Bohluli Behnam, Motamedi Mohammad Hosein Kalantar, Bagheri Shahrokh C, Bayat Mohammad, Lassemi Eshagh, Navi Fina, Moharamnejad Nima
Department of Oral and Maxillofacial surgery, Buali Hospital, Azad University, Tehran, Iran.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Jan;111(1):47-50. doi: 10.1016/j.tripleo.2010.04.043. Epub 2010 Jul 31.
Botulinum toxin type A (BTX-A) has been used to treat migraine and occipital neuralgia. We report preliminary results of an ongoing study that assesses the efficacy of BTX-A on trigeminal neuralgia (TN) patients refractory to medical treatment.
We treated 15 patients (8 men and 7 women) between 28 and 67 years of age who were suffering from drug-refractory TN from February 2008 to January 2010. Symptoms, including pain duration, provoking factors, affected nerve branch, frequency of TN attacks, and severity of pain just before injections, were evaluated 1 week, 1 month, and 6 months after injection. We injected 50 U reconstituted BTX-A solution at the trigger zones. The overall response to treatment was assessed via a 9-point patient global assessment scale and compared with values at baseline. Statistical analysis was performed by the analysis of variance (ANOVA) test for frequency of TN attacks, the Friedman test for severity of pain, and the Wilcoxon signed-rank test for PGA, and all with the use of SPSS software.
Eight men and 7 women aged 28-67 years (mean 48.9 y) suffering from TN from 6 months to 24 years all improved regarding frequency and severity of pain attacks; in 7 patients, pain was completely eradicated and there was no need for further medication. In 5 patients, nonsteroidal antiinflammatory drugs were enough to alleviate pain attacks, and 3 patients again responded to anticonvulsive drugs after injection. All patients developed higher pain thresholds after injections. The ANOVA test showed a significant difference in frequency of attacks before injection and at 1 week, 1 month, and 6 months after injection (P < .001). Friedman test and pair comparison of pain severity scores with Bonferroni correction adjustment showed a significant difference (P < .001) between severity of pain before and after injection. Wilcoxon signed-rank test showed significant improvement in all patients up to 6 months after injection (P < .001). Complications included transient paresis of the buccal branch of the facial nerve in 3 patients.
This study supports other similar studies and shows that BTX-A is a minimally invasive method that can play a role in treating TN before other more invasive therapies, i.e., radiofrequency and surgery.
A型肉毒毒素（BTX-A）已被用于治疗偏头痛和枕神经痛。我们报告一项正在进行的研究的初步结果，该研究评估BTX-A对药物治疗无效的三叉神经痛（TN）患者的疗效。
我们治疗了15例年龄在28至67岁之间的患者（8例男性和7例女性），这些患者在2008年2月至2010年1月期间患有药物难治性TN。在注射后1周、1个月和6个月评估症状，包括疼痛持续时间、诱发因素、受影响的神经分支、TN发作频率以及注射前的疼痛严重程度。我们在触发区注射50 U重组BTX-A溶液。通过9分患者整体评估量表评估治疗的总体反应，并与基线值进行比较。通过方差分析（ANOVA）测试TN发作频率、Friedman测试疼痛严重程度以及Wilcoxon符号秩检验PGA进行统计分析，所有分析均使用SPSS软件。
15例年龄在28 - 67岁（平均48.9岁）、患有6个月至24年TN的患者，在疼痛发作频率和严重程度方面均有改善；7例患者疼痛完全消除，无需进一步用药。5例患者使用非甾体类抗炎药足以缓解疼痛发作，3例患者注射后再次对抗惊厥药物有反应。所有患者注射后疼痛阈值均升高。ANOVA测试显示注射前与注射后1周、1个月和6个月的发作频率有显著差异（P < .001）。Friedman测试以及经Bonferroni校正调整的疼痛严重程度评分的配对比较显示注射前后疼痛严重程度有显著差异（P < .001）。Wilcoxon符号秩检验显示所有患者在注射后6个月内均有显著改善（P < .001）。并发症包括3例患者出现面神经颊支短暂性麻痹。
本研究支持其他类似研究，并表明BTX-A是一种微创方法，在其他更具侵入性的治疗（即射频和手术）之前可在治疗TN中发挥作用。
