (Activa®-Therapy, Medtronic Inc.) ist in Europa seit 1995 für die Behandlung des schweren Tremors bei M. Parkinson und des essenziellen Tremors durch Stimulation im Vim und seit 1998 für die Behandlung der Kardinalsymptome des M. Parkinson mittels Stimulation im STN und GPi zugelassen. Die tiefe Hirnstimulation (THS) bietet im Gegensatz zu den früheren läsionellen Verfahren den Vorteil, bilaterale Eingriffe mit geringer Morbidität durchführen zu können [33]. Nebenwirkungen oder durch Progredienz der Erkrankung wieder auftretende Symptome können variabel kompensiert werden. Dies geschieht durch Veränderung der Stimulationsparameter oder der aktiven Elektrodenkontakte, durch Umprogrammierung der Impulsgeneratoren [2, 4, 5, 8, 13, 14, 23-25, 27, 34, 40, 42, 44].

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Authors
  1. J. Vesper
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  2. A. Sarem-Aslani
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  3. D. Hellwig
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Editors and Affiliations

  1. Neurochirurgische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Joachim K. Krauss

  2. Neurologische Klinik, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Schittenhelmstraße 10, 24105, Kiel, Germany

    Jens Volkmann

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Vesper, J., Sarem-Aslani, A., Hellwig, D. (2004). Systeme zur tiefen Hirnstimulation. In: Krauss, J.K., Volkmann, J. (eds) Tiefe Hirnstimulation. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-7985-1956-5_5

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  • DOI: https://doi.org/10.1007/978-3-7985-1956-5_5

  • Publisher Name: Steinkopff, Heidelberg

  • Print ISBN: 978-3-642-62359-2

  • Online ISBN: 978-3-7985-1956-5

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