BackgroundDifferential effects of botulinum toxin (BoNT) treatment in cervical dystonia (CD) and blepharospasm (BSP) treatment satisfaction and emotional responses to a life with a disabling condition were investigated. Special interest was drawn to the course within a BoNT treatment cycle and the effects of subjective well-being vs perceived intensity of motor symptoms and quality of life.MethodsA questionnaire was distributed among 372 CD patients and 125 BSP patients, recruited from 13 BoNT centers throughout Germany. Items were related to dystonic symptoms, BoNT treatment responses and treatment satisfaction, quality of life, working situation, and emotional reactions to a life with dystonia.ResultsCD patients and BSP patients were widely satisfied with BoNT treatment, but treatment satisfaction worsened significantly within the treatment cycle. Especially CD patients reported that both the dystonic symptoms and the effects of BoNT treatment were influenced by emotional factors. Despite good overall treatment effects, patients from both groups perceived marked persistence of motor symptoms, restrictions of everyday life functions, and reduced quality of life. Functional amelioration of motor symptoms and emotional well-being were only moderately correlated. About 22% of patients from both groups reported mental disorders or emotional disturbances prior to the onset of dystonia.ConclusionAs numerous psychological factors determine perceived outcome, BoNT treatment should be further improved by patient’s education strategies enhancing behavioral self-control. From the patient’s perspective, individual intervals, which may avoid exacerbation between injection points, should be considered. Moreover, patients at risk, with reduced adherence and poor BoNT outcome, should be identified and addressed within psychoeducation.
ZusammenfassungIm Rahmen einer multizentrischen Patientenund Arztbefragung wurden 497 Patienten mit zervikaler Dystonie (n = 372) und Blepharospasmus (n = 125) in Bezug auf die Zufriedenheit mit der Botulinumtoxin-Therapie (BoNT) befragt. Zusätzlich wurden krankheits- und behandlungsbezogene Angaben, Einstufungen zur Lebensqualität, der beruflichen Situation, psychosozialen Variablen, Verhaltensdaten und Aussagen zur emotionalen Situation erhoben. Trotz der im Durchschnitt guten Beurteilung der BoNT-Therapie fanden sich 197 (40,8%) weniger zufriedene Patienten. Die Zufriedenheit stand in keinem Zusammenhang mit Angaben zur Erkrankung und Behandlung oder der subjektiven Beurteilung der Symptomschwere. Weniger zufriedene Patienten stuften ihre allgemeine Lebensqualität als schlecht ein, zeigten sich in verschiedenen Lebensbereichen als stark belastet und neigten dazu, soziale Situationen zu vermeiden. Außerdem gaben sie kurz vor dem Ende des Behandlungsintervalls eine noch schlechtere Beurteilung des Therapieergebnisses an als die zufriedenen Patienten. Die Ergebnisse werfen zumindest bei den weniger zufriedenen Patienten die Frage nach einer stärkeren Individualisierung der Behandlungsintervalle sowie und nach einem genaueren Monitoring des Krankheitsverhaltens und entsprechender psychoedukativer Maßnahmen auf.
The technique used for the radiological examination of a well preserved mummy is described. Problems of identification and determination of age, size and sex are discussed. Post mortem changes consist of subluxation of the cervical spine and fractures of the ribs and fibulae. Of medical interest, it was possible to diagnose definitely Scheuermann's disease with a scoliosis and marked reactive spondylotic and spondylo-arthritic changes. The radiological findings provided further information regarding the technique of mummification and the method of burial. Some findings of mythological significance could be demonstrated radiologically, such as the fact that the heart and kidneys had been left in the body, the presence of a scarab, various gold plates and amulets and a fayence-decorated shroud.
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