重复经颅磁刺激联合加巴喷丁治疗原发性三叉神经痛的疗效及安全性评估

目的:探讨重复经颅磁刺激(rTMS)联合加巴喷丁对于原发性三叉神经痛(PTN)的治疗效果及安全性。方法:将165例PTN患者随机分为加巴喷丁组(A组)、rTMS组(B组)、rTMS联合加巴喷丁组(C组)各55例,A组患者给与加巴喷丁胶囊口服治疗,B组患者给与rTMS治疗,C组患者给与rTMS联合加巴喷丁治疗。治疗前后对患者进行视觉模拟评分(VAS)、匹兹堡睡眠质量指数量表(PSQI)评定,并记录疼痛缓解率和加巴喷丁使用剂量以及不良反应发生情况。结果:3组患者组内比较,治疗2周后、4周后及治疗后1、3、6个月的VAS评分均呈下降趋势(均P<0.05);与A组同时间点比较,B、C组治疗4周后及治疗后随访1、3及6个月的VAS评分均显著降低(均P<0.05),且C组VAS评分降低更显著(P<0.05)。3组患者疼痛缓解情况比较均有统计学意义(均P<0.05),C组疼痛缓解率均显著高于A、B组(均P<0.05),且C组加巴喷丁使用剂量显著低于A组(P<0.05)。B组各项不良反应发生率均低于A、C组(均P<0.05),C组不良反应总计发生率低于A组(P<0.05)。治疗后,3组PSQI评分均显著低于治疗前(均P<0.05),且B、C组PSQI评分均显著低于A组(均P<0.05),C组PSQI评分显著低于B组(P<0.05)。结论:联合应用rTMS联合加巴喷丁能够提高原发性三叉神经痛的治疗效果,减少加巴喷丁的使用剂量,改善患者睡眠,同时减少不良反应的发生率,值得临床推广应用。

Efficacy and safety of repeated transcranial magnetic stimulation combined with gabapentin in the treatment of primary trigeminal neuralgia

Objective: To investigate the therapeutic effect and safety of repetitive transcranial magnetic stimulation (rTMS) combined with gabapentin in the treatment of primary trigeminal neuralgia (PTN). Methods: 165 patients with PTN were randomly divided into the gabapentin group (group A), rTMS group (group B), and rTMS combined with gabapentin group (group C), 55 cases in each group. Group A received gabapentin capsules orally, group B was treated with rTMS, and patients in group C were treated with rTMS combined with gabapentin. Before and after treatment, patients were evaluated by visual analogue score (VAS), Pittsburgh Sleep Quality Index Scale (PSQI), and the pain relief rate, gabapentin dosage and adverse reactions were recorded. Results: Among the three groups, the VAS scores after 2 weeks, 4 weeks, and 1, 3, and 6 months of treatment all showed a downward trend (all P<0.05). As compared with group A at the same time points (4 weeks and 1, 3, and 6 months after treatment), the VAS scores in groups B and C were significantly reduced (all P<0.05), and those in the group C were significantly lower than in the group B (P<0.05). The pain relief of the three groups was statistically significant (all P<0.05). The pain relief rates in group C were significantly higher than those in groups A and B (both P<0.05), and the dosage of gabapentin in group C was significantly less than that in group A (P<0.05). The incidence of adverse reactions in group B was lower than in groups A and C (both P<0.05), and the total incidence of adverse reactions in group C was lower than that in group A (P<0.05). After treatment, the PSQI scores of the three groups were significantly lower than before treatment (all P<0.05), those of groups B and C were significantly lower than those of group A (all P<0.05), and those of group C were significantly lower than those of group B (P<0.05). Conclusion: The combination of rTMS and gabapentin can improve the therapeutic effect of PTN, reduce the dose of gabapentin, improve the sleep of patients, and reduce the incidence of adverse reactions. It is worthy of clinical application.