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DOI: 10.1055/s-0034-1366536
Multiple Sklerose, Neuromyelitis optica und spastische Bewegungsstörungen: Spezifische Symptomkontrolle und Lebensqualität
Multiple Sclerosis, Neuromyelitis Optica and Spasticity: Control of Specific Symptoms and Quality of LifePublication History
20 August 2013
20 April 2014
Publication Date:
11 July 2014 (online)
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Zusammenfassung
Spastische Bewegungsstörungen haben bei Patienten mit Multipler Sklerose und Neuromyelitis optica eine hohe Lebenszeitprävalenz. Wegen der Vielzahl verschiedener Einflussgrößen stellt die Behandlung der Spastik bei MS immer einen individuellen und komplexen Abwägungsprozess dar. Die Tendenz, die symptomatische Therapie der MS eher an subjektiven Funktionsstörungen und weniger an spezifischen Effekten auf einzelne pathologische Symptome auszurichten, hat zu einer großzügigeren und mehr an den Bedürfnissen des Patienten orientierten Sicht geführt. Eine genaue Analyse, Charakterisierung und Verlaufsbeurteilung der für den einzelnen Patienten im Vordergrund stehenden Beschwerden wird dadurch jedoch nicht überflüssig, sondern gewinnt im Gegenteil weiter an Bedeutung, auch um eine unkontrollierte Polypharmazie mit entsprechend gesteigertem Nebenwirkungspotenzial zu vermeiden.
Abstract
Spastic movement disorders show a high lifetime prevalence among patients suffering from multiple sclerosis and neuromyelitis optica. Due to the high number of factors interacting with the individual manifestations of spasticity, its symptomatic treatment affords continuous and careful balancing of therapeutic measures. A trend observed over the past few years is to base symptomatic treatment of MS on subjective assessments of functional disorders rather than on specific individual pathological signs and symptoms. This has led to a more generous and more patient-oriented perspective. Therefore, a detailed analysis, characterisation and evaluation of the individual clinical course of the disease is not only indispensable, but is actually gaining even more importance in avoiding uncontrolled polypharmacy with correspondingly increased risks for side effects.
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Literatur
- 1 Nielsen JB, Crone C, Hultborn H. The spinal pathophysiology of spasticity – from a basic science point of view. Acta Physiol (Oxf) 2007; 189: 171-180
- 2 Dietz V, Sinkjaer T. Spastic movement disorder: impaired reflex function and altered muscle mechanics. Lancet Neurol 2007; 6: 725-733
- 3 O’Dwyer NJ, Ada L. Reflex hyperexcitability and muscle contracture in relation to spastic hypertonia. Curr. Opin. Neurol 1996; 9: 451-455
- 4 Dietz V, Quintern J, Berger W. Electrophysiological studies of gait in spasticity and rigidity. Evidence that altered mechanical properties of muscle contribute to hypertonia. Brain 1981; 104: 431-449
- 5 Olsson MC, Krüger M, Meyer LH et al. Fibre type-specific increase in passive muscle tension in spinal cord-injured subjects with spasticity. J. Physiol. (Lond.) 2006; 577: 339-352
- 6 Brown SH M, Carr JA, Ward SR et al. Passive mechanical properties of rat abdominal wall muscles suggest an important role of the extracellular connective tissue matrix. J. Orthop. Res 2012; 30: 1321-1326
- 7 Lieber RL, Steinman S, Barash IA et al. Structural and functional changes in spastic skeletal muscle. Muscle Nerve 2004; 29: 615-627
- 8 Rizzo MA, Hadjimichael OC, Preiningerova J et al. Prevalence and treatment of spasticity reported by multiple sclerosis patients. Mult. Scler 2004; 10: 589-595
- 9 Benecke R, Dressler D. Diagnostik, Klassifikation und Therapie der Spastik bei Multipler Sklerose. Zettl UK, Mix E, Eds. Multiple Sklerose: Kausalorientierte, symptomatische und rehabilitative Therapie. Berlin: Springer; 2001
- 10 Flachenecker P, Stuke K, Elias W et al. Multiple sclerosis registry in Germany: results of the extension phase 2005/2006. Dtsch Arztebl Int 2008; 105: 113-119
- 11 Kira JI. Neuromyelitis optica and opticospinal multiple sclerosis: Mechanisms and pathogenesis. Pathophysiology 2011; 18: 69-79
- 12 Trebst C, Berthele A, Jarius S et al. Diagnosis and treatment of neuromyelitis optica. Consensus recommendations of the Neuromyelitis Optica Study Group. Nervenarzt 2011; 82: 768-777
- 13 Kleiter I, Hellwig K, Berthele A et al. Failure of natalizumab to prevent relapses in neuromyelitis optica. Arch. Neurol 2012; 69: 239-245
- 14 Asgari N, Lillevang ST, Skejoe HP B et al. A population-based study of neuromyelitis optica in Caucasians. Neurology 2011; 76: 1589-1595
- 15 Zettl UK, Stüve O, Patejdl R. Immune-mediated CNS diseases: a review on nosological classification and clinical features. Autoimmun Rev 2012; 11: 167-173
- 16 Cheng XJ, Xu LZ. Review of the diagnosis and clinical features of multiple sclerosis in China. Neurosci Bull 2009; 25: 38-42
- 17 Siritho S, Prayoonwiwat N. A retrospective study of multiple sclerosis in Siriraj Hospital, Bankok, Thailand. Can J Neurol Sci 2007; 34: 99-104
- 18 Barnes MP, Kent RM, Semlyen JK et al. Spasticity in multiple sclerosis. Neurorehabil Neural Repair 2003; 17: 66-70
- 19 Donzé C, De Sèze J. Spasticity and everyday life in multiple sclerosis. Rev Neurol (Paris) 2012; 168 (Suppl. 03) S51-S56
- 20 Schwartz CE, Vollmer T, Lee H. North American Research Consortium on Multiple Sclerosis Outcomes Study Group.. Reliability and validity of two self-report measures of impairment and disability for MS. Neurology 1999; 52: 63-70
- 21 Farrar JT. Measuring symptoms and wellness in the multiple sclerosis patient: issues in measurement. Expert Rev Neurother 2013; 13: 21-26
- 22 Arroyo R, Massana M, Vila C. Correlation between Spasticity and Quality of Life in Patients with Multiple Sclerosis: the CANDLE Study. Int J Neurosci 2013; 123: 850-858
- 23 Pandyan AD, Johnson GR, Price CI et al. A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity. Clin Rehabil 1999; 13: 373-383
- 24 Farrar JT, Troxel AB, Stott C et al. Validity, reliability, and clinical importance of change in a 0-10 numeric rating scale measure of spasticity: a post hoc analysis of a randomized, double-blind, placebo-controlled trial. Clin Ther 2008; 30: 974-985
- 25 Ghotbi N, Nakhostin Ansari N, Naghdi S et al. Measurement of lower-limb muscle spasticity: intrarater reliability of Modified Ashworth Scale. J Rehabil Res Dev 2011; 48: 83-88
- 26 Anwar K, Barnes MP. A pilot study of a comparison between a patient scored numeric rating scale and clinician scored measures of spasticity in multiple sclerosis. NeuroRehabilitation 2009; 24: 333-340
- 27 Novotna A, Mares J, Ratcliffe S et al. A randomized, double-blind, placebo-controlled, parallel-group, enriched-design study of nabiximols* (Sativex(®)), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis. Eur J Neurol 2011; 18: 1122-1131
- 28 Storr LK, Sørensen PS, Ravnborg M. The efficacy of multidisciplinary rehabilitation in stable multiple sclerosis patients. Mult. Scler 2006; 12: 235-242
- 29 Patejdl R, Winkelmann A, Benecke R et al. Muscle rupture caused by exacerbated spasticity in a patient with multiple sclerosis. J. Neurol 2008; 255 (Suppl. 06) 115-118
- 30 Atiyeh BS, Hayek SN. Pressure sores with associated spasticity: a clinical challenge. Int Wound J 2005; 2: 77-80
- 31 Sand PK, Sand RI. The diagnosis and management of lower urinary tract symptoms in multiple sclerosis patients. Dis Mon 2013; 59: 261-268
- 32 Meca-Lallana JE, Balseiro JJ, Lacruz F et al. Spasticity improvement in patients with relapsing-remitting multiple sclerosis switching from interferon-b to glatiramer acetate: the Escala Study. J Neurol Sci 2012; 123-128
- 33 Rösche J, Paulus C, Maisch U et al. The effects of therapy on spasticity utilizing a motorized exercise-cycle. Spinal Cord 1997; 35: 176-178
- 34 Rösche J, Rüb K, Niemann-Delius B et al. Effects of physiotherapy on F-wave-amplitudes in spasticity. Electromyogr Clin Neurophysiol 1996; 36: 509-511
- 35 Kesselring J, Beer S. Symptomatic therapy and neurorehabilitation in multiple sclerosis. Lancet Neurol 2005; 4: 643-652
- 36 Smania N, Picelli A, Munari D et al. Rehabilitation procedures in the management of spasticity. Eur J Phys Rehabil Med 2010; 46: 423-438
- 37 Mailhan L, Papeix C. Non-medicinal treatments of spasticity in multiple sclerosis. Rev. Neurol. (Paris) 2012; 168 (Suppl. 03) S57-S61
- 38 Amatya B, Khan F, La Mantia L et al. Non pharmacological interventions for spasticity in multiple sclerosis. Cochrane Database Syst Rev 2013; 2 CD009974
- 39 Kakuda W, Abo M, Kobayashi K et al. Low-frequency repetitive transcranial magnetic stimulation and intensive occupational therapy for poststroke patients with upper limb hemiparesis: preliminary study of a 15-day protocol. Int J Rehabil Res 2010; 33: 339-345
- 40 Mori F, Codecà C, Kusayanagi H et al. Effects of intermittent theta burst stimulation on spasticity in patients with multiple sclerosis. Eur. J. Neurol 2010; 17: 295-300
- 41 Halpern R, Gillard P, Graham GD et al. Adherence Associated With Oral Medications in the Treatment of Spasticity. PM R 2013; 5: 747-756
- 42 Paisley S, Beard S, Hunn A et al. Clinical effectiveness of oral treatments for spasticity in multiple sclerosis: a systematic review. Mult Scler 2002; 8: 319-329
- 43 Brar SP, Smith MB, Nelson LM et al. Evaluation of treatment protocols on minimal to moderate spasticity in multiple sclerosis. Arch Phys Med Rehabil 1991; 72: 186-189
- 44 Orsnes GB, Sørensen PS, Larsen TK et al. Effect of baclofen on gait in spastic MS patients. Acta Neurol. Scand 2000; 101: 244-248
- 45 Emre M, Leslie GC, Muir C et al. Correlations between dose, plasma concentrations, and antispastic action of tizanidine (Sirdalud). J Neurol Neurosurg Psychiatr 1994; 57: 1355-1359
- 46 Henney HR, Runyan JD. A clinically relevant review of tizanidine hydrochloride dose relationships to pharmacokinetics, drug safety and effectiveness in healthy subjects and patients. Int. J. Clin. Pract 2008; 62: 314-324
- 47 Kocsis P, Farkas S, Fodor L et al. Tolperisone-type drugs inhibit spinal reflexes via blockade of voltage-gated sodium and calcium channels. J Pharmacol Exp Ther 2005; 315: 1237-1246
- 48 Stamenova P, Koytchev R, Kuhn K et al. A randomized, double-blind, placebo-controlled study of the efficacy and safety of tolperisone in spasticity following cerebral stroke. Eur J Neurol 2005; 12: 453-461
- 49 Pratzel HG, Alken RG, Ramm S. Efficacy and tolerance of repeated oral doses of tolperisone hydrochloride in the treatment of painful reflex muscle spasm: results of a prospective placebo-controlled double-blind trial. Pain 1996; 67: 417-425
- 50 Zajicek J, Fox P, Sanders H et al. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial. Lancet 2003; 362: 1517-1526
- 51 Husseini L, Leussink VI, Warnke C et al. Cannabinoids for symptomatic therapy of multiple sclerosis. Nervenarzt 2012; 83: 695-704
- 52 Wegener N, Koch M. Neurobiology and systems physiology of the endocannabinoid system. Pharmacopsychiatry 2009; 42 (Suppl. 01) S79-S86
- 53 Cutter NC, Scott DD, Johnson JC et al. Gabapentin effect on spasticity in multiple sclerosis: a placebo-controlled, randomized trial. Arch Phys Med Rehabil 2000; 81: 164-169
- 54 Mueller ME, Gruenthal M, Olson WL et al. Gabapentin for relief of upper motor neuron symptoms in multiple sclerosis. Arch Phys Med Rehabil 1997; 78: 521-524
- 55 Dunn J, Blight A. Dalfampridine: a brief review of its mechanism of action and efficacy as a treatment to improve walking in patients with multiple sclerosis. Curr Med Res Opin 2011; 27: 1415-1423
- 56 Goodman AD, Brown TR, Edwards KR et al. A phase 3 trial of extended release oral dalfampridine in multiple sclerosis. Ann Neurol 2010; 68: 494-502
- 57 Sahraian MA, Maghzi AH, Etemadifar M et al. Dalfampridine: review of its efficacy in improving gait in patients with multiple sclerosis. J Cent Nerv Syst Dis 2011; 3: 87-93
- 58 Dressler D. Pharmacology of botulinum toxin drugs. HNO 2012; 60: 496-502
- 59 Dressler D. Clinical presentation and management of antibody-induced failure of botulinum toxin therapy. Mov. Disord 2004; 19 (Suppl. 08) S92-S100
- 60 Benecke R. Clinical relevance of botulinum toxin immunogenicity. BioDrugs 2012; 26: e1-e9
- 61 Kabus C, Hecht M, Japp G et al. Botulinum toxin in patients with multiple sclerosis. J. Neurol 2006; 253 (Suppl. 01) I26-I28
- 62 Giovannelli M, Borriello G, Castri P et al. Early physiotherapy after injection of botulinum toxin increases the beneficial effects on spasticity in patients with multiple sclerosis. Clin Rehabil 2007; 21: 331-337
- 63 Wissel J, Entner T. Botulinum toxin treatment of hip adductor spasticity in multiple sclerosis. Wien Klin Wochenschr 2001; 113 (Suppl. 04) 20-24
- 64 Schuele SU, Kellinghaus C, Shook SJ et al. Incidence of seizures in patients with multiple sclerosis treated with intrathecal baclofen. Neurology 2005; 64: 1086-1087
- 65 Rekand T, Grønning M. Treatment of spasticity related to multiple sclerosis with intrathecal baclofen: a long-term follow-up. J Rehabil Med 2011; 43: 511-514
- 66 Heun R, Sliwka U, Rüttinger H et al. Intrathecal versus systemic corticosteroids in the treatment of multiple sclerosis: results of a pilot study. J Neurol 1992; 239: 31-35
- 67 Abu-Mugheisib M, Benecke R, Zettl UK. Management of spasticity in progressive multiple sclerosis: efficacy of repeated intrathecal triamcinolone acetonide administration. Curr Pharm Des 2012; 18: 4564-4569
- 68 Siegert RJ, Abernethy DA. Depression in multiple sclerosis: a review. J. Neurol. Neurosurg. Psychiatr 2005; 76: 469-475
- 69 Feinstein A. Multiple sclerosis and depression. Mult. Scler 2011; 1276-1281
- 70 Freal JE, Kraft GH, Coryell JK. Symptomatic fatigue in multiple sclerosis. Arch Phys Med Rehabil 1984; 65: 135-138
- 71 Chia YW, Fowler CJ, Kamm MA et al. Prevalence of bowel dysfunction in patients with multiple sclerosis and bladder dysfunction. J. Neurol 1995; 242: 105-108
- 72 Moulin DE, Foley KM, Ebers GC. Pain syndromes in multiple sclerosis. Neurology 1988; 38: 1830-1834
- 73 Yeh CY, Tsai KH, Chen JJ. Effects of prolonged muscle stretching with constant torque or constant angle on hypertonic calf muscles. Arch Phys Med Rehabil 2005; 86: 235-241
- 74 Harvey L, de Jong I, Goehl G, Mardwedel S. Twelve weeks of nightly stretch does not reduce thumb web-space contractures in people with a neurological condition: a randomised controlled trial. Aust J Physiother 2006; 52: 251-258
- 75 Morris SL, Dodd KJ, Morris ME. Outcomes of progressive resistance strength training following stroke: a systematic review. Clin Rehabil 2004; 18: 27-39
- 76 Bobath B. Abnormal postural reflex activity caused by brain lesion. Aspen: Heinemann Medical Books; 1985
- 77 Velikonja O, Curić K, Ozura A et al. Influence of sports climbing and yoga on spasticity, cognitive function, mood and fatigue in patients with multiple sclerosis. Clin Neurol Neurosurg 2010; 112: 597-601
- 78 Siev-Ner I, Gamus D, Lerner-Geva L et al. Reflexology treatment relieves symptoms of multiple sclerosis: a randomized controlled study. Mult Scler 2003; 9: 356-361
- 79 Laufens G. Laufband- und Vojta-Physiotherapie an ausgewählten MS-Patienten – Ein Vergleich der Soforteffekte. Phys Med Rehab Kuror 1998; 8: 174-177
- 80 Manganotti P, Amelio E. Long-term effect of shock wave therapy on upper limb hypertonia in patients affected by stroke. Stroke 2005; 36: 1967-1971
- 81 Amelio E, Manganotti P. Effect of shock wave stimulation on hypertonic plantar flexor muscles in patients with cerebral palsy: a placebo-controlled study. J Rehabil Med 2010; 42: 339-343
- 82 Vidal X, Morral A, Costa L et al. Radial extracorporeal shock wave therapy (rESWT) in the treatment of spasticity in cerebral palsy: a randomized, placebo-controlled clinical trial. NeuroRehabilitation 2011; 29: 413-419
- 83 Ansari NN, Adelmanesh F, Naghdi S et al. The effect of physiotherapeutic ultrasound on muscle spasticity in patients with hemiplegia: a pilot study. Electromyogr Clin Neurophysiol 2006; 46: 247-252
- 84 Nakhostin Ansari N, Naghdi S, Hasson S et al. Efficacy of therapeutic ultrasound and infrared in the management of muscle spasticity. Brain Inj 2009; 23: 632-638
- 85 Harlaar J, Ten Kate JJ, Prevo AJ et al. The effect of cooling on muscle co-ordination in spasticity: assessment with the repetitive movement test. Disabil Rehabil 2001; 23: 453-461
- 86 Allison SC, Abraham LD. Sensitivity of qualitative and quantitative spasticity measures to clinical treatment with cryotherapy. Int J Rehabil Res 2001; 24: 15-24
- 87 Gracies JM. Physical modalities other than stretch in spastic hypertonia. Phys Med Rehabil Clin N Am 2001; 12: 769-792 , vi
- 88 Matsumoto S, Kawahira K, Etoh S et al. Short-term effects of thermotherapy for spasticity on tibial nerve F-waves in post-stroke patients. Int J Biometeorol 2006; 50: 243-250
- 89 Noma T, Matsumoto S, Etoh S et al. Anti-spastic effects of the direct application of vibratory stimuli to the spastic muscles of hemiplegic limbs in post-stroke patients. Brain Inj 2009; 23: 623-631
- 90 Schyns F, Paul L, Finlay K et al. Vibration therapy in multiple sclerosis: a pilot study exploring its effects on tone, muscle force, sensation and functional performance. Clin Rehabil 2009; 23: 771-781
- 91 Ng SS M, Hui-Chan CW Y. Transcutaneous electrical nerve stimulation combined with task-related training improves lower limb functions in subjects with chronic stroke. Stroke 2007; 38: 2953-2959
- 92 Armutlu K, Meriç A, Kirdi N et al. The effect of transcutaneous electrical nerve stimulation on spasticity in multiple sclerosis patients: a pilot study. Neurorehabil Neural Repair 2003; 17: 79-82
- 93 Miller L, Mattison P, Paul L et al. The effects of transcutaneous electrical nerve stimulation (TENS) on spasticity in multiple sclerosis. Mult Scler 2007; 13: 527-533