Department of Neurosurgery, Kurume University School of Medicine.
Department of Pharmaceutical Sciences, International University of Health and Welfare.
Neurol Med Chir (Tokyo). 2023 Jun 15;63(6):236-242. doi: 10.2176/jns-nmc.2022-0288. Epub 2023 Apr 6.
Pharmacotherapy is frequently selected over surgical interventions for late elderly patients with trigeminal neuralgia (TN). However, medication may affect these patients' activities of daily living (ADL). Hence, we investigated the effect of the surgical treatment of TN on ADL in older patients. This study included 11 late elderly patients >75 years old and 26 nonlate elderly patients who underwent microvascular decompression (MVD) for TN at our hospital from June 2017 to August 2021. We evaluated pre- and postsurgical ADL using the Barthel Index (BI) score, side effects of antineuralgic drugs, the BNI pain intensity score, and perioperative medication. The BI score of late elderly patients significantly improved postoperatively, particularly in transfer (pre: 10.5; post: 13.2), mobility (pre: 10; post: 12.7), and feeding (pre: 5.9 points; post: 10 points). Additionally, antineuralgic drugs caused preoperative disturbances of transfer and mobility. Trends of a longer disease duration and frequent occurrence of side effects were observed in all patients in the elderly group, compared to only 9 out of 26 patients in the younger group (100% vs. 35%, p = 0.0002). In addition, drowsiness was observed more frequently in the late elderly group (73% vs. 23%, p = 0.0084). However, the change in scores indicating improvement after surgery was significantly greater in the late elderly group, although both pre- and postoperative scores were higher in the nonlate elderly group (11.4 ± 1.9 vs. 6.9 ± 0.7, p = 0.027). Surgical treatment can improve older patients' ADL because it relieves pain and facilitates discontinuation of antineuralgic drugs. Consequently, MVD can be positively recommended for older patients with TN if general anesthesia is acceptable.
药物疗法常被选择用于治疗老年晚期三叉神经痛（TN）患者，而非手术干预。然而，药物可能会影响这些患者的日常生活活动（ADL）。因此，我们研究了 TN 的手术治疗对老年患者 ADL 的影响。这项研究纳入了 2017 年 6 月至 2021 年 8 月期间在我院接受微血管减压术（MVD）治疗 TN 的 11 名 75 岁以上的老年晚期患者和 26 名非老年晚期患者。我们使用巴氏指数（BI）评分评估术前和术后 ADL，评估抗神经痛药物的副作用、布氏神经痛分级（BNI）疼痛强度评分以及围手术期药物。老年晚期患者的 BI 评分术后显著改善，特别是在转移（术前：10.5；术后：13.2）、活动能力（术前：10；术后：12.7）和进食（术前：5.9 分；术后：10 分）方面。此外，抗神经痛药物术前会干扰转移和活动能力。与非老年晚期患者（100%比 35%，p=0.0002）相比，老年组所有患者的疾病持续时间较长且副作用发生更频繁的趋势更为明显，仅在非老年晚期患者中有 9 例（23%）。此外，老年组更容易出现嗜睡（73%比 23%，p=0.0084）。然而，尽管非老年晚期组术前和术后评分更高，但术后评分改善的变化在老年晚期组更为显著（11.4±1.9比 6.9±0.7，p=0.027）。手术治疗可以改善老年患者的 ADL，因为它可以缓解疼痛并有助于停止使用抗神经痛药物。因此，如果可以接受全身麻醉，MVD 可以积极推荐用于老年 TN 患者。
