A型肉毒毒素治疗老年人原发性难治性三叉神经痛的疗效观察

Efficacy observation of botulinum toxin type A in elderly patients with primary intractable trigeminal neuralgia

目的评价A型肉毒毒素（BTX-A）治疗老年人原发性难治性三又神经痛的疗效。方法应用A型肉毒毒素局部多点注射治疗27例老年人原发性难治性三叉神经痛患者，治疗前及治疗后1周、2周、1个月、3个月、6个月采用疼痛视觉模拟评分（VAS）进行疗效分析。结果治疗前VAS评分为（9．2±1．1）分，注射后1周（5．8±3．0）分，注射后2周（3．6±2．3）分，注射后1个月（2．3±2．3）分，注射后3个月（3．2±2．9）分，注射后6个月（4．6±3．2）分。VAS评分呈现先逐渐降低，在注射后1个月时达到最低，后又逐渐升高，治疗前后比较，差异有统计学意义（P〈0．05）。治疗后的疗效评定：治疗后1周、2周、1个月、3个月、6个月的有效率分别为37．0％、85．2％、92．6％、70．4％、59．3％，组间两两比较，差异有统计学意义（P〈0．05）。不良反应主要为一过性口角歪斜、眼睑闭合不全3例，4～8周后自行恢复。27例患者无严重并发症。结论A型肉毒毒素治疗老年人原发性难治性三叉神经痛安全、有效。

Objective To investigate the therapeutic effects of botulinum toxin type A （BTX-A） in elderly patients with primary intractable trigeminal neuralgia. Methods 27 elderly patients with primary intractable trigeminal neuralgia were treated with BTX A local multiple point injection. The efficacy was assessed by visual analog scores （VAS） before and 1 week, 2 weeks, 1 month, 3 months and 6 months after the treatment. Results VAS scores was （9.2 ± 1.1）, （5.8 ± 3.0）, （3.6 ±2.3）, （2.3±2.3）, （3.2±2.9） and （4.6±3.2） before and 1 week, 2 weeks, 1 month, 3 months and 6 months after BTX-A treatment respectively. VAS score was gradually decreased, reached the lowest at 1 month after BTXA injection, and then was gradually increased. There were significant differences in VAS scores between between pre-and post-treatment （P〈0.05）. The efficiency was 37.0%, 85.2%, 92.6%, 70.4% and 59.3% at 1 week, 2 weeks, 1 month, 3 months and 6 months after the treatment respectively. There were significant differences in efficacy between different time points after the treatment （all P%0.05）. 3 patients had the transient numbness of mouth askew and incomplete eyelid closure and recovered spontaneously after 4-8 weeks. No severe adverse effects were found in the other 27 patients. Conclusions BTX A is safe and effective in the treatment of primary intractable trigeminal neuralgia in elderly patients.