Mingazova L R, Orlova O R, Soiher M I, Bychenko V G, Komissarova N V
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(6):40-45. doi: 10.17116/jnevro202112106140.
To evaluate the treatment protocol with the use of onabotulinum toxin type A (botox) and the efficacy of a single botulinum therapy procedure for clinical manifestations in patients with trigeminal neuralgia (TN).
We studied 90 patients (57 women, 33 men), including 80 people with primary TN and 10 people with secondary TN. Then 20 patients with primary TN (11 women and 9 men, mean age 61.8 years) received local injections of onabotulinum toxin type A (botox). Clinical examination included taking anamnesis, assessment of pain on a visual analogue scale (VAS), assessment of the frequency of pain paroxysms, taking into account the average indicator (0 to 100 seizures during the day); neurosensory examination according to the developed protocol with the definition of pain, temperature, tactile sensitivity, the study of stimulus-dependent pain; MRI of the brain to diagnose neurovascular conflict.
A month after the injections, the pain intensity practically did not change (8.5 versus 7.2 points on the VAS), but the number of paroxysms decreased (31.2 versus 22.5 seizures per day). Two months after the use of botox, the number of pain attacks continued to decrease (31.2 versus 17.7; Mann-Whitney U-test, =0.006). At the same time, there was a decrease in pain intensity according to the VAS (8.5 versus 6.1, -test 2.75 points; =0.02). After three months, there was a decrease in the number of paroxysms from 31.2 to 9.2 (paired Student's test, <0.001) and the severity of pain (8.85 versus 4.0 points on the VAS, paired t-test 3.95 points, <0.001). There were significant differences in the average dose of carbamazepine (867.5 versus 670.8 after 3 months, t-test 196.7 mg, =0.02). In TN patients who underwent destructive operations with exposure to the peripheral branches of the trigeminal nerve, signs of severe neurosensory deficit on the face and burning pain are added to the main symptoms, which corresponds to the clinical criteria of post-traumatic trigeminal neuropathy.
Local injections of type A onabotulinum toxin (botox) are minimally invasive, safe and effective symptomatic therapy for patients with TN. Persistent sensory disturbances that develop in patients after destructive surgeries call into question the safety of these therapies for TN.
评估使用A型肉毒毒素（保妥适）的治疗方案以及单次肉毒毒素治疗程序对三叉神经痛（TN）患者临床表现的疗效。
我们研究了90例患者（57例女性，33例男性），其中包括80例原发性TN患者和10例继发性TN患者。然后，20例原发性TN患者（11例女性和9例男性，平均年龄61.8岁）接受了A型肉毒毒素（保妥适）局部注射。临床检查包括采集病史、采用视觉模拟量表（VAS）评估疼痛、评估疼痛发作频率，并考虑平均指标（白天0至100次发作）；根据制定的方案进行神经感觉检查，确定疼痛、温度、触觉敏感性以及对刺激依赖性疼痛的研究；进行脑部MRI以诊断神经血管冲突。
注射后一个月，疼痛强度实际未发生变化（VAS评分8.5分对7.2分），但发作次数减少（每天31.2次对22.5次）。使用保妥适两个月后，疼痛发作次数持续减少（31.2次对17.7次；曼-惠特尼U检验，P = 0.006）。与此同时，根据VAS评分，疼痛强度有所下降（8.5分对6.1分，t检验2.75分；P = 0.02）。三个月后，发作次数从31.2次减少至9.2次（配对t检验，P < 0.001），疼痛严重程度下降（VAS评分8.85分对4.0分，配对t检验3.95分，P < 0.001）。卡马西平的平均剂量存在显著差异（三个月后867.5对670.8，t检验196.7mg，P = 0.02）。在接受三叉神经外周分支暴露的破坏性手术的TN患者中，面部严重神经感觉缺损和灼痛的症状被添加到主要症状中，这符合创伤后三叉神经病变的临床标准。
A型肉毒毒素（保妥适）局部注射对TN患者而言是微创、安全且有效的对症治疗方法。患者在进行破坏性手术后出现的持续性感觉障碍对这些TN治疗方法的安全性提出了质疑。
