A型肉毒毒素治疗三叉神经痛

目的:观察A型肉毒毒素治疗三叉神经痛(TN)的临床疗效。方法:选取57例TN患者,随机分为A、B 2组。A组28例患者口服卡马西平片治疗;B组29例在疼痛部位及板机点周围皮下注射肉毒素治疗。治疗后1,3及6个月时随访,行简式McGill疼痛问卷表(SF-MPQ)及生活质量评价量表(SF-36)评分,并观察不良反应。结果:治疗中脱失7例,A组3例,B组4例。与治疗前3个月SF-MPQ及SF-36平均分作为基础水平比较,治疗1,3及6个月后2组SF-MPQ评分明显下降,SF-36明显上升(P<0.01),B组表明更明显(P<0.05,P<0.01)。治疗过程中,A组出现不适患者多于B组。结论:A型肉毒毒素疼痛点皮下注射治疗TN发作作用高峰1～3个月,维持时间6个月,且临床疗效显著,不良反应轻微。     

A型肉毒毒素治疗三叉神经痛的效果及相关因子表达意义

目的:探讨A型肉毒毒素治疗三叉神经痛的剂量-效果关系及相关炎性因子的表达意义。方法:选取2016年1月至2017年1月至胜利油田中心医院神经内科就诊的三叉神经痛病人82例,采用随机、双盲的方法,总观察时间4周,根据治疗剂量分为4组。观察各组病人疼痛程度、生活质量及不良反应,并采用ELISA法检测各组病人炎性因子表达水平变化。结果:与基线视觉模拟评分(visual analogue scale,VAS)相比,采用A型肉毒毒素治疗后,四组的VAS均有较明显的下降(P<0.05)。与12.5U组比较,其余三组各时间点VAS评分差异显著(P<0.05)。至4周观察期终点可以发现25U组、50U组、75U组VAS评分变化趋势基本一致,均优于12.5U组。四组各时间点TNF-α、IL-6均与VAS评分相关。25U组、50U组、75U组病人生活质量评分基本一致,均优于12.5U组。整个研究过程各组均未出现全身不良反应。结论:A型肉毒毒素对于三叉神经痛具有治疗效果,25U的剂量即可达到治疗要求,其镇痛作用机制可能与TNF-A、IL-6等炎性因子水平下调有关。     

A型肉毒毒素对关节炎疼痛大鼠脊髓小胶质细胞活化及肿瘤坏死因子-α表达的影响

目的 观察A型肉毒毒素（BTX-A）注射对佐剂性关节炎大鼠疼痛行为及脊髓小胶质细胞激活、肿瘤坏死因子-α(TNF-α)表达的影响,并探讨BTX-A治疗佐剂性关节炎疼痛的可能机制。 方法 采用随机数字表法将60只清洁级雄性SD大鼠分为假手术组、完全弗氏佐剂组（模型组）和BTX-A组,每组20只大鼠。除假手术组外,其余2组均于左后肢踝关节腔注射50 μl CFA建立佐剂性关节炎疼痛模型,假手术组大鼠关节腔内注射50 μl生理盐水作为对照。造模成功后假手术组和模型组大鼠左后肢踝关节腔注射20 μl生理盐水,BTX-A组大鼠注射20 μl 5 U BTX-A。于造模前1天、造模后第1,3,7,14,21天及给药后第1,3,7,14天对各组大鼠机械痛阈和热痛阈进行测定;并于测试后取出相应时间点脊髓组织,采用免疫蛋白印迹法、免疫荧光染色法检测离子钙接头蛋白(IBA-1)表达及IBA-1免疫阳性细胞(IBA-1-IR)数量;另采用ELISA法、实时荧光定量逆转录-聚合酶链反应（RT-PCR）检测脊髓水平TNF-α蛋白及TNF-α mRNA表达情况。 结果 与模型组比较,BTX-A组踝关节腔注射BTX-A后第3天时其机械痛撤足阈值及热痛阈潜伏期均明显增加,直到注射后第14天时差异均具有统计学意义(P<0.01);脊髓水平IBA-1蛋白表达显著降低,IBA-1免疫阳性细胞数量明显下调（P<0.01）;TNF-α蛋白及TNF-α mRNA表达均明显降低(P<0.05)。 结论 BTX-A可减轻 CFA诱导的关节炎疼痛,其镇痛机制可能与抑制脊髓小胶质细胞活化及TNF-α释放有关。     

A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛的临床疗效

目的：观察A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛的临床效果。方法：选取33例三叉神经痛或带状疱疹后神经痛患者，进行疼痛区域A型肉毒毒素皮下或皮内注射治疗，评估患者治疗时、治疗2周后、治疗3个月后疼痛情况（NRS）、睡眠状况及生活质量（QOL），判断治疗效果，观察药物不良反应。结果：患者使用A型肉毒毒素治疗2周后、3个月后疼痛评分、睡眠评分显著低于治疗时（P<0.05），生活质量显著高于治疗时（P<0.05），治疗效果好，不良反应少。结论：A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛效果显著，可成为神经病理性疼痛治疗的一种新途径。     

A型肉毒毒素对痉挛性瘫痪大鼠腓肠肌作用的实验研究

目的:研究A型肉毒毒素注射致痉挛瘫痪大鼠腓肠肌及相关结构超微结构的改变.方法:150只大鼠随机分A、B、C、D4组:A组为30只,单纯颅骨钻孔:B组为40只、C组为50只、D组为30只,各组均以适宜电流刺激破坏左侧锥体束制备痉挛瘫痪模型.C组、D组给予腓肠肌痉挛肌肉注射A型肉毒毒索6u/kg/肌群;D组,于注射后辅以运动训练.B组为对照组,给予注射等体积生理盐水.各组于注射后不同时间进行神经行为学检测、肌肉及相关组织结构透射电镜检查.结果:C组和D组的神经、肌肉组织改变情况均较对照B组明显.C组和D组,均观察到神经芽生现象.训练后D组大鼠神经行为学及超微结构改善明显.肌膜两侧呈现不同的病理改变.结论:A型肉毒毒素肌肉注射导致的超微结构改变较单纯肌痉挛造成的改变更为明显;肌细胞膜对肉毒毒素具有阻隔作用,A型肉毒毒素可能有诱发神经芽生作用.运动训练对大鼠神经行为学有明显改善,运动训练可促进病变肌肉超微结构改善.     

A型肉毒毒素治疗面部皱纹68例疗效观察

2003—12-2004—12我院医学美容中心应用肉毒毒素治疗面部皱纹68例，效果良好，总结如下。     

A型肉毒毒素在下面部提升的临床观察

目的观察A型肉毒毒素在下面部提升的临床疗效。方法随机选取我院门诊收治的13例下面部松垂的求美者,给于A型肉毒毒素双侧咬肌(选择性)、颈阔肌注射,分别于治疗前、治疗后3月及6月对求美者面部正位片进行标准化摄影,采用Photoshop CS6测量其治疗前后下面部提升的距离,应用SPSS 17.0进行统计学分析,比较前后治疗效果。结果治疗后3月、6月与治疗前相比下面部提升差异均有统计学意义(P<0.05)。治疗后3月求美者总满意度69.23%;治疗后6月求美者总满意度49.15%。结论A型肉毒毒素提升下面部6个月内安全有效,操作简便,不良反应少,值得临床推广应用。     

A型肉毒毒素在Meige综合征中的抗痉挛作用

背景采用A型肉毒毒素对痉挛肌肉的局部注射治疗已显示出既有明显降低肌肉高张力的作用,副作用又极少.目的从患者面部痉挛改善情况、疗效、副作用等方面对A型肉毒毒素治疗Meige综合征进行综合评价.设计自身前后对照的临床实验.单位解放军第三军医大学西南医院神经内科.对象选择2000-06/2003-05在解放军第三军医大学西南医院神经科门诊确诊为Meige综合征并自愿接受A型肉毒毒素注射治疗的患者24例.痉挛性眼睑闭合10例,磨牙咂嘴咀嚼动作3例、不自主眨眼2例、皱眉1例、混合症状8例.方法对24例Meige综合征患者应用A型肉毒毒素对痉挛肌肉多点注射,每点2.5～5 U.至少门诊或电话随访1次对治疗前后患者面部痉挛变化情况、疗效进行比较.疗效判定[1]完全缓解痉挛程度分级降至0级.[2]明显缓解痉挛分级下降≥2级.[3]部分缓解痉挛分级下降1级.[4]无效痉挛分级无降低.主要观察指标[1]治疗前后肉毒毒素A对Meige综合征患者肌痉挛强度分级变化.[2]肉毒毒素A对Meige综合征患者不同症状的改善情况.[3]肉毒素素A治疗Meige综合征发生副作用情况.结果24例患者全部进入结果分析.[1]治疗前0～Ⅰ级为1例,Ⅱ级为7例,Ⅲ级为10例,Ⅳ级为6例.治疗后分别为16,6,2,0例(χ2=95.4894,P=7.313 41×10-10).[2]A型肉毒毒素对眼睑痉挛的治疗平均3 d症状缓解,2周疗效达最高峰;完全缓解率75%(18/24),明显缓解率17%(4/24),部分缓解率8%(2/24),总有效率100%.有效作用时间为8～44周,平均24.4周.[3]在注射后短期内出现注射部位肌肉无力的表现以及在非注射部位出现肌肉不全麻痹的现象,均在1～8周内可自行缓解.结论A型肉毒毒素治疗Meige综合征可明显减轻痉挛程度,提高疗效,对注射肌肉及注射位点的准确选择,可减少副作用的发生.     

A型肉毒毒素对Meige综合征的抗痉挛作用

目的从患者面部痉挛改善情况、疗效、副反应等方面对A型肉毒毒素改善Meige综合征进行综合评价。方法对24例Meige综合征患者应用A型肉毒毒素对痉挛肌肉多点注射,每点0.1～0.2mL(2.5～5U),至少门诊或电话随访1次对治疗前后的病情分级进行对比。结果A型肉毒毒素对眼睑痉挛的治疗平均3d症状缓解,2个星期疗效达最高峰;完全缓解率75%,明显缓解率17%,部分缓解率8%,总有效率100%。有效作用时间为8～44周,平均24.4周。结论A型肉毒毒素作为治疗Meige综合征的一种安全、有效、简便的方法可为临床首选。     

A型肉毒毒素减轻面部整形切口瘢痕的临床观察

目的 对A型肉毒毒素减轻面部整形切口瘢痕的疗效进行分析探讨。对型肉毒毒素减轻面部整形切口瘢痕的疗效进行分析探讨。方法 将2018年1月~2019年5月在我院接将月在我院接受面部整形手术的62例患者随机分为两组,对照组31例患者在关闭切口时注射A型肉毒毒素,对照组31例患者在关闭切口时注射A型肉毒毒素并联合减张压迫法,对比两组瘢痕情况、治疗优良率及患者满意度。结果 观察组瘢痕的颜色、宽度、弹性及平整度显著优于对照组(P<0.05)。观察组治疗优良率为93.55%,显著高于对照组的80.65%(P<0.05)。观察组治疗满意度为96.77%,显著高于对照组的77.42%(P<0.05)。结论 面部整形切口注射A型肉毒毒素联合减张压迫法,能够型肉毒毒素联合减张压迫法,能够抑制瘢痕增生,更利于术后美观,临床应用价值更高。     

Two doses of botulinum toxin type A for the treatment of trigeminal neuralgia: observation of therapeutic effect from a randomized,double-blind,placebo-controlled trial

Background

In the majority of cases, trigeminal neuralgia (TN) is a unilateral condition with ultra-short stabbing pain located along one or more branches of the trigeminal nerve. Although prophylactic pharmacological treatment is first choise, considering of insufficient effect or unacceptable side effects, neurosurgical treatment or lesion treatment should be considered. In addition to all these procedures mentioned above, one approach has been based on local intradermal and/or submucosal injections of Botulinum Toxin Type A (BTX-A).

Methods

We conducted a randomized, double-blind, placebo-controlled since November 2012, and adopted local multi-point injection in 84 cases of classical TN with different doses of BTX-A. Eighty four patients were randomized into following groups: placebo (n = 28); BTX-A 25U (n = 27); BTX-A 75U (n = 29). Follow-up visits were conducted every week after the injection, and the overall duration of the study for each patient were 8 weeks to observe the pain severity, efficacy and adverse reactions at endpoint.

Results

The visual analogue scale (VAS) scores of 25U and 75U groups reduced significantly compared to placebo as early as week 1, and sustained until week 8 throughout the study. There was no significant difference in VAS between 25U and 75U groups throughout the study. The response rates of 25U group (70.4%) and 75U group (86.2%) were significantly higher than placebo group (32.1%) at week 8, and there was no significant difference between 25U and 75U groups. Evaluation of the Patient Global Impression of Change (PGIC) demonstrated that 66.7% (25U group) and 75.9% (75U group) of the patients reported that their pain symptoms were ‘much improved’ or ‘very much improved’ versus 32.1% of the placebo group, and there was also no significant difference between 25U and 75U groups. All adverse reactions were graded as mild or moderate.

Conclusions

BTX-A injection in TN is safe and efficient. It is a useful treatment for refractory TN. Lower dose (25U) and high dose (75U) were similar in efficacy in short-term.     

Unilateral facial injection of Botulinum neurotoxin A attenuates bilateral trigeminal neuropathic pain and anxiety-like behaviors through inhibition of TLR2-mediated neuroinflammation in mice

ObjectivesIn this study, we investigated the possible analgesic effects of Botulinum toxin type A (BoNT/A) on trigeminal neuralgia (TN). A modified TN mouse model was established by chronic constriction injury of the distal infraorbital nerve (dIoN-CCI) in mice, and the possible roles of microglia toll-like receptor 2 (TLR2) and neuroinflammation was investigated.MethodsMale C57BL/6 mice were divided into 3 groups, including sham group, vehicle-treated TN group and BoNT/A-treated TN group. Bilateral mechanical pain hypersensitivity, anxiety-like and depressive-like behaviors were evaluated by using von Frey test, open field, elevated plus-maze testing, and forced swimming test in mice, respectively. The mRNA or protein expression levels of toll-like receptors (TLRs), glia activation markers and proinflammatory factors in the trigeminal nucleus caudalis (TNC) were tested by RT-qPCR, immunofluorescence and Western blotting. We also tested the pain behaviors of TN in Tlr2^−/− mice.ResultsWe found that unilateral subcutaneous injection of BoNT/A into the whisker pad on the ipsilateral side of dIoN-CCI mice significantly attenuated bilateral mechanical pain hypersensitivity and anxiety-like behaviors induced by dIoN-CCI surgery in mice. The dIoN-CCI surgery significantly up-regulated the expression of TLR2, MyD88, CD11b (a microglia marker), IL-1β, TNF-α and IL-6 in the ipsilateral TNC in mice, and BoNT/A injection significantly inhibited the expression of these factors. Immunostaining results confirmed that BoNT/A injection significantly inhibited the microglia activation in the ipsilateral TNC in dIoN-CCI mice. TLR2 deficiency also alleviated bilateral mechanical pain hypersensitivity and the up-regulation of MyD88 expression in the TNC of dIoN-CCI mice.ConclusionThese results indicate that unilateral injection of BoNT/A attenuated bilateral mechanical pain hypersensitivity and anxiety-like behaviors in dIoN-CCI mice, and the analgesic effects of BoNT/A may be associated with the inhibition of TLR2-mediated neuroinflammation in the TNC.     

Therapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study

Lew HL, Lee EH, Castaneda A, Klima R, Date E. Therapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study.

Objective

To determine the efficacy of botulinum toxin type A (BTX-A) in treating neck and upper-back pain of myofascial origin.

Design

A randomized, double-blind, placebo-controlled pilot study.

Setting

Outpatient physical medicine and rehabilitation clinic of a university-affiliated tertiary hospital.

Participants

A total of 29 subjects enrolled from among 45 screened patients. No subject withdrawal due to serious adverse events occurred.

Intervention

Subjects were evaluated at baseline, received a 1-time injection of either BTX-A (treatment group) or saline (control group), and were followed up at 2 weeks and at months 1, 2, 3, 4, and 6.

Main Outcome Measures

Visual analog scale (VAS) for pain, the Neck Disability Index (NDI), and the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36).

Results

Improvements in the VAS and NDI scores were seen in the treatment group but were not significant when compared with the controls. Statistically significant improvements for the treatment group were seen in the SF-36 bodily pain (at months 2 and 4) and mental health (at month 1) scales but not in the other scales, nor in the summary measures. No serious adverse events were reported.

Conclusions

Trends toward improvements in VAS and NDI scores of the BTX-A group are encouraging, but they were possibly due to a placebo effect and were not statistically significant. The BTX-A subjects, at certain time points, showed statistically significant improvements in the bodily pain and mental health scales of the SF-36 compared with controls. Our study had limited power and population base, but the results could be used to properly power follow-up studies to further investigate this topic.     

Botulinum toxin type A selectivity for certain types of pain is associated with capsaicin-sensitive neurons

Unlike most classical analgesics, botulinum toxin type A (BoNT/A) does not alter acute nociceptive thresholds, and shows selectivity primarily for allodynic and hyperalgesic responses in certain pain conditions. We hypothesized that this phenomenon might be explained by characterizing the sensory neurons targeted by BoNT/A in the central nervous system after its axonal transport. BoNT/A’s central antinociceptive activity following its application into the rat whisker pad was examined in trigeminal nucleus caudalis (TNC) and higher-level nociceptive brain areas using BoNT/A-cleaved synaptosomal-associated protein 25 (SNAP-25) and c-Fos immunohistochemistry. Occurrence of cleaved SNAP-25 in TNC was examined after nonselective ganglion ablation with formalin or selective denervation of capsaicin-sensitive (vanilloid receptor-1 or TRPV1-expressing) neurons, and in relation to different cellular and neuronal markers. Regional c-Fos activation and effect of TRPV1-expressing afferent denervation on toxin’s antinociceptive action were studied in formalin-induced orofacial pain.     

Activation of CamKIIα expressing neurons on ventrolateral periaqueductal gray improves behavioral hypersensitivity and thalamic discharge in a trigeminal neuralgia rat model

BackgroundPreceding studies have reported the association of chronic neuropathic orofacial pain with altered ongoing function in the ventrolateral periaqueductal gray (vlPAG). However, its role in trigeminal neuralgia (TN) lacks attention. We here reported the aspect that vlPAG neurons play in TN nociceptive processing by employing excitatory neuron-specific optogenetic approaches.MethodsTN was generated via unilateral infraorbital nerve chronic constriction in Sprague Dawley rats which induced mechanical and thermal pain sensitivity in air puff and acetone test, respectively. Channelrhodopsin conjugated virus with CamKIIα promoter was used to specifically activate the excitatory vlPAG neuronal population by optogenetic stimulation and in vivo microdialysis was done to determine its effect on the excitatory-inhibitory balance. In vivo extracellular recordings from ventral posteromedial (VPM) thalamus were assessed in response to vlPAG optogenetic stimulation. Depending on the experimental terms, unpaired student’s t test and two-way analysis of variance (ANOVA) were used for statistical analysis.ResultsWe observed that optogenetic activation of vlPAG subgroup neurons markedly improved pain hypersensitivity in reflexive behavior tests which was also evident on microdialysis analysis with increase glutamate concentration during stimulation period. Decreased mean firing and burst rates were evident in VPM thalamic electrophysiological recordings during the stimulation period. Overall, our results suggest the optogenetic activation of vlPAG excitatory neurons in a TN rat model has pain ameliorating effect.ConclusionsThis article presents the prospect of pain modulation in trigeminal pain pathway via optogenetic activation of vlPAG excitatory neurons in rat model. This outlook could potentially assist vlPAG insight and its optogenetic approach in trigeminal neuropathic pain which aid clinicians endeavoring towards enhanced pain relief therapy in trigeminal neuralgia patients.     

A型肉毒毒素联合持续减张法及面部瘢痕切除术治疗面部小面积瘢痕患者的疗效评价

目的 探讨A型肉毒毒素联合持续减张法及面部瘢痕切除术治疗面部小面积瘢痕患者的疗效.方法 选取2019年1月～2020年6月我院面部小面积瘢痕患者126例,简单随机化法分为观察组(n=63)、对照组(n=63).两组均行面部瘢痕切除术,术后对照组予以常规治疗,观察组予以A型肉毒毒素联合持续减张法.比较两组疗效、不良反应发...     

Tumor necrosis factor-α small interfering RNA alveolar epithelial cell-targeting nanoparticles reduce lung injury in C57BL/6J mice with sepsis

BackgroundThe role of tumor necrosis factor (TNF)-α small interfering (si)RNA alveolar epithelial cell (AEC)-targeting nanoparticles in lung injury is unclear.MethodsSixty C57BL/6J mice with sepsis were divided into normal, control, sham, 25 mg/kg, 50 mg/kg, and 100 mg/kg siRNA AEC-targeting nanoparticles groups (n = 10 per group). The wet:dry lung weight ratio, and hematoxylin and eosin staining, western blotting, and enzyme-linked immunosorbent assays for inflammatory factors were conducted to compare differences among groups.ResultsThe wet:dry ratio was significantly lower in control and sham groups than other groups. TNF-α siRNA AEC-targeting nanoparticles significantly reduced the number of eosinophils, with significantly lower numbers in the 50 mg/kg group than in 25 mg/kg and 100 mg/kg groups. The nanoparticles also significantly reduced the expression of TNF-α, B-cell lymphoma-2, caspase 3, interleukin (IL)-1β, and IL-6, with TNF-α expression being significantly lower in the 50 mg/kg group than in 25 mg/kg and 100 mg/kg groups.ConclusionTNF-α siRNA AEC-targeting nanoparticles appear to be effective at improving lung injury-related sepsis, and 50 mg/kg may be a preferred dose option for administration.     

Role of PGC‐1α in fiber type conversion in the palatopharyngeus muscle of OSA patients

BackgroundObstructive sleep apnea (OSA) has a high incidence and is harmful to health. It is characterized by repeated collapse of the upper airway. However, the mechanism underlying upper airway collapse is unclear.MethodsPatients with OSA and chronic tonsillitis were studied. Pathological changes in palatopharyngeus muscle were detected. The expression of peroxisome proliferator‐activated receptor‐γ co‐activator‐1α (PGC‐1α) and nuclear respiratory factor‐1 (NRF‐1) in muscles was detected by PCR and Western blotting. Immunofluorescence staining was used to detect the expression of type I and type II myofibril.ResultsThe structure of the palatopharyngeus muscle was changed, and the expression of PGC‐1α and NRF‐1 was decreased in the OSA group compared with that in the control group. The expression of PGC‐1α, NRF‐1, and type I myofibril in C2C12 myoblasts was decreased by intermittent hypoxia exposure. The expression of type I myofibril was decreased when knocking down PGC‐1α.ConclusionOSA patients exhibited pathological damage in palatopharyngeus muscle. PGC‐1α was involved in the fiber type conversion in palatopharyngeus muscle caused by intermittent hypoxia.     

血清TGF-β1、IL-17水平与急性肾盂肾炎患者头孢噻肟钠治疗预后的相关性

目的 探讨血清转化生长因子β1(TGF-β1)、白细胞介素-17(IL-17)水平与急性肾盂肾炎患者头孢噻肟钠治疗预后的相关性。方法 选取2019年7月-2021年7月于我院采用孢噻肟钠治疗的急性肾盂肾炎患者60例,治疗2周后,观察患者预后情况并分为预后不良组与预后良好组,所有患者治疗前均接受血清TGF-β1、IL-17水平检测,分析血清TGF-β1、IL-17水平与急性肾盂肾炎患者头孢噻肟钠治疗预后的相关性。结果 60例急性肾盂肾炎患者头孢噻肟钠治疗预后不良8例(13.33%),预后良好52例(86.67%);经Logistic回归分析,结果显示,血清TGF-β1、IL-17水平与急性肾盂肾炎患者头孢噻污钠治疗预后不良相关(OR>1, P<0.05);绘制ROC曲线,结果显示,血清TGF-β1、IL-17水平单独及联合预测急性肾盂肾炎患者头孢噻肟钠治疗预后的AUC>0.8,具有一定预测价值,其中联合预测价值最高。结论 血清TGF-β1、IL-17水平与急性肾盂肾炎患者头孢噻肟钠治疗预后密切相关,临床可通过检测血清TGF-β1、IL-17水平预测急性肾盂肾炎患者预后情况。