Ekstremite ve Gövde Distonileri; Botulinum Toksini Uygulamaları

Abstract

ÖZETEkstremite distonisi (ED) izole fokal bir semptom veya jeneralize distoninin bir parças› olabilir, maluliyet yarat›c› bir durumdur. ‹diopatik veya özellikle kontrlateral bazal ganglionlar› etkileyen durumlarda di¤er bir hastal›¤a sekonder olabilir. Yayg›n veya ciddi ED genellikle oral ilaçlar ile tedavi edilir. Stereotaksik cerrahi düflünülebilir. ‹diopatik ED veya fokal ekstremite semptomlar› ise botulinum toksini (BoNT) enjeksiyonuna iyi yan›t verir. BoNT tip A enjeksiyonlar› ED'li hastalar›n %80'inin üzerinde a¤r› ve spazmlar› azalt›r. Günlük yaflam aktivitesinde ve motor performansta %50-66 oran›nda fonksiyonel düzelme sa¤lar. Jeneralize distonili hastalar›n %80'inin üzerinde malul edici postürde azalma, deri laserasyonlar›nda ve a¤r›da azalma gözlenir. Post operatif dönemde spazmlar› önledi¤inden iyileflmenin h›zlanmas› amac› ile k›sa süreli olarak da kullan›labilir. Gövde distonileri s›kl›kla segmental veya jeneralize distonilerde görülür, izole formlar› nadirdir. Nörolepti¤e ba¤l› aksiyal etkilenme s›k görülür. S›kl›kla ciddi a¤r› ve özürlülük ile birliktedir ve nadiren farmakolojik tedaviye yan›t verir. Di¤er fokal distonilerde oldu¤u gibi gövde distonilerinde de tercih edilen tedavi BoNT'tur. Dikkatli hedef kas seçimi ve uygun dozlar uyguland›¤›nda genellikle klinik tabloda belirgin düzelme sa¤lar. BoNT tedavisi baflar›s›z olursa ilk alternatif, ilaç tedavisidir, ilave olarak fizyoterapi hastan›n semptomlar›n› azaltmaya yard›mc› olur, sürekli intratekal baklofen uygulamas› bu hastalarda faydal›d›r, epidural spinal elektrostimülasyonun etkisi belirsizdir, cerrahi son çare olarak düflünülmelidir. (Nöropsikiyatri Arflivi 2010; 47 Özel Say›: 19-26) Anahtar kelimeler: Ekstremite distonileri, gövde distonileri, botulinum toksini ABSTRACT Extremity dystonia (ED) is a disabling condition that may represent an isolated focal symptom or may be part of generalized dystonia. It may develop secondary to any process affecting the contralateral basal ganglia or may be idiopathic. Diffuse or severe dystonia generally improves by administration of various medications and only in rare cases, stereotaxic surgery may be needed. Idiopathic forms or focal symptoms frequently respond to botulinum toxin (BoNT) injections. BoNT type A injection decreases pain and spasms in more than 80% of cases and results in 50-66% functional improvement in daily living activities and motor performance. Furthermore, BoNT injection also provides improvement in some symptoms of generalized dystonia and relieves disabling posture, skin lacerations and pain in more than 80% of patients. BoNT may also be used to accelerate recovery in the postoperative period for a short time since it prevents the spasms. Truncal dystonia frequently accompanies segmental or generalized dystonia and it rarely presents as an isolated form. Axial involvement is mostly seen in neuroleptic use. This form of truncal dystonia is often severely painful and disabling and rarely responds to oral medications. BoNT is the treatment of choice in truncal dystonia, similar ...

Early Remission in Focal Tardive Dystonia Associated with the Use of Neuroleptic Medication: A Rare Case Report and Review of Literature

“…It has been reported that the maximum effect is observed 2-4 weeks after the injection and in subsequent weeks the effect decreases and symptoms return. As the effect is reduced after a mean of 3 months, it has been emphasised that it is necessary to repeat the injections on average every 3-4 months [18]. In this report, the case was presented of a patient with tardive dystonia who benefitted from physical therapy applications together with olanzapine and risperidone treatment for focal hand dystonia which developed associated with the use of antipsychotic medication.…”

“…In the treatment of extremity dystonia, the main objective is functional improvement and correction of abnormal posture. Opening a dystonic hand provides patient comfort and hand hygiene [18].…”