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Das Auge als Zugang zur Pathophysiologie von Parkinson-Syndromen

The eye as a window to the pathophysiology in Parkinson’s syndromes

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Zusammenfassung

Obwohl bereits seit mehr als 40 Jahren bekannt, stehen Störungen des visuellen und visuomotorischen Systems bislang nicht im Fokus der Frühdiagnose und Differenzialdiagnose bei idiopathischem Parkinson-Syndrom (IPS). Über Lewy-Körper-Pathologie, d. h. IPS-assoziierte degenerative Veränderungen in Form intraneuronaler α-Synuklein-Aggregate, in der Retina oder in anderen Komponenten des visuellen Systems ist bislang nicht berichtet worden. Im klinischen Kontext ist die Beteiligung der entsprechenden Funktionssysteme aber mittlerweile u. a. durch die Einführung der optischen Kohärenztomographie und Etablierung robuster videookulographischer Arbeitsplätze auch apparativ darstellbar. Zudem zeigen sich sowohl in psychophysischen Tests zu visuell-räumlichen Funktionen pathologische Befunde als auch deutliche Defizite der Farbwahrnehmung als Teil der nichtmotorischen Symptome. Diese Störungen des visuellen und okulomotorischen Systems sind potenziell geeignet, als nichtinvasive Diagnostik zur Früherkennung des IPS eingesetzt zu werden. Diese Arbeit stellt pathophysiologische Grundlagen und klinische Manifestationen der Beteiligung des visuellen Systems bei IPS mit den daraus folgenden differenzialdiagnostischen Optionen dar.

Summary

Although dysfunction of the visual system and dysfunctional eye movements during sporadic Parkinson’s disease have been reported for more than 40 years, they have never been the focus of early and/or differential diagnosis. To date Parkinson’s disease-related α-synuclein aggregates, i.e., Lewy pathology, are not known to develop either in the retina or in other components of the visual system. In a clinical context it is currently possible to test the involvement of the respective functional systems by means of optical coherence tomography and video oculography. Moreover, non-motor-related abnormalities are detectable both during psychophysical testing of visuospatial function as well as in the form of measurable deficits of color perception. These deficits of the visual and oculomotor systems could prove to be suitable candidates for diagnosing sporadic Parkinson’s disease in its early phase in a non-invasive manner. This article is intended to provide an overview of the fundamental pathophysiological principles and clinical aspects of visual system involvement in sporadic Parkinson’s disease together with currently available differential diagnostic options.

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Authors and Affiliations

  1. Klinik für Neurologie, Universitätsklinikum Ulm, Oberer Eselsberg 45, 89081, Ulm, Deutschland

    J. Kassubek, K. Del Tredici-Braak & E.H. Pinkhardt

  2. Sektion Klinische Neuroanatomie, Zentrum für Biomedizinische Forschung, Universität Ulm, Ulm, Deutschland

    K. Del Tredici-Braak

  3. Neurologische Klinik, Klinikum der Universität München, Campus Großhadern, München, Deutschland

    A. Danek

  4. Institut für Experimentelle Psychologie, Universitätsklinikum Regensburg, Regensburg, Deutschland

    M.W. Greenlee

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  1. J. Kassubek
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  3. K. Del Tredici-Braak
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  4. M.W. Greenlee
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  5. E.H. Pinkhardt
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Correspondence to J. Kassubek.

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Kassubek, J., Danek, A., Del Tredici-Braak, K. et al. Das Auge als Zugang zur Pathophysiologie von Parkinson-Syndromen. Nervenarzt 84, 909–917 (2013). https://doi.org/10.1007/s00115-013-3754-3

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