Efikasnost terapije botulinskim toksinom tipa A u lečenju različitih formi fokalnih distonija u srpskoj populaciji: iskustvo Centra za botulinski toksin

  • Aleksandra Tomić Klinika za neurologiju, Klinički centar Srbije, Beograd Clinic for Neurology, Clinical Center of Serbia, Belgrade
  • Balša Vujović Clinic for Neurology, Clinical Center of Montenegro, Podgorica, Montenegro
  • Nataša Dragašević Mišković Clinic for Neurology, Clinical Center of Serbia, Belgrade, Serbia
  • Igor Petrović Clinic for Neurology, Clinical Center of Serbia, Belgrade, Serbia
  • Tatjana Pekmezović Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Vladimir S Kostić Clinic for Neurology, Clinical Center of Serbia, Belgrade, Serbia
DOI: https://doi.org/10.2298/5224

Sažetak


Uvod/Cilj.  Botulinski toksin (BT) ireverzibilno inhibira presinaptičko oslobađanje acetilholina sa posledičnom relaksacijom prekomerno kontrahovanih mišića. To je efikasna i bezbedna terapija sa dugotrajnim povoljnim dejstvom kod brojnih bolesti nevoljnih pokreta, kao i kod drugih neuroloških i neneuroloških oboljenja. Cilj  ovog istraživanja bio je predstavljanje našeg iskustva sa BT tipa A u lečenju različitih formi fokalnih distonija. Metode. U studiju je bilo uključeno 100 bolesnika sa različitim formama fokalnih distonija (spastični tortikolis, blefarospazam, grafospazam) lečenih u Centru za botulinski toksin Klinike za neurologiju, Kliničkog centra Srbije. Svi bolesnici su pregledani i ocenjeni pre primene BT, a zatim pri sledećoj poseti, nakon 3–4 meseca. Korišćeni su upitnik za samoprocenu poboljšanja i standardne skale za procenu težine bolesti. Rezultati. Poboljšanje ≥ 50% utvrđeno je kod 68,2% od ukupnog broja analiziranih primena BT (199). Nezavisni prediktori dobrog odgovora na terapiju (poboljšanje ≥ 50%) bili su muški pol (p = 0,011), prisustvo senzornog trika (p = 0,013) i ukupan broj aplikacija BT (p = 0,002). Efekat BT bio je statistički značajno bolji kod bolesnika sa tortikolisom i blefarospazmom (poboljšanje 57,3 ± 27,5%, odnosno 54,1 ± 28,3%), nego kod bolesnika sa grafospazmom (26,7 ± 25,6%). Većina bolesnika nije imala komplikacije terapije (81,4% i 72% u dve primene). Neželjeni efekti kod preostalih bolesnika (slabost mišića, disfagija, ptoza, diplopije, slabost vrata i poremećaj lakrimacije) trajali su 28,3 ± 18,6 dana posle prve primene i 32,5 ± 36,2 dana posle druge. Zaključak. Botulinski toksin je bezbedan i veoma efikasan u dugotrajnoj terapiji kod bolesnika sa različitim formama fokalnih distonija. Neželjeni efekti su blagi i dobro se podnose.

 

Ključne reči:

distonija; botulin toksini; srbija; upitnici; kvalitet života.

Reference

Ramirez-Castaneda J, Jankovic J. Long-term efficacy and safety of botulinum toxin injections in dystonia. Toxins 2013; 5(2): 249−66.

Dressler D, Adib SF. Botulinum Toxin: Mechanisms of Action. Eur Neurol 2005; 53(1): 3−9.

Costa J, Espírito-Santo C, Borges A, Ferreira JJ, Coelho M, Moore P, et al. Botulinum toxin type B for cervical dystonia. Cochrane Database Syst Rev 2005; 25(1): CD004315.

Jankovic J. Treatment of cervical dystonia with botulinum toxin. Mov Disord 2004; 19 (Suppl 8): S109−15.

Costa J, Espírito-Santo C, Borges A, Ferreira JJ, Coelho M, Moore P, et al. Botulinum toxin type A therapy for blepharospasm. Cochrane Database Syst Rev 2005; 25(1) CD004900.

Schuele S, Jabusch H, Lederman RJ, Altenmüller E. Botulinum toxin injections in the treatment of musician's dystonia. Neurology 2005; 64(2): 341−3.

Karp BI. The role of botulinum toxin type A in the management of occupational dystonia and writer's cramp. In: Brin MF, Jankovic J, Hallet M, editors. Scientific and therapeutic aspects of botulinum toxin. Philadelphia: Lippincott Williams and Wilkins; 2000. p. 251−8

Kruisdijk JJ, Koelman JH, Ongerboer de Visser BW, de Haan RJ, Speelman JD. Botulinum toxin for writer's cramp: a randomised, placebo-controlled trial and 1-year follow-up. J Neurol Neurosurg Psychiatr 2007; 78(3): 264−70.

Hsiung GY, Das SK, Ranawaya R, Lafontaine AL, Suchowersky O. Long-term efficacy of botulinum toxin A in treatment of various movement disorders over a 10-year period. Mov Disord 2002; 17(6): 1288−93.

Albanese A, Asmus F, Bhatia KP, Elia AE, Elibol B, Filippini G, et al. EFNS guidelines on diagnosis and treatment of primary dystonias. Eur J Neurol 2011; 18(1): 5−18.

Consky ES, Lang AE. Clinical assessments in patients with cervical dystonia. In: Jankovic J, Hallet M, editors. Therapy with botulinum toxin. New York, NY: Marcel Dekker; 1994. p. 211−37.

Goertelmeyer R, Brinkmann S, Comes G, Delcker A. The Blepharospasm Disability Index (BSDI) for the assessment of functional health in focal dystonia. Clin Neurophysiol 2002; 113(1): S77−8.

Jankovic J, Orman J. Botulinum A toxin for cranial-cervical dystonia: a double-blind, placebo-controlled study. Neurology 1987; 37(4): 616−23.

Wissel J, Kabus C, Wenzel R, Klepsch S, Schwarz U, Nebe A, et al. Botulinum toxin in writer's cramp: objective response evaluation in 31 patients. J Neurol Neurosurg Psychiatr 1996; 61(2): 172−5.

Kostić V, Covicković-Sternić N, Filipović S. Local treatment of spasmodic torticollis with botulinum toxin. Neurologija 1990;39(1):29-33.

Brashear A, Bergan K, Wojcieszek J, Siemers ER, Ambrosius W. Patients' perception of stopping or continuing treatment of cervical dystonia with botulinum toxin type A. Mov Disord 2000; 15(1): 150−3.

Skogseid IM, Kerty E. The course of cervical dystonia and patient satisfaction with long-term botulinum toxin A treatment. Eur J Neurol 2005; 12(3): 163−70.

Cillino S, Raimondi G, Guépratte N, Damiani S, Cillino M, di Pace F, et al. Long-term efficacy of botulinum toxin A for treatment of blepharospasm, hemifacial spasm, and spastic entropion: a multicentre study using two drug-dose escalation index. Eye (Lond) 2010; 24(4): 600−7.

Bentivoglio AR, Fasano A, Ialongo T, Soleti F, Lo FS, Albanese A. Fifteen-year experience in treating blepharospasm with Botox or Dysport: same toxin, two drugs. Neurotox Res 2009; 15(3): 224−31.

Lungu C, Karp BI, Alter K, Zolbrod R, Hallett M. Long-term follow-up of botulinum toxin therapy for focal hand dystonia: outcome at 10 years or more. Mov Disord 2011; 26(4): 750−3.

Byrnes ML, Thickbroom GW, Wilson SA, Sacco P, Shipman JM, Stell R, et al. The corticomotor representation of upper limb muscles in writer's cramp and changes following botulinum toxin injection. Brain 1998; 121(Pt 5): 977−88.

Naumann M, Albanese A, Heinen F, Molenaers G, Relja M. Safety and efficacy of botulinum toxin type A following long-term use. Eur J Neurol 2006; 13(Suppl 4): 35−40.

Mejia NI, Vuong KD, Jankovic J. Long-term botulinum toxin efficacy, safety, and immunogenicity. Mov Disord 2005; 20(5): 592−7.

Objavljeno
2017/01/20
Broj časopisa
Vol. 72 Br. 12 (2015)
Rubrika
Originalni članak