Botulinumtoxin-Therapie bei Dystonien

B. Leplow; A. Eggebrecht; J. Pohl

doi:10.1055/s-0038-1627531

Nervenheilkunde, Table of Contents

Nervenheilkunde 2017; 36(10): 827-834
DOI: 10.1055/s-0038-1627531

Originalarbeit

Schattauer GmbH

Botulinumtoxin-Therapie bei Dystonien

Was unterscheidet zufriedene von unzufriedenen Patienten?Botulinum toxin treatment in dystonia

Authors

B. Leplow

¹Institut für Psychologie, Martin-Luther-Universität zu Halle-Wittenberg
A. Eggebrecht

¹Institut für Psychologie, Martin-Luther-Universität zu Halle-Wittenberg
J. Pohl

¹Institut für Psychologie, Martin-Luther-Universität zu Halle-Wittenberg

Abstract

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

Full Text

References

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