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Übersichtsartikel

Primäre Dystonien – zwischen Botulinum Toxin-Behandlung, Neuropsychologie, Psychotherapie und Tiefer Hirnstimulation

Published Online:August 23, 2011https://doi.org/10.1024/1016-264X/a000045

Abstract

Wegen ihrer psychophysiologischen und emotionalen Besonderheiten standen die Primären Dystonien viele Jahrzehnte lang im Spannungsfeld unterschiedlichster medizinischer und psychologischer Ätiologievorstellungen und Therapiestrategien. Inzwischen ist klar, dass es sich um Erkrankungen der Basalganglien handelt, deren Pathophysiologie weit über die rein motorischen Funktionen hinaus wirkt. Dieser Umstand erklärt auch die psychische, psychophysiologische und neuropsychologische Symptomatik, auf die in diesem Beitrag ausführlich eingegangen wird. Aber auch die Behandlungen am somatischen Substrat,wie sie heute durch die Botulinum Toxin Therapie und die „Tiefe Hirnstimulation“ praktiziert werden, bringen eine Vielzahl psychologischer Indikationen mit sich. Das betrifft die Verbesserung der Compliance bei der Botulinum-Behandlung ebenso wie die klinisch-psychologische und neuropsycholigische Diagnostik vor und nach einer Hirnoperation. Zusätzlich wird auf die Möglichkeiten einer Begleitbehandlung mit Hilfe formalisierter Psychotherapie eingegangen.


Primary Dystonia – between Botulinum Toxin Treatment, Neuropsychology, Psychotherapy and Deep Brain Stimulation

Primary Dystonia is characterized by varieties of psychophysiological and emotional symptoms. These disorders were long regarded being exclusively psychogenic or neurogenic. Now they are understood as being due to basal ganglia malfunction which is related both to motor behaviour and non-motor functions. Therefore aberrant motor behaviour is partly under control of emotional, psychophysiological and cognitive stimuli. These factors are targeted by means of psychological interventions. Moreover, Botulinum Toxin treatment and „Deep Brain Stimulation“ both require psychological assistance. Examples for psychological indications are life-time assessment of mental disorders, neuropsychological assessment, enhancement of compliance for patients undergoing state-of-the-arts medical treatment, counselling with respect to preoperative anxiety and postoperative long-term development. In addition, methods of adjuvant psychological therapy and neuropsychological treatment are outlined.

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