Clinical neuropharmacology
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Clin Neuropharmacol · Sep 2013
Randomized Controlled TrialAcute treatment of trigeminal neuralgia with onabotulinum toxin A.
A double-blind, randomized, placebo-controlled study of patients with essential trigeminal neuralgia and treatment with a single injection of onabotulinum toxin A (BTX) was carried out. The efficacy, safety, and tolerability of either 1 mL 0.9% saline plus 50 U of BTX or only 1 mL of 0.9% saline injected subcutaneously in the affected area were evaluated. Cases with involvement of the third branch of the trigeminal nerve also received intramuscularly either 10 U of BTX or matching placebo in the masseter muscle, ipsilateral to the pain location. ⋯ Two months after the intervention, a trend to statistical significance was observed for the VAS mean values in subjects treated with BTX and those who received placebo (VAS 4.9 vs 6.63, t test, P = 0.07). Three months after the injection, significant differences were observed in the average VAS score for subjects treated with BTX and those treated with placebo (VAS 4.75 vs 6.94, respectively; t test, P = 0.01). Onabotulinum toxin A was well tolerated and seems to be a safe and useful therapy for patients with essential trigeminal neuralgia.
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Mania is generally associated with bipolar disorder; however, it can be iatrogenic. For instance, antibiotics and corticosteroids can cause manic symptoms. ⋯ Adverse events of psychotic mania have been rarely reported with erythromycin and acetaminophen with codeine, despite these being commonly prescribed medications. Clinicians should be aware that these drugs may be an iatrogenic cause of psychiatric disturbances and that these adverse events are more likely to occur during their concomitant use.