Therapeutic Efficacy of Botulinum Toxin in Trigeminal Neuralgia

Abstract

Trigeminal neuralgia (TN) is a unilateral, paroxysmal, sharp, shooting, or jabbing pain that occurs in the trigeminal nerve divisions, including the ophthalmic (V1), maxillary (V2), and mandibular (V3) nerves. Typically, an episode is triggered by anything touching the face or teeth. TN is a clinical diagnosis with no specific diagnostic test; it is determined by the patient's medical history and pain description. Imaging is necessary to exclude secondary causes. The precise reason for TN is uncertain, but it is commonly believed to result from vascular compression of the trigeminal nerve root, typically near its origin in the pons. There are numerous surgical and medical treatment options available. The most frequently applied medical treatment therapies are carbamazepine and oxcarbazepine. Surgical alternatives are reserved for patients who do not respond to medical treatment. Botulinum toxin A (BTX-A) has emerged as a novel and promising alternative to surgery for individuals whose pain is unresponsive to medication. Multiple studies have established the safety and usefulness of BTX-A in treating TN, with the most significant benefits occurring between six weeks and three months after the surgery. This article reviews various studies published in the last 10 years regarding the therapeutic use of BTX-A in TN. These studies include various observational, clinical, pilot, and animal studies.

How Does Botulinum Toxin Inhibit Itch?

“…There are several conditions for which BoNT is not yet approved for clinical use, but off-label use has been presented, with beneficial effects, for example, in dermatology [ 33 , 34 , 35 ], primary headaches other than migraine [ 36 ], depression [ 37 ], and neuropathic pain [ 38 , 39 ]. One large area in which the off-label use of BoNT has been practiced for the last two decades is dermatology, for various conditions that appear with or without itch [ 40 , 41 , 42 , 43 ].…”