He L, Wu B, Zhou M
First University Hospital, Department of Neurology, West China University of Medical Sciences, Chengdu 610041, Sichuan, China.
Cochrane Database Syst Rev. 2006 Jul 19(3):CD004029. doi: 10.1002/14651858.CD004029.pub2.
Non-antiepileptic drugs have been used in trigeminal neuralgia management since the 1970s.
The objective was to review systematically the efficacy of non-antiepileptic drugs for trigeminal neuralgia.
We searched the Cochrane Neuromuscular Disease Group Register, MEDLINE, EMBASE, and LILACS (all to August 2005) and the Chinese Biomedical Retrieval System, the database of the Chinese Cochrane Center (The Cochrane Library, Issue 1 2005), conference paper databases and checked bibliographies. We handsearched ten Chinese journals.
We searched for randomized or quasi-randomized controlled trials.
Two authors decided which trials fitted the inclusion criteria and graded methodological quality independently.
Nine trials of different non-antiepileptic drugs involving 223 participants were included. Each trial investigated one non-antiepileptic drug. Two trials tested baclofen. In one, more people gained 50% reduction from baseline than with placebo (relative risk 15.00, 95% CI 0.97 to 231.84, P value = 0.05). In the other, slightly more participants on baclofen had a 75% reduction in attacks on the 10th day compared with carbamazepine (relative risk 2.38, 95% CI 0.83 to 6.85, P value = 0.11). One trial showed no significant difference in reduction in average daily frequency of attacks with L-Baclofen compared with racemic baclofen. Tizanidine was investigated in two trials. In one, the proportion of people with reduction in the average number of paroxysms per day increased with tizanidine compared with placebo (relative risk 8.00, 95% CI 1.21 to 52.69, P value = 0.03). In the other, one of five participants improved in visual analog scale score with tizanidine and four of six with carbamazepine (relative risk 0.30, 95% CI 0.05 to 1.89, P value = 0.20). One study showed that the improvement in mean values of pain scores with tocainide was similar to that of carbamazepine. In one study more participants improved during the pimozide than the carbamazepine period (relative risk 1.78, 95% CI 1.39 to 2.28). In one study, proparacaine hydrochloride 0.5% instillation into the eyes was not significantly different from placebo (relative risk 1.06, 95% CI 0.37 to 2.99, P value = 0.92). In another, there was moderate or marked improvement in seven of nine participants treated with clomipramine and three of nine with amitriptyline after a 12-week treatment (RR 2.33, 95% CI 0.87 to 6.27).
AUTHORS' CONCLUSIONS: There is insufficient evidence from randomized controlled trials to show significant benefit from non-antiepileptic drugs in trigeminal neuralgia. More research is needed.
自20世纪70年代以来，非抗癫痫药物已被用于三叉神经痛的治疗。
系统评价非抗癫痫药物治疗三叉神经痛的疗效。
我们检索了Cochrane神经肌肉疾病组登记册、MEDLINE、EMBASE和LILACS（截至2005年8月）以及中国生物医学文献数据库、中国Cochrane中心数据库（《Cochrane图书馆》，2005年第1期）、会议论文数据库，并查阅了参考文献。我们手工检索了10种中文期刊。
检索随机或半随机对照试验。
两位作者确定哪些试验符合纳入标准，并独立对方法学质量进行分级。
纳入了9项涉及223名参与者的不同非抗癫痫药物试验。每项试验研究一种非抗癫痫药物。两项试验测试了巴氯芬。其中一项试验中，与安慰剂相比，更多患者的症状较基线水平减轻了50%（相对危险度15.00，95%可信区间0.97至231.84，P值=0.05）。另一项试验中，与卡马西平相比，服用巴氯芬的参与者在第10天发作次数减少75%的人数略多（相对危险度2.38，95%可信区间0.83至6.8,5，P值=0.11）。一项试验显示，L-巴氯芬与消旋巴氯芬相比，在平均每日发作频率降低方面无显著差异。两项试验研究了替扎尼定。其中一项试验中，与安慰剂相比，服用替扎尼定的患者每日平均发作次数减少的比例增加（相对危险度8.00，95%可信区间1.21至52.69，P值=0.03）。另一项试验中，5名服用替扎尼定的参与者中有1名视觉模拟量表评分改善，6名服用卡马西平的参与者中有4名改善（相对危险度0.30，95%可信区间0.05至1.89，P值=0.20）。一项研究表明，妥卡尼治疗后疼痛评分均值的改善与卡马西平相似。一项研究中，与卡马西平治疗期相比，匹莫齐特治疗期有更多参与者病情改善（相对危险度1.78，95%可信区间1.39至2.28）。一项研究中，0.5%盐酸丙美卡因滴眼液滴眼与安慰剂相比无显著差异（相对危险度1.06，95%可信区间0.37至2.99，P值=0.92）。另一项研究中，12周治疗后，9名服用氯米帕明的参与者中有7名有中度或明显改善，9名服用阿米替林的参与者中有3名改善（相对危险度2.33，95%可信区间0.87至6.27）。
随机对照试验的证据不足，无法表明非抗癫痫药物治疗三叉神经痛有显著益处。需要更多研究。
