A comparative study of Botulinum toxin type A versus conventional oral therapy as a second-line treatment of diabetic neuropathy

Abstract

BackgroundDiabetes mellitus is commonly complicated by diabetic peripheral neuropathy. Poor adherence to medication is common in diabetic peripheral neuropathy mainly due to common side effects and poor tolerance to medication. Botulinum toxin A intradermal injection has proved efficacy in cases of diabetic peripheral neuropathy, however there is a need to compare its effect to other lines of treatment. The aim of the study was to compare Botulinum toxin type A versus conventional oral treatment as a second-line treatment of painful diabetic peripheral neuropathy. The current study was a comparative study on 30 patients with type 2 diabetes mellitus. Diabetic peripheral neuropathy was proved by nerve conduction study. All patients were on carbamazepine. Patients were divided randomly into three groups. First group was add-on duloxetine, second group was add-on gabapentin and the third group was injected intradermal with Botulinum toxin A.ResultsOur study showed that Botulinum A intradermal injection, gabapentin and duloxetine add-on therapy decreased the VAS and PSQI over a 12-week study period and this was statistically significant at p < 0.001*. Botulinum A intradermal injection also decreased the mean of PSQ1 from 17.3 ± 1.8 to 10.9 ± 3.1 in 12 weeks constituting the highest decline in PSQ1 among the three groups and this was statistically significant at p < 0.001*.ConclusionBotulinum toxin A injection had a comparable if not superior efficacy to duloxetine and gabapentin as a second-line treatment of diabetic peripheral neuropathy.