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Essenzieller Blepharospasmus

Praxisnahe Therapie mit Botulinumtoxin unter Verwendung verkürzter Behandlungsintervalle

Essential blepharospasm

Practice-oriented therapy with botulinum toxin employing reduced treatment intervals

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Zusammenfassung

Hintergrund

Botulinumtoxininjektionen sind Therapie der Wahl beim essenziellen Blepharospasmus. In der Regel müssen die Injektionen regelmäßig alle 3 Monate wiederholt werden. Bei Patienten mit kürzerer Wirkungsdauer kam es bisher zu längeren Zeiten ohne Wirkung, da frühere Reinjektionen aus Sorge vor verstärkten Nebenwirkungen und einem sekundären Wirkungsverlust vermieden wurden.

Methodik

Xeomin® ist ein reines Botulinumtoxin Typ A, bei dem die Hüll- und Komplexproteine entfernt wurden. Daher haben wir uns in geeigneten Fällen (bei erheblichem Leidensdruck des Patienten mit kürzerer Wirkungsdauer) entschieden, schon nach 10 und weniger Wochen das Präparat Xeomin® erneut zu injizieren. Anhand von 11 Patienten werden typische Patientencharakteristika und Therapieverläufe analysiert.

Ergebnisse

Relevante Nebenwirkungen traten nicht auf. Bei allen Patienten verkürzten sich die Zeiten ohne Therapiewirkung bzw. verschwanden vollständig. Bei 6 der Patienten konnten in der Folge bei guter Wirkung die Injektionsintervalle langsam wieder erhöht werden.

Schlussfolgerung

Zur optimierten Therapie des essenziellen Blepharospasmus sollten nicht nur Dosis, Dosisverteilung und Injektionsorte, sondern auch die Injektionsintervalle individuell an den jeweiligen Patienten angepasst werden; 6 Wochen sollten aber nicht unterschritten werden.

Abstract

Background

Botulinum neurotoxin injections are a primary symptomatic treatment for blepharospasm. Injections are generally repeated every 3 months. For patients with short-term treatment effects there have therefore been long intervals without sufficient treatment effects, as reinjections have previously been avoided due to concerns of increased side effects or production of antibodies against complexing proteins.

Methods

As Xeomin® is a pure A botulinum toxin type complexing proteins are not present. We have hence decided to treat appropriate patients with injection intervals of 10 or less weeks if these patients have been suffering from psychological stress.

Patients

In 11 of these patients the typical patient characteristics and course of therapy were analyzed. There were no relevant adverse events. In all patients, time periods without treatment effect were shorter or no longer present. In 6 patients injection intervals could be prolonged after several injections due to the good effect.

Conclusion

An optimized therapy of essential blepharospasm should not only take dose, dose distribution and injections site into account but also injection intervals. Reinjections could be performed if necessary after at least 6 weeks.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: B. Wabbels: Unterstützung von Forschungsprojekten und klinischen Studien: Merz, Allergan. P. Roggenkämper: Unterstützung von Forschungsprojekten und klinischen Studien, Reisekosten: Merz, Allergan.

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  1. Universitäts-Augenklinik Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Deutschland

    B. Wabbels & P. Roggenkämper

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  2. P. Roggenkämper
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Correspondence to B. Wabbels.

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Wabbels, B., Roggenkämper, P. Essenzieller Blepharospasmus. Ophthalmologe 109, 45–53 (2012). https://doi.org/10.1007/s00347-011-2457-z

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