An open study of botulinum-A toxin treatment of trigeminal neuralgia

Piovesan, Élcio Juliato; Teive, H.; Kowacs, Pedro André; Coletta, Marcus Vinicius Della; Werneck, Lineü Cesar; Silberstein, Stephen D.

doi:10.1212/01.wnl.0000180940.98815.74

Cited by 153 publications

(127 citation statements)

References 20 publications

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“…Mean BoNT-A dose was 3.22 units/cm 2 administered directly into the affected facial regions subcutaneously. At 60 days follow-up the pain began to slowly return in most patients [Piovesan et al 2005].…”

Section: Medical Treatmentmentioning

confidence: 93%

Treatment options in trigeminal neuralgia

Obermann

2010

Ther Adv Neurol Disord

175

133

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The incidence of trigeminal neuralgia (TN) is 4.3 per 100,000 persons per year, with a slightly higher incidence for women (5.9/100,000) compared with men (3.4/100,000). There is a lack of certainty regarding the aetiology and pathophysiology of TN. The treatment of TN can be very challenging despite the numerous options patients and physicians can choose from. This multitude of treatment options poses the question as to which treatment fits which patient best. The preferred medical treatment for TN consists of anticonvulsant drugs, muscle relaxants and neuroleptic agents. Large-scale placebo-controlled clinical trials are scarce. For patients refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma knife surgery and microvascular decompression are the most promising invasive treatment options.

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Section: Medical Treatmentmentioning

confidence: 93%

Treatment options in trigeminal neuralgia

Obermann

2010

Ther Adv Neurol Disord

175

133

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“…Of the patients reported by our group, three presented with facial asymmetry (3/13) and one with ptosis (1/13) 4 . It should be noted that two of our patients who did not belong to our original cohort developed infectious complications (a hard palate abscess and a retropharyngeal abscess) from intra-oral BoNT/A injections.…”

mentioning

confidence: 76%

“…The therapeutic effect of BoNT/A in TN was first mentioned after a serendipitous finding by Wang and Jankovic 5 . Reporting a case similar to the one that motivated a previous study by our group 4 , Jankovic described a patient who presented with hemifacial spasm and TN whose TN improved after treatment of the hemifacial spasm with BoNT/A. Since then, case reports and case series have been published in neurology, headache, pharmacology and pain medicine journals 6,7,8,9,10,11,12,13,14 .…”

mentioning

confidence: 78%

“…Treatment includes pharmacological therapy, usually with membrane stabilizers; invasive or minimally-invasive (mainly percutaneous procedures) surgical therapies; and radiosurgery 3 . In 2005, OnabotulinumtoxinA (BoNT/A) was reported to be effective for cases of TN that failed to respond to other therapies 4 . The therapeutic effect of BoNT/A in TN was first mentioned after a serendipitous finding by Wang and Jankovic 5 .…”

mentioning

confidence: 99%

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OnabotulinumtoxinA for trigeminal neuralgia: a review of the available data

Kowacs

Utiumi

Nascimento

et al. 2015

Arq. Neuro-Psiquiatr.

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Trigeminal neuralgia (TN) is a unilateral disorder characterized by brief electric-shock-like attacks of pain, abrupt in onset and termination and limited to the distribution of one or more divisions of the trigeminal nerve 1 . It is reported to have a prevalence of 0.1-0.2 per thousand and an incidence ranging from about 2 to 7.1/100 000/year and extending up to 20/100 000/year in individuals over 60 years of age. The condition is more common in women than in men (ratio 3:2) 2 . Treatment includes pharmacological therapy, usually with membrane stabilizers; invasive or minimally-invasive (mainly percutaneous procedures) surgical therapies; and radiosurgery 3 . In 2005, OnabotulinumtoxinA (BoNT/A) was reported to be effective for cases of TN that failed to respond to other therapies 4 . The therapeutic effect of BoNT/A in TN was first mentioned after a serendipitous finding by Wang and Jankovic 5. Reporting a case similar to the one that motivated a previous study by our group 4 , Jankovic described a patient who presented with hemifacial spasm and TN whose TN improved after treatment of the hemifacial spasm with BoNT/A. Since then, case reports and case series have been published in neurology, headache, pharmacology and pain medicine journals 6,7,8,9,10,11,12,13,14 . This literature, although suggesting the therapeutic effects of BoNT/A in TN, has been challenged 15 or even ignored by panels of experts 16,17 . The present review was undertaken to give readers an overview of the available evidence that BoNT/A has a therapeutic effect on TN. AbstrActTrigeminal neuralgia (TN) patients may develop side effects from centrally acting drugs, have contraindications for neurosurgical procedures, or experience relapse during conventional therapies. OnabotulinumtoxinA (BoNT/A) has been reported to be effective for TN, although this finding has been challenged. An overview of the available evidence based on a narrative/qualitative analysis of the literature is presented. About 90% of patients who receive BoNT/A show an improvement, a higher figure than that reported for the placebo effect of BoNT/A for other headaches. Tolerability of BoNT/A is good, and its few side-effects are transient. The articles reviewed were mainly case reports, case series and open-label trials; however, randomized controlled trials have endorsed the efficacy of BoNT/A for TN. This evidence, together with a better understanding of the analgesic mechanisms of BoNT/A and its proven efficacy in treating other pain syndromes, supports the use of this toxin as a therapeutic option for TN.Keywords: trigeminal neuralgia, botulinum neurotoxin type A, botulinum-A toxin, onabotulinumtoxinA, neuropathic pain. resumO Pacientes com neuralgia do trigêmeo (NT) podem apresentar efeitos colaterais decorrentes do uso de drogas psicoativas, contra-indicações a procedimentos neurocirúrgicos ou perda da eficácia destas terapias. A neurotoxina botulínica do tipo A (NTB/A) tem demonstrado ser eficaz no alívio da NT, ainda que este achado tenha sido contestado. Uma...

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“…[23,25] It has also shown significant anti nociceptive effects in post herpetic neuralgia and trigeminal neuralgia and improved the quality of life of the patients without causing any deleterious adverse effect. [26,27] It has an excellent safety profile with no systemic side effects, though pain at injection site is common. Although it has shown promising results for various types of NP, long term trials involving large number of patients using different study designs are required to further explore this effect.…”

Section: High-concentration Capsaicin Patchmentioning

confidence: 99%