Ultraschall-gezielte Botulinumtoxin-Therapie in der Neurologie: etablierte Indikationen und Techniken

Zusammenfassung

Botulinumtoxin (BT) wird in der Neurologie eingesetzt zur Behandlung von Erkrankungen mit Muskelhyperaktivität, wie Dystonie, Spastik und Zerebralparese, muskulär bedingten Nervenengpass-Syndromen, sowie von Erkrankungen mit Hyperaktivität exokriner Drüsen.

Mittels Ultraschall (US) kann die gesamte Prozedur der BT-Injektion in oberflächennahe Muskeln und Drüsen in Echtzeit visualisiert und geführt werden. Die Ergebnisse verschiedener Studien sprechen dafür, dass die US-gezielte im Vergleich zur konventionellen Injektionstechnik den Effekt der BT-Therapie verbessert und Nebenwirkungen reduziert. Die US-gezielte Injektionstechnik ist heute etabliert zur BT-Injektion in die Glandula parotis und die Glandula submandibularis bei neurologischen Erkrankungen mit Hypersalivation. Des Weiteren ist die US-gezielte BT-Injektion zu empfehlen bei komplizierten Formen der zervikalen Dystonie sowie bei dystonem Kopftremor, insbesondere zur Injektion der Mm. scaleni, des M. obliquus capitis inferior und des M. longissimus capitis. Die US-gezielte BT-Injektion ist Standard bei der Behandlung spezifischer Unterarmmuskeln (z.B. einzelner Fingerflexoren), wenn deren Funktionalität von Bedeutung ist, insbesondere bei tätigkeitsassoziierten Dystonien und bei milder Spastik. Die US-gezielte Injektionstechnik ist sinnvoll bei Therapie bestimmter Beinmuskeln. In dieser Übersicht werden die Technik und die häufigen neurologischen Indikationen der US-geführten BT-Injektion vorgestellt.

Abstract

Botulinum toxin (BT) therapy is used in neurology to treat muscle hyperactivity disorders including dystonia, spasticity and cerebral palsy, nerve entrapment syndromes caused by muscles, as well as exocrine gland hyperactivity disorders. Ultrasonography (US) can visualise and guide the entire procedure of BT application into muscles and glands. The results of several studies suggest that US-guidance can improve efficacy and reduce adverse effects of BT therapy when compared to conventional placement. US is meanwhile established for guiding the BT injection into the parotid and submandibular glands in neurological disorders with sialorrhea. Moreover, US-guidance of BT-injection is recommendable for use in patients with complicated forms of cervical dystonia and dystonic head tremor, especially for exactly targeting the scaleni, obliquus capitis inferior, and longissimus capitis muscles. US-guidance can be regarded as being state-of-the-art in the treatment of single forearm muscles (e.g., single finger flexors) if their functionality matters, especially in task-related dystonia, and mild spasticity. US is recommended for guidance of BT injection in selected leg muscles. Here the technique and indications of US-guidance for BT injection in neurological disorders are reviewed.

Schlüsselwörter

Myosonologie - Botulinumtoxin - Dystonie - Spastik - Hypersalivation - Ultraschall-gezielte Injektion

Key words

myosonology - botulinum toxin - dystonia - spasticity - hypersalivation - ultrasound-guided injection

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