Open AccessC-Arm Guided Percutaneous Radiofrequency Thoracic Sympathectomy for Treatment of Primary Palmar Hyperhidrosis in Comparison with Local Botulinum Toxin Type A Injection, Randomized Trial
Author(s) -
Tarek Mostafa,
Abdel A Hamed,
Basma M Mohammed,
Nabil Ali El Sheikh,
Ahmed A Shama
Publication year - 2019
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2019.22.591
Subject(s) - medicine , hyperhidrosis , quality of life (healthcare) , randomized controlled trial , botulinum toxin , surgery , dermatology life quality index , sympathectomy , percutaneous , patient satisfaction , radiofrequency ablation , randomization , ablation , anesthesia , disease , nursing
Background: Hyperhidrosis is a disorder associated with detrimental effects on patients’ quality oflife, occupational activities, and social interactions.Objectives: This study compares C-arm guided percutaneous radiofrequency (RF) ablation of thesecond and third thoracic sympathetic ganglions and local intradermal botulinum toxin type A (BTX-A)injection for the treatment of primary palmar hyperhidrosis. It focuses on clinical effectiveness, patientsatisfaction, quality of life, safety, and the time at which repetition of the procedure is needed overone-year follow-up.Study Design: This is a randomized single-blinded trial.Setting: This study took place in a single hospital.Methods: Eighty patients with primary palmar hyperhidrosis were randomly assigned to one of 2interventions: local intradermal BTX-A injection (n = 40) or C-arm guided percutaneous RF ablation (n= 40). The Dermatology Life Quality Index (DLQI) questionnaire and the Hyperhidrosis Disease SeverityScale (HDSS) were used for assessment at one week, one month, and 2, 6, and 12 months afterintervention. The number of patients who required repetition of the procedure later on and the timeat which they needed it were recorded, and possible side effects were assessed.Results: HDSS scores in the RF group were statistically significantly lower than in the BTX-A groupat one week, one month, and 2, 6, and 12 months of follow-up. DLQI scores in the RF group werestatistically significantly lower than in the BTX-A group at 6- and 12-month follow-up, whereas atone week, one month, and 2 months of follow-up, there was no statistically significant differencebetween both groups. The number of patients who required that the procedure be repeated wasstatistically significantly lower in the RF group than in the BTX-A group. The time at which patientsneeded repetition of the procedure in the BTX-A group was about 3 to 7 months after the firstintervention. All patients in this group showed an increase in HDSS scores within this one-year followup. In the RF group, however, only one patient complained of increased HDSS scores after 8 months.There was no statistically significant difference in side effects between both groups.Limitations: The first limitation of this study is that results were based on subjective scales. Thesecond is the radiation exposure associated with the technique described.Conclusions: This study supports percutaneous C-arm guided RF ablation of the second and thirdthoracic sympathetic ganglions and local intradermal BTX-A injection as safe, effective options andrapid lines of treatment of primary palmar hyperhidrosis. However, percutaneous RF ablation provedto be more effective, with longer effectiveness time and better patient satisfaction, compared to localintradermal BTX-A injection.