A型肉毒素治疗70岁以上三叉神经痛患者的安全性及疗效

Evaluation of therapeutic effectiveness and safety of botulinum toxin type A in the treatment of idiopathic trigeminal neuralgia in patients older than 70 years

目的 探讨A型肉毒毒素治疗70岁以上原发性三叉神经痛患者的安全性及疗效.方法 收集2008年8月至2013年9月期间苏州大学附属第二医院神经内科住院或肉毒素门诊针对原发性三叉神经痛进行诊治的64例患者,按年龄分为老年组（≥70岁,35例）及中青年组（＜60岁,29例）,比较两组的治疗剂量、安全性及疗效.采用视觉模拟评分进行疼痛测评.结果 老年组的A型肉毒素治疗剂量为（88 ±30）U,中青年组为（72 ±33）U,两组比较差异无统计学意义（P＞0.05）.两组治疗前视觉模拟评分为（7.7±2.2）分,治疗后为（4.4±2.9）分,治疗后疼痛显著减轻（P＜0.01）.老年组治疗前视觉模拟评分为（8.2±1.9）分,治疗后为（4.5±3.2）分,治疗后疼痛显著减轻（P＜0.01）.中青年组治疗前视觉模拟评分为（7.2±2.4）分,治疗后为（4.4±2.5）分,治疗后疼痛显著减轻（P＜0.01）.老年组治疗前后视觉模拟评分差值为（3.5±3.6）分,中青年组治疗前后视觉模拟评分差值为（2.8±3.5）分,两组比较差异无统计学意义（P＞0.05）.老年组治疗后出现上睑下垂、口角歪斜等轻度不良反应为5例,中青年组为2例,两组比较差异无统计学意义（P＞0.05）.结论 A型肉毒素治疗70岁以上原发性三叉神经痛患者安全、有效,其治疗剂量、有效性及安全性与中青年患者相似.

Objective To evaluate therapeutic effectiveness and safety of botulinum toxin type A in the treatment of idiopathic trigeminal neuralgia in patients older than 70 years.Methods The total 64 patents were involved from neurology clinic and inpatient department from Aug 2008 to Sep 2013.They were divided into two groups according to the age （older than 70 years versus younger than 60 years.The therapeutic dose,safety,effectiveness were compared between two groups.Visual analog scores were employed to measure the degree of pain.Results The mean dosage was （88 ± 30） U in the group aged above 70 years old,and （72 ± 33） U in the group aged below 60 years old respectively.There was no significant difference of dosage between the two groups.The average visual analog score of all patients was （7.7 ± 2.2） before the treatment and decreased to （4.4 ± 2.9） one month after the treatment.To be precise,the average visual analog score of the group aged above 70 years old was （8.2 ± 1.9） before and （4.5 ± 3.2） after the treatment,and the visual analog score of the group aged below 60 years old was （7.2 ± 2.4） before and （4.4 ± 2.5） after the treatment.The effect of botulinum toxin type A in the treatment of idiopathic trigeminal neuralgia was considered statistically significant.The D-value of visual analog score in the elderly group was （3.5 ± 3.6）,and （2.8 ± 3.5） in the younger group.There was no significant difference in the D-value between the two groups.Five patients had transient minor side effects in the former group and two patients had transient minor side effects in latter group.There was no significant difference in the incidence rate of side effects between the two groups （P 〉 0.05）.Conclusions Botulinum toxin type A is safe and effective in the treatment of idiopathic trigeminal neuralgia for the patients older than 70 years and the dosages of it are approximate to the patients under 60 vears old.