Therapeutic efficacy and safety of Botulinum Toxin A Therapy in Trigeminal Neuralgia: a systematic review and meta-analysis of randomized controlled trials

Abstract

BackgroundSeveral different interventions have been examined to alleviate pain and reduce frequency of trigeminal neuralgia (TN) paroxysms. However, some patients continue to have persistent or recurrent painful attacks. Using a systematic review and meta-analysis approach, we aimed to synthesize evidence from published randomized controlled trials (RCTs) regarding safety and efficacy of botulinum toxin type A (BTX-A) as a possible emerging choice of treatment for TN.MethodsWe conducted an electronic search in 10 databases/electronic search engines to access relevant publications. All articles in all languages reporting RCTs on the efficacy and safety of BTX-A in the treatment of TN were included for systematic review and meta-analysis.ResultsA total of four RCTs (n = 178) were identified for final meta-analysis. The overall effect favored BTX-A versus placebo in terms of proportion of responders (risk ratio RR = 2.87, 95 % confidence interval CI [1.76, 4.69], p <0.0001) with no significant detected heterogeneity (p = 0.31; I2 = 4 %). Paroxysms frequency per day was significantly lower for BTX-A group (mean difference MD = -29.79, 95 % CI [-38.50,–21.08], p <0.00001) with no significant heterogeneity (p = 0.21; I2 = 36 %).ConclusionDespite limited data, our results suggest that BTX-A may be an effective and safe treatment option for patients with TN. Further larger and well-designed RCTs are encouraged to translate these findings into better clinical outcome and better quality of life for TN patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s10194-016-0651-8) contains supplementary material, which is available to authorized users.

The efficacy and safety of botulinum toxin type A in treatment of trigeminal neuralgia and peripheral neuropathic pain: A meta‐analysis of randomized controlled trials

“…Recently, three reviews have demonstrated that BTX-A may provide a clinically significant benefit in treating TN (Morra et al, 2016), PN (Shackleton et al, 2016), and DNP (Lakhan et al, 2015). However, thus far, few investigations have explored the evidence for the overall effect of BTX-A on TN and PNP.…”

Neuromodulation and Devices in Trigeminal Neuralgia

“…Muscle relaxants such as tizanidine and anti‐arrhythmics such as tocainide were studied as well. Chemodenervation with onabotulinumtoxinA has been found to be effective for treatment of trigeminal neuralgia; however, the techniques and dosing have often been different among the several studies done . Clinicians often use these same medications in painful trigeminal neuropathies from various causes, however there is very limited evidence for the use of oral pharmacologic therapy in these disorders.…”

Two Doses of Botulinum Toxin Type A for the Treatment of Trigeminal Neuralgia: Observation of Therapeutic Effect from A Randomized, Placebo-Controlled Trial

“…The application of BTX-A to relieve TN was first reported in 2002, and its safety and effectiveness was later confirmed by series studies [3][4][5][6][7][8][9][10][11][12][13]. In 2012, our team conducted the first RCT study in this field, and obtained the prima facie evidence of BTX-A for TN.…”