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Klinische Neurophysiologie 2003; 34(3): 138-144
DOI: 10.1055/s-2003-42252
Originalia
© Georg Thieme Verlag Stuttgart · New York

Die Rolle der EMG-Steuerung bei der Botulinumtoxintherapie

The Role of EMG Guidance in Botulinum Toxin (BTX) TherapyA.  Ceballos-Baumann1
  • 1Neurologische Klinik der Technischen Universität München, Klinikum rechts der Isar
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Publication History

Publication Date:
18 September 2003 (online)

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Zusammenfassung

Die Rolle der EMG-Steuerung und simultaner Kontrolle mittels EMG-ableitefähigen Injektionsnadeln im Rahmen der Botulinumtoxin(BTX)-Therapie wird unterschiedlich bewertet. Beim Blepharospasmus und Spasmus hemifacialis wurde in den vielen publizierten Studien keine EMG-Steuerung verwendet. In der überwiegenden Mehrzahl der Untersuchungen zur zervikalen Dystonie wurde ohne EMG-Steuerung gearbeitet und über 60 % der zervikalen Dystoniepatienten halten BTX auch noch nach Jahren für eine lohnenswerte Therapie. In den Studien zum Schreibkrampf sowie zu der spasmodischen Dysphonie wurde mehrheitlich EMG zur Injektionssteuerung heranzogen. Bei diesen Indikationen sowie bei weiteren Beschäftigungskrämpfen, der Kieferöffnungsdystonie und Problemsituationen bei der zervikalen Dystonie wie der Anterokollis sind EMG-gesteuerte Injektionen meist Voraussetzung, um BTX sinnvoll injizieren zu können. Bei einer unkomplizierten zervikalen Dystonie, dem rotatorischen Tortikollis 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.

Abstract

Nowadays, botulinum toxin (BTX) is the treatment of choice for most patients with focal dystonia. Guidelines regarding technique and dosage vary considerably. One issue remains the role of EMG in refining treatment outcome. Basically all studies on blepharospasm were conducted without EMG. More than 60 % of patients with cervical dystonia consider BTX 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 been only rarely assessed. The effectiveness of BTX 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, to minimise side effects and to save toxin, has not yet been clarified.

Key words

Botulinum toxin - dystonia - torticollis - blepharospasm - writer's cramp - EMG

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Prof. Dr. Andres O. Ceballos-Baumann

Dept. of Neurology · Technische Universität München · Klinikum rechts der Isar

Moehlstraße 28

81675 München

Email: a.ceballos@lrz.tu-muenchen.de

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