Therapie der fokalen Spastik mit Botulinumtoxin

Zusammenfassung

Der Erfolg des therapeutischen Einsatzes von Botulinumtoxin in den 1990er-Jahren bei fokalen Dystonien (z. B. Blepharospasmus, Torticollis spasmodicus) und Spasmus hemifacialis führte zu einer breiten Akzeptanz. In der Zwischenzeit wurde Botulinumtoxin für die Therapie von mehr als 50 Indikationen vorgeschlagen. Zugelassene Massenindikationen stellen bei den Bewegungsstörungen neben der Dystonie der Spasmus hemifacialis und zunehmend auch die Spastik dar. Eine Zulassung in Deutschland gibt es allerdings nur für die Zerebralparese und die fokale Spastik der oberen Extremität nach Schlaganfall. Im klinischen Alltag erfolgt der Einsatz von Botulinumtoxin zur Therapie der fokalen Spastik auch außerhalb der in Deutschland gültigen Indikationen, nicht zuletzt da in einer Reihe von europäischen Ländern Botulinumtoxin für die Spastik der oberen Extremitäten unabhängig von der Genese zugelassen ist. Bei der Spastik ist die Effizienz von Botulinumtoxin neben pflegerischen Indikationen besonders bewiesen, wenn die Haltungsanomalie des Arms subjektiv als stigmatisierend erlebt wird und wenn eine schmerzhafte Schulter bei spastischer Hemiparese die Indikation darstellt.

Summary

The therapeutic successes in the 90s for the indications focal dystonia (e. g. blepharospasm, spasmodic torticollis) and hemifacial spasm led to a broad acceptance of Botulinum toxin treatment. Meanwhile, more than 50 indications for therapy have been suggested. In the field of movement disorders beside focal dystonia spasticity has become a mass indication, although Botulinum toxin treatment is only labelled for spastic pes equinus in cerebral palsy and focal spasticity of the upper limb following stroke. For the latter indication, Botox^® and Dysport^® are labelled preparations, while Xeomin^® is expected to receive labelled status in the near future. In clinical practice the use of Botulinum toxin does not only follow the labelled indications, also because registration of Botulinum toxin in other European countries entails the treatment of spasticity independent from its etiology. Beside beneficial effects on hygienic care, the use of Botulinum toxin is indicated for stigmatizing flexion anomalies of the arm and painful shoulder in spastic hemiparesis.

Schlüsselwörter

Botulinumtoxin - Spastik - zerebrale Parese - Dystonie - Physiotherapie

Keywords

Botulinum toxin - spasticity - cerebral palsy - dystonia - spasm - physiotherapy

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