Therapie der Dystonien

Zusammenfassung

Botulinumneurotoxin (BoNT) ist das Mittel der ersten Wahl für die meisten Dystonie-Patienten. Die dystone Fehlhaltung ist auch das zugrunde liegende Zielsymptom bei der Anwendung von BoNT bei der Spastik. Insbesondere bei generalisierten und bestimmten fokalen Dystonien ist BoNT nicht ausreichend oder nicht indiziert. Hier stehen systemische Medikation, in zunehmendem Maße die tiefe Hirnstimulation, eine begleitende Psychotherapie sowie physiound ergotherapeutische Methoden zur Verfügung. Erfahrungen zu etablierten Vorgehensweisen und neuen Entwicklungen in der Dystonie-Therapie werden in der Übersicht diskutiert, ausgewählte Problemstellungen der BoNTTherapie bei Dystonien im kraniozervikalen Bereich mit Illustrationen dargestellt.

Summary

Botulinum neurotoxin (BoNT) is the treatment of choice for most patients with dystonia. Dystonic postures represent also the underlying treatment target when using BoNT for spasticity. Mainly in generalized, but also in certain focal dystonias BoNT may not be sufficient or appropriate. Besides BoNT pharmacotherapy, nowadays deep brain stimulation, psychotherapy, physio- and occupational therapy approaches are increasingly included in the management of dystonic patients. The review focuses on experiences with established management guidelines and new developments in the treatment of dystonias. Selected issues related to the use of BoNT in the craniocervical region are linked with pertinent illustrations.

Schlüsselwörter

Dystonie - Botulinumtoxin - tiefe Hirnstimulation

Keywords

Dystonia - botulinum toxin - deep brain stimulation

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