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Statische Posturographie bei ausgewählten Parkinson-Syndromen

Quantitative Beurteilung der posturalen Kontrolle

Static posturography in selected Parkinson syndromes

Quantitative analysis of postural control

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Zusammenfassung

Hintergrund

Parkinson-Erkrankungen sind mit Gleichgewichtsstörungen und Stürzen assoziiert. Die klinische Beurteilung der posturalen und supportiven Fähigkeiten über einen Pull-Test kann zu unsicheren Ergebnissen bei der Beurteilung des Gleichgewichtes in diesen Patientengruppen führen. Die Posturographie scheint als valides Messverfahren zielführend und soll hinsichtlich eines möglichen differenzialdiagnostischen Einsatzes für den Kliniker beurteilt werden.

Patienten und Methoden

Insgesamt 53 Parkinson-Patienten (18 idiopathische akinetisch-rigide [IPSa.r], 18 atypische [APS] und 17 sekundäre Parkinson-Syndrom-Patienten [SPS]) mit gleichem symptomatischem Beschwerdebeginn (posturale Instabilität) und eine gesunde Kontrollgruppe [KG] wurden einer statischen Posturographie und einem Pull-Test unterzogen.

Ergebnisse

Die IPSa.r-Gruppe kann mittels Pull-Test und Posturographie nicht gegenüber einer gesunden Kontrollgruppe differenziert werden. Die APS-Gruppe liegt beim Schwankungsflächenradius (SR) unter „Augen-offen-Bedingung“ (AO) signifikant höher gegenüber der KG (APS: 16,89 mm vs. KG: 6,89 mm, p≤0,001) und der IPSa.r-Gruppe (APS: 16,89 mm vs. IPSa.r: 9,55 mm p=0,005). Der SR AO aus der APS-Gruppe korreliert mit dem Pull-Test signifikant (r=0,526, p=0,025). Unter Augenschluss (AG) nimmt die Instabilität der APS-Gruppe unwesentlich zu (SR +2%, p=0,847). Die SPS-Gruppe zeigt signifikant höhere SR unter AG gegenüber den anderen Untersuchungsgruppen (SPS: 26,29 mm vs. KG: 8,79 mm, p≤0,001; SPS: 26,29 mm vs. IPSa.r: 11,06 mm p≤0,001; SPS: 26,29 mm vs. APS: 17,28 mm, p=0,027). Der Schwankungsparameter (SR AG) der SPS-Gruppe nimmt gegenüber der Bedingung „Augen offen“ signifikant um 67% zu (p=0,001). In der SPS-Gruppe korrelieren die Ergebnisse aus der Posturographie und dem Pull-Test nicht.

Schlussfolgerung

Die statische Posturographie kann den Kliniker bei der Evaluierung der posturalen Fähigkeiten im Rahmen einer Parkinson Erkrankung als differenzialdiagnostisches Messverfahren unterstützen.

Summary

Objectives

Idiopathic Parkinson’s disease (IPD) is associated with postural disturbances and falls. The assessment of postural instability by the pull test may lead to inconclusive results. Static posturography measurements may give more reliable information regarding the differential diagnosis of Parkinson syndromes.

Patients and methods

We compared results of the pull test and static posturography (sway area in eyes-open/eyes-closed conditions) in healthy controls (C) and patients with akinetic-rigid IPD (n=18), atypical Parkinson syndromes (APS; n=18) and secondary Parkinson syndromes (SPS; n=17).

Results

Static posturography and the pull test results did not differ significantly between controls and patients with akinetic-rigid IPD. APS patients had significantly greater postural sway areas when tested with eyes open compared to controls (APS: 16.89 vs C: 6.89 mm, p≤0.001) and IPD patients (APS: 16.89 vs IPD: 9.55 mm, p=0.005). The correlation in the APS group between the pull test and sway area in the eyes-open condition was significant (r=0.526, p=0.025). With eyes closed, postural instability in APS patients was not significantly increased (+2%, p=.847). SPS patients were more unstable under the eyes-closed condition compared to controls (sway area SPS: 26.29 vs C: 8.79 mm, p≤0.001), IPD patients (sway area SPS: 26.29 vs IPD: 11.06 mm, p≤0.001) and APS patients (sway area SPS: 26.29 vs APS: 17.28 mm, p=0.027), without a significant correlation to the pull test. The sway area in the SPS patients increased significantly by 67% (p=0.001) under the eyes-closed condition.

Conclusion

Static posturography may be a helpful tool for the differentiation of Parkinson syndromes.

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Authors and Affiliations

  1. Abteilung für Neurologie, Landes-Nervenklinik Wagner-Jauregg,Universitätslehrkrankenhaus, Wagner-Jauregg-Weg 15, 4020, Linz, Austria

    T. Wolfsegger, I. Rotaru, A.M. Schneider & F.T. Aichner

  2. Interfakultärer Fachbereich Sport- und Bewegungswissenschaft/Universitätssport, Universität Salzburg, Salzburg, Austria

    H. Schwameder

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  1. T. Wolfsegger
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  2. I. Rotaru
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Correspondence to T. Wolfsegger.

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Wolfsegger, T., Rotaru, I., Schneider, A. et al. Statische Posturographie bei ausgewählten Parkinson-Syndromen. Nervenarzt 82, 1584–1589 (2011). https://doi.org/10.1007/s00115-011-3323-6

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