• Ching-Piao Tsai, Chih-Yang Liu, Kon-Ping Lin, and Kai-Chen Wang.
• Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan. cptsai@vghtpe.gov.tw
• Clin Drug Investig. 2006 Jan 1;26(9):511-5.

Background And ObjectivesBotulinum toxin type A has been shown to relieve primary headaches, myofascial pain and various neuropathic pains. Carpal tunnel syndrome (CTS) is a common disorder resulting from median nerve compression at the wrist. As reports of botulinum toxin A in the treatment of CTS were limited, this study set out to evaluate the safety and tolerability of botulinum toxin A and its effects on the relief of nerve entrapment and pain in patients with CTS.MethodsWe conducted an open-label, prospective pilot study using 60 units of botulinum toxin A injected intracarpally in patients with primary CTS. Changes in median nerve conduction velocities, distal latencies, compound muscle action potentials and visual analogue scale (VAS) pain scores were evaluated for 3 months following injection. All adverse experiences, reported spontaneously or observed directly by the investigator, were recorded.ResultsFive women aged 52.2 +/- 2.5 years with 1-2 years' history of CTS were enrolled. Botulinum toxin A was well tolerated and safe. No exacerbated hand weakness was observed in any of the patients. At 3 months, pain was lessened in three patients, remained static in one patient, and was aggravated in one patient. The VAS pain score showed a trend to improvement during the 3 months of follow-up, although it did not reach statistical significance (p = 0.2).ConclusionOur data suggest long-lasting antinociceptive effects of botulinum toxin A rather than electrophysiological restoration in patients with CTS. Intracarpal injection of botulinum toxin A was shown to be well tolerated and safe. A double-blind, placebo-controlled trial of botulinum toxin A in CTS is warranted since the current study may have been confounded by the placebo effect of intracarpal injection.

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