Wissel J, auf dem Brinke M, Hecht M, Herrmann C, Huber M, Mehnert S, Reuter I, Schramm A, Stenner A, van der Ven C, Winterholler M, Kupsch A
Kliniken Beelitz GmbH, Paracelsusring 6 A, 14547, Beelitz-Heilstätten.
Nervenarzt. 2011 Apr;82(4):481-95. doi: 10.1007/s00115-010-3172-8.
Spasticity is one of the major causes of functional impairment in adults with lesions of the central nervous system. For instance, approximately 30% of post-stroke patients suffer from different degrees of spasticity with possible consecutive impairments. Numerous studies or meta-analyses showed that local injections of botulinum toxin in spastic muscles lead to dose-dependent reduction in muscle tone and improvement of passive movements (e. g. facilitated care), especially following repeated injections.However, country-specific regulations and patient-remote administration in German health care often do not allow adequate provision of this therapy. Thus, the present consensus statement based on the EBM analyses of the published international literature tries to highlight recent advances and the standard in the field of local spasticity treatment, aiming to facilitate communication between the decision makers and German reimbursement institutions in health care. Prior to initiation of BoNT-A injections, patient-oriented goals should be identified in a multiprofessional context to assure realistic goals for this specific treatment and patient expectations. In Germany for the treatment of focal spasticity following stroke three products have been approved: Botox® (Pharm Allergan, Ettlingen), Dysport® (Ipsen Pharma, Ettlingen) and Xeomin® (Merz Pharma, Frankfurt/Main). For all preparations safety has been repeatedly shown. Functional improvements have also been illustrated for selected patients concerning hand/arm function and gait. The dose per muscle and the selection of muscles to be injected have to be individualized according to the patient's symptoms and should be accompanied by modern neurorehabilitative therapies such as redression or repetitive activation of the injected and antagonistic muscles.
痉挛是中枢神经系统受损成人功能障碍的主要原因之一。例如，约30%的中风后患者患有不同程度的痉挛，并可能伴有后续功能障碍。大量研究或荟萃分析表明，在痉挛肌肉中局部注射肉毒杆菌毒素可导致肌张力呈剂量依赖性降低，并改善被动运动（如护理便利），尤其是在重复注射后。然而，德国医疗保健中的国家特定法规和患者远程管理往往不允许充分提供这种治疗。因此，本基于已发表国际文献的循证医学分析的共识声明试图突出局部痉挛治疗领域的最新进展和标准，旨在促进医疗保健领域决策者与德国报销机构之间的沟通。在开始注射A型肉毒毒素之前，应在多专业背景下确定以患者为导向的目标，以确保该特定治疗的现实目标和患者期望。在德国，有三种产品已被批准用于治疗中风后的局灶性痉挛：保妥适（艾尔建制药公司，埃特林根）、丽舒妥（益普生制药公司，埃特林根）和泽明（默克制药公司，美因河畔法兰克福）。所有制剂的安全性已多次得到证实。对于部分患者，在手部/手臂功能和步态方面也显示出功能改善。每块肌肉的注射剂量和要注射的肌肉选择必须根据患者症状个体化，并应辅以现代神经康复治疗，如对注射肌肉和拮抗肌肉进行牵伸或重复激活。
