Lee John-Ih, Günther Albrecht, Paus Sebastian, Royl Georg, Weyen Ute, Wissel Jörg, Zeuner Kirsten E, Klebe Stephan
Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland.
Nervenarzt. 2024 Feb;95(2):133-140. doi: 10.1007/s00115-023-01571-8. Epub 2023 Nov 21.
Spastic movement disorder (SMD) develops in up to 43% of cases as a sequela of stroke. In the event of a functionally relevant or daily life impairing SMD or to avoid an impending complication, the medicinal treatment of a focal, multifocal and segmental increase in muscle tone with botulinum neurotoxin A (BoNT-A) is recommended; however, treatment data reveal a lack of guideline-conform treatment with BoNT‑A in Germany.
The aim of the reported expert meeting was to discuss solutions to the incorrect treatment and undertreatment of patients with SMD and to formulate consensus recommendations to improve the care situation.
At a consensus meeting held in April 2022, eight experts from the fields of neurology, physical medicine and rehabilitation discussed the causes for the incorrect treatment and undertreatment and formulated consensus solution approaches.
Possible reasons for the current incorrect treatment and undertreatment in SMD management in Germany include insufficient awareness of SMD among physicians, a lack of treatment capacities, a lack of information transfer in discharge management as well as staff shortages in the specialized inpatient and outpatient SMD treatment centers. The committee therefore recommended a patient pathway in which affected patients with SMD are provided with correctly implemented BoNT‑A treatment in combination with physical measures.
The recommended treatment pathway for use in stroke patients is intended to close gaps in care and thus ensure guideline-conform treatment of post-stroke SMD.
高达43%的中风患者会继发痉挛性运动障碍（SMD）。如果SMD对功能有影响或损害日常生活，或者为避免即将发生的并发症，建议使用A型肉毒杆菌毒素（BoNT-A）药物治疗局灶性、多灶性和节段性肌张力增高；然而，治疗数据显示德国在使用BoNT-A治疗方面缺乏符合指南的治疗。
本次专家会议旨在讨论解决SMD患者治疗不当和治疗不足的问题，并制定共识性建议以改善护理状况。
在2022年4月举行的一次共识会议上，来自神经病学、物理医学与康复领域的八位专家讨论了治疗不当和治疗不足的原因，并制定了共识性解决方案。
德国目前在SMD管理中治疗不当和治疗不足的可能原因包括医生对SMD的认识不足、治疗能力缺乏、出院管理中信息传递不畅以及SMD专科住院和门诊治疗中心的人员短缺。因此，委员会建议采用一种患者治疗路径，为受影响的SMD患者提供正确实施的BoNT-A治疗并结合物理治疗措施。
推荐用于中风患者的治疗路径旨在弥补护理缺口，从而确保对中风后SMD进行符合指南的治疗。
