玻尿素毒素A型三神经疼痛:一个全面的文献评论
Yan Tereshko1, Simone Dal Bello1, Christian Lettieri1
1Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy.
Toxins
|November 26, 2024
概括
毒素A型有效治疗三角神经疼痛 (TN) 疼痛. 然而,不一致的方法和小患者群体阻碍了它的批准,需要进一步的标准化研究.
科学领域:
- 神经学 神经学
- 疼痛管理 疼痛管理
- 药理学 药理学是指药理学的学科.
背景情况:
- 三神经疼痛 (TN) 是一种使人虚弱的神经病痛状况.
- 毒素A型已经成为TN的潜在治疗剂.
- 目前的文献缺乏对其在TN中的应用进行全面分析.
研究的目的:
- 从2002年到2024年,审查和分析关于三角神经疼痛A型肉毒素的研究.
- 确定最佳的技术,剂量,途径和患者群体,用于TN的甲型肉毒素治疗.
- 评估A型肉毒毒素在治疗TN时的疗效和安全性.
主要方法:
- 2002年至2024年1月期间发表的MEDLINE索引文章的系统审查.
- 包括病例报告,病例系列,开放标签,回顾性和涉及人体TN患者的RCT研究.
- 使用的关键词:"三神经疼痛"和"botulinum".
主要成果:
- 包括35篇文章,证实了毒素A型对TN疼痛的有效性.
- 在研究中观察到技术,剂量和注射途径的显著异质性.
- 使用的主要配方是onabotulinumtoxinA和lanbotulinumtoxinA,分别治疗了300名和760名患者.
- 过渡性面部不对称是报告的主要不良事件.
结论:
- 甲型玻尿素毒素是一种有前途且有效的三角神经疼痛治疗方法.
- 缺乏标准化的方法和有限的样本大小阻碍了监管部门的批准 (FDA/EMA).
- 需要进行进一步的大规模标准化研究,以确定甲型肉毒素作为TN的主流治疗方法.
相关概念视频
01:26Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin
Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
The binding of dantrolene to the RYR1...
The binding of dantrolene to the RYR1...
01:31Skeletal Muscle Relaxants: Therapeutic Uses
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...
01:24Local Anesthetics: Differential Sensitivity of Nerve Fibers
Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
01:22Botulism
Botulism is a life-threatening neuroparalytic condition caused by botulinum neurotoxin, which is produced by the bacterium Clostridium botulinum, a Gram-positive, spore-forming, obligate anaerobe.In adults, the toxin enters the body in different ways: in foodborne botulism, the preformed toxin is absorbed in the intestine. In wound botulism, spores grow in injured tissue and release the toxin into the blood. Infant botulism differs mechanistically from adult forms. In infants, botulism commonly...