Anxiety,Depression And Sleep Disorder In Patients With Trigeminal Neuralgia,and The Therapeutic Effect Of Botulinum Toxin Type A

Background and Objectives:Trigeminal neuralgia is defined as paroxysmal,brief,severe,stabbing recurrent episodes of pain within the distribution of one or more branches of the trigeminal nerve. The treatments include drugs and surgical treatment, but there still lack lasting, highly safe treatments. Botulinum toxin type A is one of the serotypes of botulinum neurotoxins derived from Clostridium botulinum and has significant effect on dystonia.In recent years, studies have shown that botulinum toxin A can significantly reduce the pain of patients with trigeminal neuralgia. Both domestic and international studies have shown that anxiety,depression and sleep disorder on patients usually accompany with various pain which seriously affect the patients’ quality of life.This study is to explore the incidence and features of anxiety,depression,sleep disorder on trigeminal neuralgia patients and to observe the efficacy and safety of infecting botulinum toxin A on patients of trigeminal neuralgia,so as to providing a safe and effective method to treat trigeminal neuralgia.Methods:The recruitment period was between November2011and September2012with a 9-week follow up period:1-week for screening,8-week for observing.The cases came from outpatient and hospitalization of patients with one branch of the trigeminal nerve. The study proceeded by subcutaneous injection of botulinum toxin A in the dermatome where pain was experienced and was measured by pain severity (assessed by a visual analog scale), pain attack frequency per day,Sleep interference score,the Hamilton Anxiety Scale,the Hamilton Depression Scale,adverse reactions,the MOS36-item short form health survey before and after8weeks treatment. Anxiety, depression and sleep disorder were measured by the Hamilton Anxiety Scale,the Hamilton Depression Scale, sleep interference and quality of life was measured by the MOS36-item short form health survey and the safety evaluation was measured by adverse reaction. Quantitative variables were measured by mean plus or substract standard deviation, maximum, median and minimum. The chi-square test was used to analyze the statistics of correlation and efficiency of treatment on patients of trigeminal neuralgia with anxiety, depression. Wilcoxon rank sum test was used to measure visual analog scale score,sleep interference score,anxiety score,depression score,the MOS36-item short form health survey score.The above statistics was analyzed by using SPSS20.0and achieved p<0.05as significant.Results:87classical trigeminal neuralgia patients conformed to the criteria of inclusion and exclusion including38(43.68%) male cases and49(56.32%) female cases.There were35cases (40.23%) accompanied by anxiety(35.63%) or depression(35.63%) with pure anxiety4.60%,pure depression4.6%,anxiety with depression31.03%.patients accompanied by Sleep disorder was71.26%.Each week after treatment comparing to before treatment, VAS score, sleep interference score, anxiety score and depression score were significantly reduced(p<0.01).The effective rate was48.28%,66.67%,78.16%and48.28%after1,2,4,8weeks treatment and was90.32%,96.77%on patients of anxiety, depression.Quality of life in RP, BP, GH, VT, SF, RE, MH significantly improved(p<0.01) after treatment than before treatment. There was no significant difference (p=0.317>0.05) In the aspect of PF(Physical Functioning). Botulinum toxin type A was well tolerated, with2patients experienced temporary facial edema on the injection area and7patients experienced short-term facial asymmetry on the injection area.Conclusion:The results of this9-week trial were encouraging. Many trigeminal neuralgia patients accompanied with anxiety, depression and sleep disorders and there was a correlation on anxiety and depression. Botulinum toxin type A significantly eased the pain of trigeminal neuralgia patients at the same time significantly improving the anxiety, depression, sleep disorder and quality of life of patients.Botulinum toxin A is a safe and effective treatment method for classical trigeminal neuralgia patients.