r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2023-28-4-16-23r-n-j-451Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯ И НАБЛЮДЕНИЯCLINICAL RESEARCH AND SURVEILLANCEЦервикальная дистония: пути достижения долгосрочного эффекта лечения и улучшения качества жизни больныхCervical dystonia: ways to achieve long-term treatment eff ects and improve patients’ quality of lifehttps://orcid.org/0000-0002-9234-3179СалоухинаН. И.SalouhinaN. I.

 Салоухина Наталья Ильясовна

Санкт-Петербург

 Saint Petersburg

natalya.salouhina@mail.ruhttps://orcid.org/0000-0003-2511-5560НодельМ. Р.NodelM. R.

Москва

 Moscow

nodell_m@yahoo.comhttps://orcid.org/0000-0002-8115-2668ТолмачеваВ. А.TolmachevaV. A.

Москва

 Moscow

vtolmacheva@yandex.ruИнститут экспериментальной медициныРоссияInstitute of Experimental MedicineRussian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет) Минздрава РоссииРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет) Минздрава России; Российский геронтологический научно-клинический центр, Российский национальный исследовательский медицинский университет им. Н.И. Пирогова Минздрава РоссииРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University); Russian Gerontological Research and Clinical Center, N.I. Pirogov Russian National Research Medical UniversityRussian Federation2023300920232841623Copyright © Салоухина Н.И., Нодель М.Р., Толмачева В.А., 20232023Салоухина Н.И., Нодель М.Р., Толмачева В.А.Salouhina N.I., Nodel M.R., Tolmacheva V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/451

Введение. Основным методом терапии цервикальной дистонии (ЦД) являются инъекции ботулинического токсина типа А (БТА), но по результатам ряда долгосрочных исследований от 19–46% пациентов прекращают лечение. Показана значимая роль тревоги и депрессии в снижении качества жизни пациентов с ЦД.Цель исследования. Оценка динамики показателей тяжести симптомов ЦД, эмоциональных нарушений, качества жизни пациентов на фоне разных методов терапии.Материал и методы. Обследованы 61 пациент с ЦД, 16 мужчин (26%) и 45 женщин (74%), в возрасте 50 [40; 59] лет; длительность болезни 4 [2; 7] года, возраст начала заболевания — 44 [34; 54] года. Проводилась оценка разных методов лечения — монотерапии БТА, антидепрессантом (АД), комбинированной терапии (БТ + АД) через 2 и 4 мес. Результаты. Показано преимущество комбинированной терапии (БТ + АД) перед монотерапией БТА при долгосрочном наблюдении пациентов в отношении коррекции депрессии, тревоги, интегративной оценки качества жизни (КЖ) и тяжести дистонии. Через 4 мес. лечения в подгруппе (БТ + АД) сохранялась положительная динамика показателей тяжести дистонии. В группе БТ к концу периода наблюдения отмечался регресс положительного эффекта терапии до первоначальных оценок тяжести ЦД.Заключение. Для достижения устойчивого терапевтического эффекта у пациентов с ЦД необходима коррекция эмоциональных нарушений. Требует дальнейшего изучения потенциальная эффективность антидепрессантов в отношении двигательных и сенсорных симптомов ЦД.

The main treatment for cervical dystonia (CD) is botulinum toxin type A (BTA) injections, but several long-term studies have found that between 19-46% of patients discontinue treatment. Anxiety and depression play a signi fi cant role in reducing the quality of life in patients with CD, according to previous surveys.

Aim

Aim: to assess the dynamics of CD symptom severity, emotional disturbance, and quality of life in patients under different treatment methods.

Material and methods

Material and methods. 61 patients with CD, 16 (26%) men and 45 (74%) women, age 50 [40; 59] years, duration of illness 4 [2; 7] years, age at onset 44 [34; 54] years, were studied. Changes in motor and aff ective disturbances, quality of life in patients with CD were assessed after 2 and 4 months in the context of diff erent treatment methods — BTA monotherapy, antidepressant (AD), combined therapy (AD + AD).

Results

Results. Combination therapy (BT + AD) was shown to be superior to BTA monotherapy in long-term follow-up of patients in terms of correction of depression, anxiety, integrative assessment of quality of life and severity of dystonia. After 4 months of treatment, the (BT + AD) subgroup maintained the positive trend achieved in dystonia severity (p < 0.001). At the end of the follow-up period in the BT group, the positive eff ect of therapy had regressed to baseline levels of dystonia severity.

Conclusion

Conclusion. To achieve a sustained therapeutic response in patients with CD, diagnosis and appropriate correction of emotional disturbances is necessary. The potential effi cacy of antidepressants in the treatment of motor and sensory symptoms of CD requires further investigation.

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The authors declare that there are no conflicts of interest present.