Botulinumtoxin zur Behandlung von neuropathischen Schmerzen

Zusammenfassung

Die Behandlung neuropathischer Schmerzen mit systemisch wirksamen oral verabreichten Pharmaka ist bei vielen Patienten wirksam, kann jedoch zu zentralnervösen unerwünschten Wirkungen wie Müdigkeit oder Schwindel führen. Daher sind in den letzten Jahren topische Therapien in das Zentrum der Aufmerksamkeit gerückt. Botulinumtoxin, etabliert in der Therapie von Dystonien und Spastik, wurde zunehmend bei Schmerzerkrankungen getestet, hierbei ist Botulinum-Neurotoxin A der am besten untersuchte Serotyp. Die häufigsten Indikationen waren Schmerzen im Trigeminusversorgungsbereich und periphere neuropathische Schmerzen. Bei den meisten Studien war Botulinum-Neurotoxin A Placebo deutlich überlegen. Präklinische Studien zum Wirkmechanismus erbrachten die Erkenntnis, dass neben dem erwarteten peripheren Effekt sehr wahrscheinlich auch eine zentrale Reduktion der Ausschüttung von exzitatorischen Neurotransmittern an der Wirkung beteiligt ist.

Summary

Treatment of neuropathic pain with orally administered systemically acting drugs is effective in many patients, but can lead to side effects in the central nervous system such as fatigue or dizziness. Therefore, topical therapies have been the focus of attention in recent years. Botulinum toxin, established in the treatment of dystonia and spasticity, has been increasingly tested in recent years for painful diseases. Botulinum neurotoxin A was most often studied. The most common indications were pain in the trigeminal area and peripheral neuropathic pain. In most studies, botulinum neurotoxin A was significantly superior to placebo. Preclinical studies on the mechanism of action have shown that besides the expected peripheral effect, a central reduction of the excretion of excitatory neurotransmitters is most likely involved in the effect.

Schlüsselwörter

Neuropathischer Schmerz - Botulinumtoxin - Therapie

Keywords

Neuropathic pain - Botulinum toxin - therapy

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