Sustained effect of repeated botulinum toxin type A injections in trigeminal neuralgia

Abstract

Background Trigeminal neuralgia is a chronic severely disabling facial pain syndrome, which significantly affects the quality of life of patients. Drugs are effective in controlling pain, but surgery is offered in drug‐refractory cases, which may not be feasible due to lack of availability of neurosurgeons or due to unfavorable risk‐benefit ratio or patient preference. Botulinum neurotoxin is an effective alternative in patients who are drug refractory and not willing for surgery. Objectives To study the safety and efficacy of repeated injections of botulinum neurotoxin in the treatment of drug‐refractory trigeminal neuralgia. Methodology Retrospective review of all case files was done, and required data were retrieved for analysis. Results In 23 patients, 54 injections of botulinum neurotoxin were given. The pain on VAS decreased from 9.08 ± 1.41 to 1.03 ± 1.69 with P < 0.0001. All patients had >50% relief in pain. The efficacy of injection was comparable in single injection as well as repeated injections group. Conclusions Repeated injection of botulinum neurotoxin is safe and effective method of treatment in patients who do not want or those who are not fit for surgery.

Advances in botulinum toxin type A for the treatment of pain

“…There was a significant improvement in VAS in the BTX-A group versus the placebo group, while VAS scores did not differ significantly between the BTX-A groups (Taheri et al, 2020) revealed that after single and continuous injections of BTX-A, the severity of pain in patients was significantly reduced, the efficiency of pain relief was 100% in both cases, and there was no significant difference in the mean duration of pain relief. No significant adverse effects were seen in either case, suggesting that repeated injections of BTX-A are safe and effective (Gorimanipalli et al, 2019). In addition, some cases have reported that BTX-A is equally effective in trigeminal neuralgia caused by multiple sclerosis, suggesting that BTX-A can also treat atypical trigeminal neuralgia (Calejo et al, 2019).…”

“…The efficacy of BTX-A combined with 0.2% local anaesthetic ropivacaine hydrochloride injection (BTX group) with ropivacaine hydrochloride injection alone (LA group) for the treatment of pelvic floor myofascial syndrome and chronic pelvic pain showing that neither group exhibited any significant differences on day 60. However, the two groups showed an overall improvement in pain, meaning that intramuscular injection with ropivacaine hydrochloride alone was justified (Gorimanipalli et al, 2019;Levesque et al, 2021). The randomized clinical trials of BTX-A for myofascial pain has also been elaborated (Table 1).…”

Neuromodulators for Atypical Facial Pain and Neuralgias: A Systematic Review and Meta‐Analysis

“…The most common reasons for exclusion were insufficient data, followed by incorrect indication and inappropriate study design. Among the included studies, 45 were noncontrolled observational studies 2,7‐41 (Table I) and 29 were randomized controlled trials 3,4,9,23,40,42‐64 (Table II). One study reported on multiple trials, including an observational study and a randomized controlled trial 9 .…”

“…There were 24 therapies assessed. Carbamazepine was the most common intervention examined across studies, with 19 observational studies 5,6,[20][21][22][27][28][29][30][31]33,35,[65][66][67][68][69][70][71] and 9 randomized controlled trials, 23,44,[47][48][49]58,59,62,63 followed by botulinum toxin A with 11 observational studies 8,[12][13][14][15][16][17][18][19]41,72 32 oxcarbazepine, 7,36,44 pregabalin, 39 valproic acid, 38 gabapentin, 6,21,73 lamotrigine 21,60,62,64 ), local anesthetics (lidocaine, 37,53,57,61,67 tocainide 48 ), selective serotonin receptor agonists (sumatriptan…”

“…There were 24 therapies assessed. Carbamazepine was the most common intervention examined across studies, with 19 observational studies 5,6,[20][21][22][27][28][29][30][31]33,35,[65][66][67][68][69][70][71] and 9 randomized controlled trials, 23,44,[47][48][49]58,59,62,63 followed by botulinum toxin A with 11 observational studies 8,[12][13][14][15][16][17][18][19]41,72 and 4 randomized controlled trials. 4,[50][51][52] Other pharmacologic interventions studied include antidepressants (amitriptyline, 2,11,42 duloxetine, 23,24 venlafaxine 3 ), anticonvulsants (clonazepam, 25,26,34 eslicarbazepine, ...…”