Download PDF
psychoneuro 2008; 34(1): 37-44
DOI: 10.1055/s-2008-1061492
Schwerpunkt

© Georg Thieme Verlag Stuttgart · New York

Botulinumtoxin - Therapeutischer Einsatz bei Bewegungsstörungen

Botulinum toxin - Treatment of movement disordersMichael Messner1 , Urban Fietzek1 , Andres Ceballos-Baumann1
  • 1Abt. Neurologie und klinische Neurophysiologie, Neurologisches Krankenhaus München (Ärztliche Leitung: Prof. Dr. A. Ceballos-Baumann)
Further Information

Publication History

Publication Date:
27 February 2008 (online)

    Permissions and Reprints

Der Erfolg des therapeutischen Einsatzes von Botulinumtoxin in den 90er Jahren bei Bewegungsstörungen, fokalen Dystonien (z.B. Blepharospasmus, Torticollis spasmodicus) und Spasmus hemifacialis führte zu einer breiten Akzeptanz. In der Zwischenzeit wurde Botulinumtoxin für die Therapie von mehr als 50 Indikationen vorgeschlagen. Zugelassene Massenindikationen stellen bei den Bewegungsstörungen die verschiedenen Formen der Spastik und Dystonie sowie der Zerebralparese dar, ferner der Spasmus hemifacialis. Bei der Spastik ist die Effizienz von Botulinumtoxin neben pflegerischen Indikationen besonders bewiesen, wenn die Haltungsanomalie des Arms subjektiv als stigmatisierend erlebt wird und wenn nach einem Schlaganfall eine schmerzhafte Schulter bei spastischer Hemiparese die Indikation darstellt. Botulinumtoxin ist bei ausgewählten Patienten auch hilfreich bei Tic-Störungen, Krampussyndromen, Myoklonien, Tremor und Rigor.

Because of the successes with the therapeutical injections of botulinum toxin in the 1990s for the treatment of movement disorders, such as the focal dystonias (e.g. blepharospams or torticollis) a hemifacial spasm, botulinum toxin can nowadays be considered an established and widely accepted therapy concept. Meanwhile more than 50 indications for botulinum toxin have been suggested. Major labelled indications include the various forms of focal dystonia and spasticity, as well as cerebral palsy and hemifacial spasm. In spastic motor disorders treatment with botulinum toxin is efficacious for improving hygiene-related disability but also to reduce stigmatisation due to limb position. In addition, botulinum toxin can be helpful for indications such as tics, crampus syndrome, tremor, or rigidity.

Key words

Botulinum toxin - dystonia - spasm - tremor - hyperhidrosis - migraine - tension-type headache

Literatur

  • 1 Adler CH. et al. . Botulinum toxin type A for treating voice tremor.  Arch Neurol. 2004;  61 1416-1420
    CrossrefPubMedGoogle Scholar
  • 2 Bakheit AM. et al. . A randomized, double-blind, placebo-controlled, dose-ranging study to compare the efficacy and safety of three doses of botulinum toxin type A (Dysport) with placebo in upper limb spasticity after stroke.  Stroke. 2000;  31 2402-2406
    CrossrefPubMedGoogle Scholar
  • 3 Barbano RL.. Needle EMG guidance for injection of botulinum toxin. Needle EMG guidance is useful.  Muscle Nerve. 2001;  24 1567-1568
    CrossrefPubMedGoogle Scholar
  • 4 Benecke R. et al. . A new botulinum toxin type A free of complexing proteins for treatment of cervical dystonia.  Neurology. 2005;  64 1949-1951
    CrossrefPubMedGoogle Scholar
  • 5 Berweck S. et al. . Sonography-guided injection of botulinum toxin A in children with cerebral palsy.  Neuropediatrics. 2002;  33 221-223
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Berweck S. et al. . Sonography-guided injection of botulinum toxin in children with cerebral palsy.  Lancet. 2004;  363 249-250
    PubMedGoogle Scholar
  • 7 Bhakta BB. et al. . Use of botulinum toxin in stroke patients with severe upper limb spasticity.  J Neurol Neurosurg Psychiatry. 1996;  61 30-35
    PubMedGoogle Scholar
  • 8 Bhakta BB. et al. . Treatment of chronic limb spasticity with botulinum toxin A.  J Neurol Neurosurg Psychiatry. 1995;  59
    PubMedGoogle Scholar
  • 9 Bhakta BB. et al. . Impact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: a randomised double blind placebo controlled trial.  J Neurol Neurosurg Psychiatry. 2000;  69 217-221
    CrossrefPubMedGoogle Scholar
  • 10 Blitzer A, Brin MF.. Laryngeal dystonia: a series with botulinum toxin therapy.  Ann Otol Rhinol Laryngol. 1991;  100 85-89
    PubMedGoogle Scholar
  • 11 Blitzer A. et al. . Abductor laryngeal dystonia: a series treated with botulinum toxin.  Laryngoscope. 1992;  102 163-167
    PubMedGoogle Scholar
  • 12 Blitzer A. et al. . Electromyographic findings in focal laryngeal dystonia (spastic dysphonia).  Ann Otol Rhinol Laryngol. 1985;  94 591-594
    PubMedGoogle Scholar
  • 13 Borg-Stein J. et al. . Botulinum toxin for the treatment of spasticity in multiple sclerosis. New observations.  Am J Phys Med Rehabil. 1993;  72 364-368
    PubMedGoogle Scholar
  • 14 Borodic GE. et al. . Treatment of spasticity with botulinum toxin.  Ann Neurol. 1992;  31
    PubMedGoogle Scholar
  • 15 Brashear A. et al. . Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke.  N Engl J Med. 2002;  347 395-400
    CrossrefPubMedGoogle Scholar
  • 16 Brin MF. et al. . A randomized, double masked, controlled trial of botulinum toxin type A in essential hand tremor.  Neurology. 2001;  56 1523-1528
    CrossrefPubMedGoogle Scholar
  • 17 Ceballos-Baumann A.. Die Rolle der EMG-Steuerung bei der Botulinumtoxin-Therapie.  Klin Neurophysiol. 2003;  34 1-7
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Ceballos-Baumann A. et al. .Blue Book Dystonia Botulinum toxin: Basics - Clinical Aspects - Atlas - Evaluation Scales. Bonn, Berlin: Child&Brain GmbH 2007
    Google Scholar
  • 19 Ceballos-Baumann A. et al. .Dystonie. In: www.dgn.org/leitl.shtml, editor. Leitlinien der Deutschen Gesellschaft für Neurologie 2005
    Google Scholar
  • 20 Chen R. et al. . Effect of muscle activity immediately after botulinum toxin injection for writer's cramp.  Mov Disord. 1999;  14 307-312
    CrossrefPubMedGoogle Scholar
  • 21 Comella C. et al. .Botulinum serotype A compared to B in cervical dystonia: Randomized, double-blind, parallel study. 
    Google Scholar
  • 22 Comella CL. et al. . Botulinum toxin injection for spasmodic torticollis: increased magnitude of benefit with electromyographic assistance.  Neurology. 1992;  42 878-882
    CrossrefPubMedGoogle Scholar
  • 23 Daelen B. et al. . Neurogene Kiefergelenkluxation. Definition und Therapie mit Botulinumtoxin.  Nervenarzt. 1997;  68 346-350
    CrossrefPubMedGoogle Scholar
  • 24 Das TK, Park DM.. Botulinum toxin in treating spasticity.  Br J Clin Pract. 1989;  43 401-403
    PubMedGoogle Scholar
  • 25 Deuschl G. et al. . Ear click in palatal tremor: its origin and treatment with botulinum toxin.  Neurology. 1991;  41 16771-1679
    PubMedGoogle Scholar
  • 26 Friedman A. et al. . Effects of botulinum toxin A on upper limb spasticity in children with cerebral palsy.  Am J Phys Med Rehabil. 2000;  79 53-59
    CrossrefPubMedGoogle Scholar
  • 27 Geenen C. et al. . Localizing muscles for botulinum toxin treatment of focal hand dystonia.  Can J Neurol Sci. 1996;  23 194-197
    PubMedGoogle Scholar
  • 28 Gilles R. et al. . Traitment de la luxation temporo-mandibulaire récidivante par toxine botulique.  Rev Stomatol Chir Maxillofac. 2000;  101 189-191
    PubMedGoogle Scholar
  • 29 Grazko MA. et al. . Botulinum toxin A for spasticity, muscle spasms, and rigidity.  Neurology. 1995;  45 712-717
    PubMedGoogle Scholar
  • 30 Haussermann P. et al. . Long-term follow-up of cervical dystonia patients treated with botulinum toxin A.  Mov Disord. 2004;  19 303-308
    CrossrefPubMedGoogle Scholar
  • 31 Herting B. et al. . Computed tomographically-controlled injection of botulinum toxin into the longus colli muscle in severe anterocollis.  Mov Disord. 2004;  19 588-590
    CrossrefPubMedGoogle Scholar
  • 32 Hesse S. et al. . Short-term electrical stimulation enhances the effectiveness of Botulinum toxin in the treatment of lower limb spasticity in hemiparetic patients.  Neurosci Lett. 1995;  201 37-40
    CrossrefPubMedGoogle Scholar
  • 33 Hesse S. et al. . Ankle muscle activity before and after botulinum toxin therapy for lower limb extensor spasticity in chronic hemiparetic patients.  Stroke. 1996;  27 455-460
    PubMedGoogle Scholar
  • 34 Hesse S. et al. . Botulinum toxin treatment for lower limb extensor spasticity in chronic hemiparetic patients.  J Neurol Neurosurg Psychiatry. 1994;  57 1321-1324
    PubMedGoogle Scholar
  • 35 Hesse S. et al. . Botulinum toxin type A and short-term electrical stimulation in the treatment of upper limb flexor spasticity after stroke: a randomized, double-blind, placebo-controlled trial.  Clin Rehabil. 1998;  12 381-388
    CrossrefPubMedGoogle Scholar
  • 36 Hyman N. et al. . Botulinum toxin (Dysport) treatment of hip adductor spasticity in multiple sclerosis: a prospective, randomised, double blind, placebo controlled, dose ranging study.  J Neurol Neurosurg Psychiatry. 2000;  68 707-712
    CrossrefPubMedGoogle Scholar
  • 37 Jabusch HC. et al. . Quantification of focal dystonia in pianists using scale analysis.  Mov Disord. 2004;  19 171-180
    CrossrefPubMedGoogle Scholar
  • 38 Jankovic J.. Needle EMG guidance for injection of botulinum toxin. Needle EMG guidance is rarely required.  Muscle Nerve. 2001;  24 1568-1570
    CrossrefPubMedGoogle Scholar
  • 39 Jankovic J, Schwartz K.. Botulinum toxin treatment of tremors.  Neurology. 1991;  41 1185-1188
    CrossrefPubMedGoogle Scholar
  • 40 Jankovic J. et al. . A randomized, double-blind, placebo-controlled study to evaluate botulinum toxin type A in essential hand tremor.  Mov Disord. 1996;  11 250-256
    CrossrefPubMedGoogle Scholar
  • 41 Konstanzer A. et al. . Lokale Injektionsbehandlung mit Botulinumtoxin A bei schwerer Arm- und Beinspastik.  Nervenarzt. 1993;  64 517-523
    PubMedGoogle Scholar
  • 42 Lim JY. et al. . Intramuscular botulinum toxin-A reduces hemiplegic shoulder pain: a randomized, double-blind, comparative study versus intraarticular triamcinolone acetonide.  Stroke. 2008;  39 126-131
    PubMedGoogle Scholar
  • 43 Molloy FM. et al. . Accuracy of muscle localization without EMG: implications for treatment of limb dystonia.  Neurology. 2002;  58 805-807
    CrossrefPubMedGoogle Scholar
  • 44 Clinical use of botulinum toxin.  National Institutes of Health Consensus Development Conference Statement. 1990;  48 1294-1298
    PubMedGoogle Scholar
  • 45 Pavesi G. et al. . Botulinum toxin type A in the treatment of upper limb spasticity among patients with traumatic brain injury.  J Neurol Neurosurg Psychiatry. 1998;  64 419-420
    PubMedGoogle Scholar
  • 46 Roggenkämper P. et al. . Efficacy and safety of a new Botulinum Toxin Type A free of complexing proteins in the treatment of blepharospasm.  J Neural Transm. 2005;  113 303-312
    PubMedGoogle Scholar
  • 47 Ross MH. et al. . Treatment of occupational cramp with botulinum toxin: diffusion of toxin to adjacent noninjected muscles.  Muscle Nerve. 1997;  20 593-598
    PubMedGoogle Scholar
  • 48 Schuele S. et al. . Botulinum toxin injections in the treatment of musician's dystonia.  Neurology. 2005;  64 341-343
    CrossrefPubMedGoogle Scholar
  • 49 Scott AB.. Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery.  Ophthalmology. 1980;  87 1044-1049
    CrossrefPubMedGoogle Scholar
  • 50 Shakespeare DT. et al. . Anti-spasticity agents for multiple sclerosis.  Cochrane Database Syst Rev. 2000;  4
    PubMedGoogle Scholar
  • 51 Simpson DM. et al. . Botulinum toxin type A in the treatment of upper extremity spasticity: a randomized, double-blind, placebo-controlled trial.  Neurology. 1996;  46 1306-1310
    CrossrefPubMedGoogle Scholar
  • 52 Singer C. et al. . Use of mirror dystonia as guidance for injection of botulinum toxin in writing dysfunction.  J Neurol Neurosurg Psychiatry. 2005;  76 1608-1609
    CrossrefPubMedGoogle Scholar
  • 53 Snow BJ. et al. . Treatment of spasticity with botulinum toxin: a double-blind study.  Ann Neurol. 1990;  28 512-515
    CrossrefPubMedGoogle Scholar
  • 54 Trosch RM, Pullman SL.. Botulinum toxin A injections for the treatment of hand tremors.  Mov Disord. 1994;  9 601-609
    CrossrefPubMedGoogle Scholar
  • 55 Umstadt HE.. Botulinum toxin in der MKG-Chirurgie.  Mund Kiefer GesichtsChir. 2002;  6 249-260
    CrossrefPubMedGoogle Scholar
  • 56 Wissel J. et al. .Blue Book Botulinumtoxin: Rehabilitation und Botulinumtoxin. Grundlagen - Praxis - Atlas - Skalen. Bonn, Berlin: Child&Brain GmbH 2004
    Google Scholar
  • 57 Wissel J. et al. . Quantitative assessment of botulinum toxin treatment in 43 patients with head tremor.  Mov Disord. 1997;  12 722-726
    CrossrefPubMedGoogle Scholar
  • 58 Yablon SA. et al. . Botulinum toxin in severe upper extremity spasticity among patients with traumatic brain injury: an open-labeled trial.  Neurology. 1996;  47 939-944
    CrossrefPubMedGoogle Scholar
  • 59 Yelnik AP. et al. . Treatment of shoulder pain in spastic hemiplegia by reducing spasticity of the subscapular muscle: a randomised, double blind, placebo controlled study of botulinum toxin A.  J Neurol Neurosurg Psychiatry. 2007;  78 845-848
    CrossrefPubMedGoogle Scholar

Korrespondenz

Dr. med. Michael Messner

Oberarzt Neurologisches Krankenhaus München Zentrum für Parkinson und Bewegungsstörungen

Parzivalplatz 4

80804 München

Email: michael.messner@nk-m.de