Botulinumtoxin-Therapie bei Dystonien

Zusammenfassung

Im Rahmen einer multizentrischen Patientenund Arztbefragung wurden 497 Patienten mit zervikaler Dystonie (n = 372) und Blepharospasmus (n = 125) in Bezug auf die Zufriedenheit mit der Botulinumtoxin-Therapie (BoNT) befragt. Zusätzlich wurden krankheits- und behandlungsbezogene Angaben, Einstufungen zur Lebensqualität, der beruflichen Situation, psychosozialen Variablen, Verhaltensdaten und Aussagen zur emotionalen Situation erhoben. Trotz der im Durchschnitt guten Beurteilung der BoNT-Therapie fanden sich 197 (40,8%) weniger zufriedene Patienten. Die Zufriedenheit stand in keinem Zusammenhang mit Angaben zur Erkrankung und Behandlung oder der subjektiven Beurteilung der Symptomschwere. Weniger zufriedene Patienten stuften ihre allgemeine Lebensqualität als schlecht ein, zeigten sich in verschiedenen Lebensbereichen als stark belastet und neigten dazu, soziale Situationen zu vermeiden. Außerdem gaben sie kurz vor dem Ende des Behandlungsintervalls eine noch schlechtere Beurteilung des Therapieergebnisses an als die zufriedenen Patienten. Die Ergebnisse werfen zumindest bei den weniger zufriedenen Patienten die Frage nach einer stärkeren Individualisierung der Behandlungsintervalle sowie und nach einem genaueren Monitoring des Krankheitsverhaltens und entsprechender psychoedukativer Maßnahmen auf.

Summary

To document satisfaction of Botulinum toxin (BoNT) treatment in cervical dystonia and blepharospasm, 497 patients with long standing dystonia (372 ST, 125 BP) were investigated with respect to perceived intensity of motor symptoms, characteristics of the dystonia, treatment variables, treatment satisfaction especially within the course of BoNT cycles, quality of life, psychosocial variables and the patient’s emotional responses to a life with dystonia. Despite good mean improvement, 197 patients (40,8%) were less satisfied with their respective BoNT treatments. Treatment satisfaction was neither related to disease characteristics nor to treatment variables. Both, satisfied and dissatisfied patients still reported moderate intensity of dystonic symptoms. Patients who were less satisfied with BoNT treatment reported less quality of life, increased psychosocial load and avoidance behaviour. These patients especially worsened towards the end of their respective treatment cycles. It may be concluded that at least these dystonia patients may be subjected to individualized treatment cycles. Moreover, patients who are less satisfied with BoNT treatment should be carefully monitored between BoNT injections, especially both, with respect to their courses between BoNT injections and their emotional reactions to their disorders. Psychoeducation may help to overcome dysfunctional illness behavior. As a result, individualized treatment cycles at least for subgroups of patients may be appropriate.

Schlüsselwörter

Botulinumtoxin - zervikale Dystonie - Blepharospasmus - Therapiezufriedenheit - Adhärenz

Keywords

Botulinum toxin - cervical dystonia - blepharospasm - treatment satisfaction - adherence

• Literatur

• 1 Albanese A, Abbruzzese G, Dressler D. et al. Practical guidance for CD management involving treatment of botulinum toxin: a consensus statement. J Neurol 2015; 262: 2201-2213.
• 2 Ben-Schlomo Y, Camfield L, Warner T. ESDE collaborative group. What are the determinants of quality of life in people with cervical dystonia?. J Neurol Neurosurg Psychiatry 2002; 72: 608-614.
• 3 Birner P, Schnider P, Müller J. et al. Torticollis spasmodicus, Blepharospasmus und hemifazialer spasmus, Subjektive Bewertungen der Therapie durch Patienten. 1999; Nervenarzt 70: 903-908.
• 4 Camfield L, Ben-Slomo Y, Warner T. Impact of cervical dystonia on quality of life. Mov Disord 2002; 17: 838-841.
• 5 Comella CL, Jankovic J, Truong DD, Hanschmann A, Grafe S. U. S. Xeomin Cervical Dystonia Study Group. Efficacy and safety of incobotulinumtoxinA (NT, 201, XEOMIN, botulinum neurotoxin type A, without accessory proteins) in patients with cervical dystonia. Journal of the Neurological Sciences 2011; 308: 1213-1218.
• 6 Conte A, Berardelli I, Ferrazzano G, Pasquini M, Beradelli A, Fabbrini G. Non-motor symptoms in patients with adult-onset focal dystonia: sensory and psychiatric disturbances. Parkinsonism and Relat Disord 2016; 22: 111-114.
• 7 Costa J, Espirito-Santo C, Borges A, Ferreira JJ, Coelho M. Moore et al. Botulinum type B for cervical dystonia. Cochrane Database System Rev 2005; 25: CD004315.
• 8 Dressler D, Tacik P, Saberi FA. Botulinum toxin therapy of cervical dystonia: duration of therapeutic effects. J Neural Transm 2015; 122: 297-300.
• 9 Evidente VGH, Truong D, Jankovic J, Comella CL, Grafe S, Hanschmann A. IncobotulinumtoxinA (Xeomin®) injected for blepharospasm or cervical dystonia according to patient needs is well tolerated. J Neurol Sciences 2014; 346: 116-120.
• 10 Fabbrini G, Berardelli I, Moretti G. et al. Psychiatric disorders in adult-onset focal dystonia: a case-controlled study. Mov Disord 2010; 25: 459-465.
• 11 Fernandez H, Pagan F, Danisi F. Greeley et al. Prospective study evaluating incobotulinum- toxinA for cervical dystonia or blepharospasm: interim results from the first 145 subjects with cervical dystonia. Tremor Other Hyperkinetic Mov 2013; 3.
• 12 Fezza J, Burns J, Woodward J, Truong D, Hedges T, Verma A. A cross-sectional structured survey of patients receiving botulinum toxin type A treatment for blepharospasm. J Neurol Sciences 2016; 367: 56-62.
• 13 Gündel H, Wolf A, Xidara V, Busch R, Ceballos-Baumann AO. Social phobia in spasmodic torticollis. J Neurol Neurosurg Psychiatry 2001; 71: 499-504.
• 14 Häussermann P, Marczoch S, Klinger C, Landgrebe M, Conrad B, Ceballos-Baumann A. Longterm-follow-up of cervical dystonia patients treated with botulinum toxin A. Mov Disord 2004; 19: 303-308.
• 15 Hall TA, McGwin G, Searcey K, Xie A, Hupp SL, Owsley C, Kline LB. Health-related quality of life and psychosocial characteristics of patients with benign essential blepharospam. Arch of Ophthal 2006; 124: 116-119.
• 16 Hallett M, Albanese A, Dressler D. Segal et al. Evidence-based review and assessment of botulinum neurotoxin for the treatment of movement disorders. Toxicon 2013; 67: 94-114.
• 17 Hefter H, Benecke R, Erbguth F, Jost W, Reichel G, Wissel J. An open-label cohort study of the improvement of quality of life and pain in de novo cervical dystonia patients after injections with 500 U botulinum toxin A (Dysport). BMJ open 2013; 3.
• 18 Hilker R, Scgischniaschvili M, Ghaemi M. et al. Health related quality of life is improved by botulinum neurotoxin type A in long term treated patients with focal dystonia. J Neurol Neurosurg Psychiatry 2001; 71: 193-199.
• 19 Junker J, Oberwittler C, Jackson D, Berger K. Utilization and perceived effectiveness of complementary and alternative medicine in patients with dystonia. Mov Disord 2004; 19: 158-161.
• 20 Lencer R, Steinlechner S, Stahlberg J. et al. Primary focal dystonia: evidence for distinct neuropsychiatric and personality profiles. J Neurol Neurosurg Psychiatry 2009; 80: 1176-1179.
• 21 Leplow B, Jersch M, Schönfeld R. Medizinische und nicht-medizinische Begleitbehandlungen zur Botulinum-Toxin-Therapie bei Torticollis spasmodicus Patienten. Nervenarzt 2013; 84: 493-497.
• 22 Leplow B, Wiemann J. Zwischen “disability” und “handicap” – Zur Frage der Therapietreue von Torticollispatienten bei der Therapie mit Botulinum-Toxin. Nervenheilkunde 2010; 28: 519-525.
• 23 Leplow B, Eggebrecht A, Pohl J. Treatment satisfaction with Botulinum-Toxin: A comparison between Blepharospasm and Cervical Dystonia. Patient Preference Adherence. 2017 angenommen.
• 24 Loh A, Jost WH. Dystonie-Patienten unter der Behandlung mit Botulinumtoxin. Nervenheilkunde 2013; 32: 942-948.
• 25 Mills RR, Pagan FL. Patient considerations in the treatment of cervical dystonia: focus on botulinum type A. Patient Preference Adherence 2015; 09: 725-731.
• 26 Moraru E, Schnider P, Wimmer A, Wenzel T, Birner P, Griengl H, Auff E. Relation between depression and anxiety in dystonic patients: implications for clinical management. Depression Anxiety 2002; 16: 100-113.
• 27 Mordin M, Masaquel C, Abbott C, Copley CMerriman. Factors affecting the health-related quality of life of patients with cervical dystonia and impact of treatment with botulinumtoxin A (Dysport): results from a randomised, double-blind, placebocontrolled study. Brit Med J 2014; 04: e005150.
• 28 Müller J, Kemmler G, Wissel J, Schneider A, Voller B, Grossmann J, Diez J, Homan N, Wenning GK, Schnider P, Poewe W. The impact of blepharospasm and cervical dystonia on health related quality of life and depression. J Neurol 2002; 249: 842-846.
• 29 Ojo OO, Fernandez HH. Is it time for flexibility in botulinum inter-injection intervals?. Toxicon 2015; 107: 72-76.
• 30 Ozel-Kizil ET, Akbostanci MC, Ozguven HD, Atbasoglu EC. Secondary social anxiety in hyperkinesia. Mov Disord 2008; 15: 641-645.
• 31 Page D, Butler A, Jahanshahi M. Quality of life in focal, segmental, and generalized dystonia. Mov Disord 2007; 22: 341-347.
• 32 Pekmezovic T, Svetel M, Ivanovic N. et al. Quality of life in patients with focal dystonia. Clin Neurol Neurosurg 2009; 111: 161-164.
• 33 Poliziani M, Koch M, Liu X. Striving for more good days: patient perspectives on botulinum toxin for the treatment of cervical dystonia. Patient Preferences Adherence 2016; 10: 1601-1608.
• 34 Sethi KD, Rodriguez R, Olayinka B. Satisfaction with botulinum toxin treatment: a cross-sectional survey of patients with cervical dystonia. J Med Econ 2012; 1583: 419-423.
• 35 Simpson DM. et al. Assessment: Botulinum neurotoxin for the treatment of movement disorders (an evidence-based review). Neurol 2008; 70: 1690-1706.
• 36 Skogseid IM. et al. Determinants and status of quality f life after long-term botulinum therapy for cervical dystonia. Europ J Neurol 2007; 14: 1129-1137.
• 37 Slawek J, Friedman A, Potulska A. et al. Factors effecting the health-related quality of life of patients with cervical dystonia and the impact of botulinum toxin type A injections. Funct Neurol 2007; 22: 95-100.
• 38 Tomic S, Petkovic I, Pucic T, Resan B, Juric S, Rotim T. Cervical dystonia and quality of life. Acta Neurol Belgica 2016; 116: 589-592.
• 39 Truong D, Brodsky M, Lew M, Brashear A, Jankovic J, Molho E. et al. Long-term efficacy and safety of botulinum toxin type A (Dysport) in cervical dystonia. Parkinsonism Relat Disord 2010; 16: 316-323.
• 40 Truong D. Botulinum neurotoxin and dystonia: a case for greater flexibility in treatment regimens?. CNS 2017; 02 (02) 12-17.
• 41 van den Dool Tijssen MA, Koelman JH, Engelbert RH, Visser B. Determinants of disability in cervical dystonia. Parkinsonism Relat Disord 2016; 32: 48-53.
• 42 Werle RW, Takeda SYM, Zonta MB, Guimarães ATB, Teive HAG. The physical, social and emotional aspects are the most affected in the quality of life of the patients with cervical dystonia. arquivos de neuro-psiquiatria 2014; 72: 405-410.