Abstract
Botulinum neurotoxin (BoNT), atoxin of the anaerobic spore-forming bacterium Clostridium botulinum is used as adrug for alleviating muscle spasticity. Other indications include the cosmetic application in facial muscles, hyperhidrosis and neurogenic bladder disorders. It has been approved since 2010 as the first prophylactic treatment for chronic migraine. The analgesic effect of BoNT was observed early on and is currently the subject of intensive research. Painful postherpetic neuralgia is acommon complication of an infection with herpes zoster virus. Despite modern treatment algorithms and medication, satisfactory pain treatment is not achieved in all patients. The use of BoNT could represent anew treatment option. The aim of this article is to provide an overview of the current evidence for the use of BoNT for postherpetic neuralgia. We conducted asystematic literature search with the keywords "botulinum" and "neuropathic" and included original articles in which BoNT was used subcutaneously or intradermally for the treatment of postherpetic neuralgia. The initial search yielded 212 results. After atitle and abstract screening, the number was reduced to 11 relevant publications (5case reports or series and 6 prospective studies). The results in the currently available literature show that BoNT is an effective therapeutic option for postherpetic neuralgia. In all studies, asignificant effect on the pain and also on relevant patient-oriented secondary variables, such as the quality of life and especially the quality of sleep was shown. The only reported side effect was pain during administration.
Highlights
a toxin of the anaerobic spore-forming bacterium Clostridium botulinum is used as a drug for alleviating muscle spasticity
Other indications include the cosmetic application in facial muscles
Painful postherpetic neuralgia is a common complication of an infection with herpes zoster virus
Summary
Botulinum neurotoxin (BoNT), a toxin of the anaerobic spore-forming bacterium Clostridium botulinum is used as a drug for alleviating muscle spasticity. Als Prädiktoren für einen guten Behandlungseffekt konnten die Autoren eine gute thermische Sensibilität sowie das Fehlen von Brennschmerz bzw. In der bisher größten Studie zu diesem Thema untersuchten Xiao et al bei 60 Patienten mit Post-Zoster-Neuralgie die Wirkung von BoNT-A im Vergleich zu Lidocain und Placebo [55]. Abgesehen von Schmerzen bei der Injektion wurden keine relevanten Nebenwirkungen gefunden. Emad et al untersuchten den Effekt einer intradermalen BoNT-A-Injektion an 15 Patienten mit Post-Zoster-Neuralgie in einer longitudinalen Beobachtungsstudie [15].
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