Author/Editor		Pirtošek, Zvezdan
Title		Zdravljenje z botulinom
Translated title		Treatment with botulinus toxin
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 37, št. Suppl 4
Publication year		1998
Volume		str. 326-31
Language		slo
Abstract		In the last ten years, botulinus toxin has become the preferred treatment for many disorders characterised by muscular hyperactivity. It is a first-line treatment for hemifacial spasm and focal dystonia, such as torticollis, laryngeal (adductor) dystonia and blepharospasm. However, it may also be helpful in selected cases of spasticity, writer's cramp and other occupational cramps, tremor and rigidity. In children, its main indication remains cerebral palsy, although it has also been successfully used in patients suffering from squinting, tics, laryngeal dystonia and self-mutilatory stereotypes. The main 'pros' of treatment with botulinus toxin include: its simplicity; its ability to be carried out on an outpatient basis; the general lack of side effects; focality; possible incremental strategies; the fact that a single treatment may suffice if combined with physiotherapy; the fact that any type of muscular hyperactivity may be treated; the possibility of dramatic overall improvement; its ability to be safely administered along with other treatments; and the fact that it does not produce permanent disfiguring deformities. The main 'cons' include: the possibility of very costly treatment; development of antibodies; the fact that the side effects of prolonged chronic botulinus toxin treatment are unknown; transient excessive weakness; the possibility that abolishing; spasticity may make standing more difficult; and that for certain indications, very large doses of toxin are needed. *
Summary		Proti številnim motnjam, povezanim z mišično hiperaktivnostjo, se je v zadnjih 10 letih najbolje izkazal botulin. Postal je zdravilo izbire pri hemifacialnem spazmu in žarišćnih distonijah, kot so tortikolis, grlna (adduktorska) distonija in blefarospazem. Koristen je lahko tudi pri spastičnosti, grafospazmu ("krč pisca") in drugih krčih, ki jih sproščajo kretnje, povezane s poklicem, pri tresenju udov in rigidnosti. Pri otrocih je zanj glavna indikacija cerebralna paraliza, uspešno pa so ga uporabIjali tudi proti škiljenju, tikom, distoniji grla in stereotipičnim samopoškodovalnim kretnjam. Največje prednosti zdravljenja z botulinom so preprostost, saj ne zahteva hospitalizacije bolnika; na splošno nima stranskih učinkov; zdravljenje je žariščno, brez opaznejših sistemskih učinkov; odmerek je mogoče povečevati; ob sočasni psihoterapiji je lahko učinkovito po enem samem odmerku; primerno je za katerokoli mišično hiperaktivnost; učinek je lahko izjemno dober, kar dramatičen; bolnik lahko sočasno prejema še druga zdravila; ne povzroča trajnih deformacij udov. Glavne slabosti pa so visoka cena, pojav protiteles, občasna premočna prehodna oslabelost mišic, če odpravi spastičnost, lahko poveča težave s stojo, vćasih potreba po precejšnjih odmerkih in, konćno, nepoznavanje učinkov dolgotrajnega zravljenja.
Descriptors		BOTULINUM TOXINS CHILD BLEPHAROSPASM CEREBRAL PALSY TORTICOLLIS