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Erschienen in: DGNeurologie 4/2019

17.06.2019 | Apoplex | Leitlinie

S2k-Leitlinie: Therapie des spastischen Syndroms

Eine fachgesellschaftsübergreifende Aktualisierung der Leitlinie der Deutschen Gesellschaft für Neurologie

verfasst von: Prof. Dr. T. Platz

Erschienen in: DGNeurologie | Ausgabe 4/2019

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Auszug

  • Das Verstehen des „spastischen Syndroms“ und damit die Voraussetzung für eine adäquate Therapie integriert das Wissen um die spastische Bewegungsstörung („spastic movement disorder“, SMD) und um nicht-neurogene sekundäre periphere Veränderungen der Weichteile in spastisch gelähmten Extremitäten. Die SMD umfasst dabei alle „Plus-Phänomene“ einer Schädigung des oberen motorischen Neurons wie gesteigerte Muskeleigenreflexe, eine geschwindigkeitsabhängige Tonuserhöhung, Klonus, einschießende Spasmen oder die spastische Dystonie. Die SMD wird unterschieden von der Lähmung und der eingeschränkten Willkürinnervationsfähigkeit („Minus-Phänomene“) bei der Schädigung des oberen motorischen Neurons.
  • Neben der Ashworth-Skala (AS) und der Modifizierten Ashworth-Skala (MAS) hat sich die Tardieu-Skala (TS) zur klinischen Einschätzung der geschwindigkeitsabhängigen Tonuserhöhung und der Spastizität etabliert. Eine auf der Ashworth-Skala basierte Standardisierung der Durchführung und Bewertung klinischer Spastikmessung ermöglicht ein reliables klinisches Assessment und validierte Summenscores für die spastikbedingte Tonuserhöhung (Widerstand gegenüber passiver Bewegung) der Extremitäten (RESistance to PAssive movement Scale, REPAS).
  • Für einzelne Therapieverfahren wie das Arm-Basis-Training bei subakuten Schlaganfallpatienten und die „constraint-induced movement therapy“, CIMT, konnte neben einer Verbesserung der aktiven Funktion auch eine parallele Reduktion der Spastik gezeigt werden.
  • Botulinumtoxin A (BoNT A) verbessert durch seine positive Wirkung auf die fokale Spastik im Arm die Integrierbarkeit des schwer spastisch gelähmten Armes im Alltag und bei einem Teil der Patienten auch aktive Hand- und Armfunktionen; am Bein kann eine effektive Tonusreduktion u. a. bei Adduktorenspastik und spastischem Pes equinovarus erreicht werden.
  • Parallel an Arm und Bein zur Spastikbehandlung eingesetztes BoNT A war in höheren Dosierungen sicher und wirksam.
  • Eine adjuvante zur BoNT A-Behandlung eingesetzte Cast-Behandlung und neuromuskuläre Elektrostimulation verstärkten den Wirkeffekt von BoNT A auf die Spastik.
  • Für neuere Behandlungsmethoden wie die repetitive periphere Magnetstimulation, die repetitive transkranielle Magnetstimulation, die Ganzkörpervibration und die extrakorporale Stoßwellentherapie gibt es begrenzte Evidenz für ein Potenzial in der Spastiktherapie, wobei die erbrachte Evidenz allerdings noch nicht für eine Praxisempfehlung ausreicht.
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Metadaten
Titel
S2k-Leitlinie: Therapie des spastischen Syndroms
Eine fachgesellschaftsübergreifende Aktualisierung der Leitlinie der Deutschen Gesellschaft für Neurologie
verfasst von
Prof. Dr. T. Platz
Publikationsdatum
17.06.2019
Verlag
Springer Medizin
Schlagwort
Apoplex
Erschienen in
DGNeurologie / Ausgabe 4/2019
Print ISSN: 2524-3446
Elektronische ISSN: 2524-3454
DOI
https://doi.org/10.1007/s42451-019-0090-2

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