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Schmerzen bei zervikaler Dystonie

Pain and cervical dystonia

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Zusammenfassung

Hintergrund

Als Dystonien werden hyperkinetische Bewegungsstörungen bezeichnet, die durch anhaltende oder intermittierende Muskelkontraktionen zu Verdrehungen, Verkrampfungen und Tremor führen. Die zervikale Dystonie ist die häufigste Dystonieform, sie betrifft den Kopf‑, Hals- und/oder Schulterbereich. Neben diesen motorischen Symptomen sind Schmerzen und psychiatrische Symptome bei (zervikalen) Dystonien häufig.

Fragestellung

Beschreibung des Vorkommens und der Evaluation von Schmerzen bei zervikaler Dystonie, Zusammenfassung und Diskussion der Behandlungsmöglichkeiten und -wirkungen.

Material und Methoden

Im vorliegenden Übersichtsbeitrag werden die Erkenntnisse aus der wissenschaftlichen Fachliteratur zu Schmerzen bei Dystonien zusammengefasst und diskutiert.

Ergebnisse

Im Vergleich zu anderen Dystonieformen treten Schmerzen bei Patienten mit einer zervikalen Dystonie am häufigsten auf. Ein Großteil der Patienten mit einer zervikalen Dystonie leidet unter Schmerzen. Diese tragen am meisten zur Beeinträchtigung der Patienten bei. Die motorischen Symptome werden meist mit Botulinumtoxininjektionen behandelt. Diese wirken muskelentspannend und zudem auch schmerzlindernd. Die Studienlage zum Vorkommen und zur Therapie von Schmerzen bei anderen Dystonieformen ist bislang sehr limitiert. Der Schmerz kann bei Patienten mit einer zervikalen Dystonie im Vordergrund des Krankheitsbilds stehen. Die Evaluation von Schmerzen bei zervikalen Dystonien kann mittels standardisierter Fragebögen durchgeführt werden.

Schlussfolgerungen

Es ist wichtig, Patienten mit zervikaler Dystonie zu Schmerzen zu befragen und diese in der Therapieplanung und -evaluation zu berücksichtigen. Umgekehrt sollte bei Schmerzen auch an eine Dystonie als mögliche Ursache gedacht werden. Zur Evaluation gibt es teils neu entwickelte Fragebögen, um Schmerzen bei Patienten mit Dystonien standardisiert zu erfassen. Weitere Forschung ist nötig, um die Pathomechanismen der Schmerzen bei Dystonien besser zu verstehen.

Abstract

Background

Dystonia is a hyperkinetic movement disorder that results in twisting, cramps and tremors due to sustained or intermittent muscle contractions. Cervical dystonia is the most common form of dystonia, in which the head, neck and/or shoulder areas are affected. In addition to these motor symptoms, pain and psychiatric symptoms are frequent in (cervical) dystonia.

Objective

Description of the incidence and evaluation of pain in cervical dystonia, summary and discussion of treatment options and effects.

Material and methods

In this review article the results in the scientific literature on pain in dystonia are summarized and discussed.

Results

Compared to other forms of dystonia, pain occurs most frequently in patients with cervical dystonia. A large proportion of patients with cervical dystonia suffer from pain, which contributes most to impairment of the patient. The motor symptoms of dystonia are usually treated with botulinum toxin injections. These have a muscle relaxing effect and also relieve pain. The study situation on the occurrence and treatment of pain in other forms of dystonia is so far very limited. Pain can dominate the clinical picture in patients with cervical dystonia. Evaluation of pain in cervical dystonia can be performed using standardized questionnaires.

Conclusion

It is important to ask patients with cervical dystonia about pain and to consider it in treatment planning and evaluation. Vice versa, if pain is present the possibility of a causative dystonia should also be considered. For pain assessment there are some newly developed questionnaires to assess pain in a standardized way in patients with dystonia. Further research is needed to better understand the pathomechanisms of pain in dystonia.

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Authors and Affiliations

  1. Institut für Systemische Motorikforschung, Center of Brain, Behavior and Metabolism (CBBM), Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland

    Feline Hamami &  Tobias Bäumer

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Interessenkonflikt

T. Bäumer: Referententätigkeit für Pharmazeutische Unternehmen, die Botulinumtoxin herstellen. F. Hamami gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Hamami, F., Bäumer, T. Schmerzen bei zervikaler Dystonie. Schmerz 38, 41–47 (2024). https://doi.org/10.1007/s00482-024-00790-5

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