Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Abstract
Aims: The aims of this study were to investigate the clinical effects and safety of
botulinum toxin A (BTX-A) in treating trigeminal neuralgia and its influences on
accompanied depression, anxiety, sleep disorders, and quality of life.
Methods and Material: Eighty-seven patients with one-branch classical trigeminal
neuralgia were injected with BTX-A in the pain area. The visual analogic scale (VAS)
score, sleep interferance score, Hamilton Anxiety Scale (HAMA) score, Hamilton
Depression Scale (HAMD) score, and side effects were assessed at 1 week prior to
and 8 weeks after treatment, respectively.
Results: The effective rates after 1, 2, 4, and 8 weeks of treatment were 48.28%,
66.67%, 78.16%, and 80.46%, respectively. The effective rates of anxiety and
depression were 90.32% and 96.77%, respectively. When compared to that before
treatment, the quality of life was significantly better in terms of role-physical (RP),
bodily pain (BP), general health (GH), vitality (VT), social functioning (SF),
role-emotional (RE), and mental health (MH) (all P < 0.01), while physical function
(PF) was not significantly improved (P D 0.317).
Conclusion: BTX-A treatment can significantly relieve the pain in trigeminal
neuralgia patients; improve anxiety, depression, and sleep; and increase the quality
of life. BTX-A treatment is a safe and effective method to treat classical trigeminal
neuralgia.
2015 Informa Healthcare USA, Inc. This provisional PDF corresponds to the article as it appeared upon acceptance. Fully
formatted PDF and full text (HTML) versions will be made available soon.
DISCLAIMER: The ideas and opinions expressed in the journals Just Accepted articles do not necessarily reflect those of Informa Healthcare (the Publisher), the Editors
or the journal. The Publisher does not assume any responsibility for any injury and/or damage to persons or property arising from or related to any use of the material
contained in these articles. The reader is advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each
drug to be administered to verify the dosages, the method and duration of administration, and contraindications. It is the responsibility of the treating physician or other
health care professional, relying on his or her independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient.
Just Accepted have undergone full scientific review but none of the additional editorial preparation, such as copyediting, typesetting, and proofreading, as have articles
published in the traditional manner. There may, therefore, be errors in Just Accepted articles that will be corrected in the final print and final online version of the article.
Any use of the Just Accepted articles is subject to the express understanding that the papers have not yet gone through the full quality control process prior to publication.
TE
D
Neuralgia
Jian-Hua Xia, Dr. 1,2,# Cai-Hong He, Dr.1,#; Hai-Feng Zhang, Dr.1,#; Ya-Jun
EP
1Department
AC
Zhumadian, China
2Department
ST
JU
Lian, Dr. prof.1,*, Yuan Chen, Dr.1; Chuan-Jie Wu, Dr.1; Yun-Qing Ma, Dr.1
# These
*Correspondence
author
27
TE
D
EP
C
AC
ST
JU
Email: lianyajun369@sina.com
27
Abstract
Aims: The aims of this study were to investigate the clinical effects
TE
D
EP
AC
ST
JU
role-emotional (RE), and mental health (MH) (all P < 0.01), while
physical function (PF) was not significantly improved (P = 0.317).
Conclusion: BTX-A treatment can significantly relieve the pain in
trigeminal neuralgia patients; improve anxiety, depression, and
27
EP
C
AC
ST
JU
TE
D
27
Background
Trigeminal neuralgia (TN) is defined as a sudden, usually
TE
D
EP
AC
1987, Brin, for the first time, reported that pain was obviously
relieved simultaneously with improved muscle tonus in 74% of
patients who received BTX-A for dystonia disorder[3]. In 2002,
ST
JU
TE
D
EP
AC
ST
JU
Methods
Subjects
One-branch classical trigeminal neuralgia patients treated in the
Neurology Department as outpatients or inpatients of the First
Affiliated Hospital, Zhengzhou University, from Nov. 2011 to Sept.
27
TE
D
EP
AC
ST
Treatment strategy
JU
sites of the pain area and trigger site, according to the extent of
pain. A total of 1520 injection sites were made at an injection
depth of 0.1 cm and a separation of 15 mm.
The patients were required to record their daily pain extent, sleep
TE
D
EP
Study 36-item Short Form Health Survey (SF-36) was used for
AC
ST
The pain severity was evaluated through the VAS. The effective
treatment and was defined as the rate of patients with a VAS score
JU
100%.
27
TE
D
EP
AC
ST
Quality of life
JU
Side effects
27
TE
D
Statistical analsysis
SPSS 20.0 was used for statisical analysis with the 2-sided test.
EP
effective rate. The Wilcoxon rank test was used to analyze the VAS
significance.
ST
Results
AC
and before-after SF-36 score. P < 0.05 was set as the level of
(56.32%), aged 3789 years old (mean, 60.80 years old) were assessed in
JU
this study. The disease history was 6300 months with a mean of 74.93
months, and the onset frequency was 360 times/day with mean of 18.7
times/day. All patients experienced pain in the unilateral one-branch,
including 5 in the left first branch, 2 in the left second branch, 3 in the left
third branch, 13 in the right first branch, 19 in the right second branch,
27
TE
D
EP
only depression (Table 2). There was a close correlation between anxiety
AC
and depression; the rate of depression in patients with anxiety was greater
than in patients without anxiety (P < 0.01), while the rate of anxiety in
patients with depression was greater than in patients without depression
ST
that before treatment (P < 0.01; Table 3). The effective rates after
JU
TE
D
decreased (P < 0.01; Table 5). The anxiety was not effectively
treated in 1 case, improved in 2 cases, significantly improved in 7
EP
Sleep improvement
Table 6).
AC
ST
JU
Side effects
Nine patients experienced mild local side effects. Local swelling
TE
D
and disappeared within 6 weeks. All these side effects were mild
EP
Discussion
AC
ST
Borodic [14], Piovesan [5], Allam [15], Turk [16], Piovesan , Zuniga
[17], Ngeow [18], Bohluli [19] and Wu [6] have reported that
injection of BTX-A in the facial pain areas significantly relieves
trigeminal neuralgia. In the present study, we found that the VAS
JU
in most patients. One male patient with a VAS score of 8 was totally
relieved from pain after 6 h of treatment and had no recurrence
TE
D
EP
AC
ST
was longer than the time of relieving muscle tension [21, 22]. In the
present study, the VAS score after 8 weeks was still significantly
different from that before treatment, suggesting that BTX-A has a
longer effective duration in treating classical trigeminal neuralgia
JU
TE
D
EP
AC
ST
JU
TE
D
EP
AC
ST
JU
TE
D
EP
was found to be safe. Only local mild side effects were observed,
and there were no systemic side effects. There were 9 patients who
AC
ST
JU
27
Conclusions
The present study indicated that trigeminal neuralgia patients are
TE
D
EP
and sleep disorder, and increase the quality of life. Only local mild
side effects were observed, and there was no systemic side effect.
Local injection of BTX-A has significant therapeutic effect and high
AC
safety.
Acknowledgements
ST
JU
(201203006).
1.
TE
D
References
Olesen J and Steiner T, The International classification of headache
disorders, 2nd edn (ICDH-II). Journal of Neurology, Neurosurgery &
EP
2.
3.
AC
ST
4.
5.
JU
6.
Wu C-J, Lian Y-J, Zheng Y-K, Zhang H-F, Chen Y, Xie N-C and Wang
L-J, Botulinum toxin type A for the treatment of trigeminal neuralgia:
27
TE
D
7.
9.
EP
AC
10.
ST
JU
12.
27
13.
TE
D
Borodic GE and Acquadro MA, The use of botulinum toxin for the
EP
15.
16.
17.
AC
ST
JU
19.
27
20.
21.
TE
D
2002;25: 260-262.
Turk U, Ilhan S, Alp R and Sur H, Botulinum toxin and intractable
trigeminal neuralgia. Clin Neuropharmacol. 2005;28: 161-162.
EP
trigeminal neuralgia: preliminary report. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod. 2011;111: 47-50.
23.
AC
ST
25.
JU
22.
26.
27
27.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey
(SF-36). I. Conceptual framework and item selection. Med Care. 1992.
TE
D
30(6): 473-83.
EP
Median
Minimum/Maximum
60.80 12.00
61
37/89
74.93 70.08
50
6/300
18.70 15.33
15
3/60
VAS score
6.59 2.18
4/10
4.03 3.59
0/10
HAMA score
4.87 4.75
0/20
HAMD score
5.74 5.63
0/23
Age (years)
ST
AC
Mean SD
JU
Tables
27
TE
D
EP
Total
27
31
Depression (-)
52
56
Total
31
56
87
-test
ST
Anxiety (-)
AC
Depression (+)
Anxiety (+)
JU
27
TE
D
EP
C
AC
Treatment group
VAS score
P value
Before treatment
6.59 2.18
3.66 2.24
P < 0.001
2.69 2.10
P < 0.001
2.09 2.01
P < 0.001
1.93 1.85
P < 0.001
1.68 1.74
P < 0.001
1.74 1.80
P < 0.001
1.74 1.83
P < 0.001
1.95 1.96
P < 0.001
ST
(n = 87)
JU
27
TE
D
EP
C
AC
ST
Treatment group
Effective Rate
P value
48.28% (42/87)
66.67% (58/87)
0.014
78.16% (68/87)
0.090
80.46% (70/87)
0.708
(n = 87)
JU
2 -test
27
TE
D
EP
C
AC
ST
Treatment group
(n = 87)
Anxiety (n =
Depression
P value
31)
value
(n = 31)
Before treatment
10.16 3.53
12.26 3.84
5.55 3.70
P<
6.65 4.81
P < 0.001
3.68 3.43
P < 0.001
3.03 3.38
P < 0.001
JU
2 weeks after
0.001
3.32 2.64
P<
0.001
treatment
3 weeks after
2.90 2.47
P<
0.001
treatment
27
4 weeks after
2.55 2.13
P<
2.42 2.68
P < 0.001
2.10 2.47
P < 0.001
0.001
treatment
5 weeks after
2.52 2.38
P<
6 weeks after
2.16 2.02
P<
1.77 2.33
0.001
7 weeks after
2.03 1.94
P<
1.65 2.29
8 weeks after
2.06 2.00
treatment
P<
1.77 2.36
0.001
ST
AC
27
P < 0.001
P < 0.001
EP
0.001
treatment
JU
treatment
TE
D
0.001
treatment
P < 0.001
Improved
Significantly improved
1 (3.23%)
2 (6.45%)
7 (22.58%)
Cured
Total
TE
D
Anxiety
No effect
21
31
(67.74%)
Depression
1 (3.23%)
0 (0.00%)
4 (12.90%)
26
EP
C
AC
ST
JU
(83.87%)
27
31
Score
P value
4.03 3.59
1.46 2.30
P < 0.001
0.99 1.87
P < 0.001
0.69 1.77
P < 0.001
0.41 1.26
P < 0.001
0.47 1.34
P < 0.001
0.40 1.28
P < 0.001
0.44 1.38
P < 0.001
AC
EP
Before treatment
0.32 1.16
ST
JU
(n = 87)
Sleep interference
TE
D
Treatment group
27
P < 0.001
TE
D
RP
BP
GH
VT
Before
87.13
41.95
41.67 15.87
56.55
78.74
treatment
18.52
40.26
After
87.24
81.90
treatment
18.44
33.82
P value
P = 0.317
P < 0.001
18.19
83.10 15.11
65.11
14.61
P < 0.001
ST
AC
27
RE
MH
87.10
63.22
78.85
14.25
20.60
44.03
15.99
86.49 6.61
97.83 7.92
97.70 9.90
90.57 7.29
P < 0.001
P < 0.001
P < 0.001
P < 0.001
P < 0.001
SF
EP
PF
JU