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DOI: 10.1055/s-2005-871977
© Georg Thieme Verlag Stuttgart · New York
EMG-Steuerung bei Botulinumtoxin-Therapie: sinnvoll oder überflüssig?
Is EMG-guidance of botulinum toxin injections useful?Publication History
Publication Date:
30 June 2005 (online)
![](https://www.thieme-connect.de/media/psychoneuro/200506/lookinside/thumbnails/10.1055-s-2005-871977-1.jpg)
Zusammenfassung
Die kontrollierte Injektion von Botulinumtoxin mittels EMG-Steuerung und EMG-ableitefähigen Injektionsnadeln wird unterschiedlich bewertet. Beim Blepharospasmus und Spasmus hemifacialis wird keine EMG-Steuerung verwendet. Bei zervikaler Dystonie wird in der überwiegenden Zahl der Fälle ohne EMG-Steuerung gearbeitet und über 60 % der zervikaler Dystoniepatienten halten Botulinumtoxin auch noch nach Jahren für eine lohnenswerte Therapie. Beim Schreibkrampf, beim Musikerkrampf und beim Golfer-Krampf („Yips”) wird das EMG zur Injektionssteuerung heranzogen. Bei diesen Indikationen sowie bei weiteren Beschäftigungskrämpfen, der Kieferöffnungs-Dystonie und Problemsituationen bei der zervikalen Dystonie wie der Anterocollis sind EMG-gesteuerte Injektionen meist Voraussetzung, um Botulinumtoxin sinnvoll injizieren zu können. Bei einer unkomplizierten zervikalen Dystonie, dem rotatorischen Torticollis, und der Spastik ist der Nutzen der EMG-Steuerung, etwa durch Dosiseinsparung, höhere Effektivität und geringere Nebenwirkungsrate, bisher unzureichend belegt. Bei diesen häufigen Indikationen werden gute Ergebnisse auch ohne EMG-Steuerung erreicht.
Summary
Guidelines regarding technique and dosage of botulinum toxin vary considerably. One issue remains the role of EMG to refine treatment outcome. Basically all studies in blepharospasm were conducted without EMG. More than 60 % of patients with cervical dystonia consider Botulinumtoxin even after years of regular injection sessions every 3 to 4 months as a valuable treatment and ask for reinjections. The impact of EMG guidance has only been rarely assessed. The effectiveness of Botulinumtoxin with EMG control in writer's cramp and in spasmodic dysphonia has been demonstrated in a number of studies. Refinement of therapy remains a challenge in writer's cramp and other occupational dystonias, jaw opening dystonia and anterocollis. EMG guidance may be helpful, probably even a prerequisite in these indications. The role of EMG guidance in the major indications such as uncomplicated cervical dystonia and spasticity to improve outcome, minimize side effects and to save toxin remains unclear.
Key words
botulinum toxin - dystonia - torticollis - blepharospasm - writer's cramp - EMG
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Korrespondenzadresse:
Prof. Dr. Andres Ceballos-Baumann
Neurologisches Krankenhaus München
Zentrum für Parkinson und Bewegungsstörungen
Tristanstraße 20
80804 München
Email: andres.ceballos-baumann@nk-m.de
Email: a.ceballos@lrz.tum.de