Behandlung der Spastizität mit Botulinumtoxin-Typ-A-Injektionen

Zusammenfassung

Im Deutschland und Österreich sind drei Botulinumtoxin-Typ-A-Produkte (BoNT A) zur Behandlung der Spastizität der oberen Extremität nach Schlaganfall zugelassen (Abo-, Ona-, Incobotulinumtoxin A). Die Evidenzlage erlaubt die Feststellung, dass die Behandlung der fokalen und segmentalen Spastizität auch der unteren Extremität nach Schlaganfall und andere zentralnervöse Erkrankungen als Behandlung der Wahl zu empfehlen ist. Auf der Basis der klinischen Evaluation sollte gemeinsam mit dem Patienten, ggf. unter Einbeziehung eines multiprofessionellen Therapieteams, ein realistisches und objektivierbares Ziel und die Muskeln für die BoNT-A-Behandlung definiert werden. Im Anschluss kann die Injektion von BoNT A mit der notwendigen Genauigkeit (ggf. sonografische oder elektrostimulationsgestützte Injektionskontrolle) in die spastische Muskulatur (in Endplattennähe) erfolgen. Falls indiziert, sollten begleitende synergistische Behandlungen wie Lagerungen, Dehnungen und Casting zeitlich abgestimmt eingesetzt werden. Diese BoNT-A-Behandlungen sollten so häufig wie notwendig wiederholt werden, um die gesteckten realistischen Ziele zu erreichen. Falls im Verlauf kein Therapieziel für eine BoNTA-Behandlung mehr mit dem Patienten definiert werden kann, sollte die Therapie ausgesetzt und bei Indikation eine Therapieeskalation diskutiert werden.

Summary

In Austria and Germany three different botulinum toxin type A (BoNT A) products are licensed for treatment of upper limb spasticity after stroke (abo-, ona-, inco-botulinum toxin A). Published evidence allows the statement: BoNT A injections are treatment of choice for focal and segmental spasticity following stroke and other aetiologies, too. Goal selection and muscle selection for focal treatment with BoNT A should be based on a thorough clinical neurological evaluation as well as on a discussion on goals for treatment (realistic and measurable) with the patient and the multi-professional therapy team. When muscles for BoNT A injections are selected those should be injected near the endplate regions with the highest accuracy possible (ultrasound or electrical stimulation guided injections). If necessary synergistic treatments like positioning, stretching and casting should be provided in the adequate time frame after injection. BoNT A treatment should be provided as long as necessary to reach realistic goals for treatment. If no realistic goal could be defined, BoNT A treatment should be stopped and if necessary therapy should be escalated.

Schlüsselwörter

Spastizität - Botulinumtoxin - Injektionskontrolle - Muskelsonografie

Keywords

Spasticity - botulinum toxin - injection guidance - muscle sonography

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