Botulinum toxin A điều trị đau thần kinh

  • Nguyễn Phương Thảo Bệnh viện Da liễu Thành Phố Hồ Chí Minh
  • Nguyễn Hữu Minh Bệnh viện Ung bướu Thành phố Hồ Chí Minh

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Keywords

Độc tố botulinum A (BoNT-A), đau do thần kinh, điều trị đau do thần kinh

Tóm tắt

Botulinum toxin A (BoNT-A) sau gần 3 đến 4 thập kỷ lãng quên vì được xem là độc tố chết người. Đến năm 1980, một bác sĩ nhãn khoa, Alan B Scott người đầu tiên đã sử dụng độc tố trị lé (lác) mắt cho bệnh nhân [1, 2, 3, 4, 5]. Gần 10 năm sau, tháng 12/1989, Cơ quan Thuốc và Dược phẩm Hoa Kỳ (FDA) phê chuẩn onabotulinumtoxin A (Botox®) điều trị, lác (strabismus), co thắt mí mắt (blepharospasm), co thắt nửa mặt (hemifacial spasm) ở trẻ dưới 12 tuổi. Năm 2000, điều trị rối loạn co thắt không tự ý cơ cổ (cervical dystonia) [6, 7, 8, 9]. Một thời gian dài tác dụng giảm đau của BoNT-A được xem là do giãn cơ [1, 10, 11]. Tuy nhiên, gần đây các nghiên cứu cơ chế đau thần kinh nhận thấy tác dụng giảm đau BoNT-A hoàn toàn độc lập với giãn cơ [11, 12, 13, 14, 15, 16]. Trong bài này, chúng tôi xin tóm lược các y văn khảo sát cơ chế tác dụng của BoNT-A trên các cơn đau khó trị do thần kinh như: Đau thần kinh sau nhiễm vi rút Herpes, đau thần kinh do đái tháo đường, hội chứng đau phức hợp vùng (complex regional pain syndrome), đau dây thần kinh tam thoa, đau tận cùng mỏm cụt thần kinh như đau chi ma (phantom limb pain), đau sau thương tổn tủy sống, và đau sau đột quỵ

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