Therapeutic effect of Botulinum toxin-A in 88 patients with trigeminal neuralgia with 14-month follow-up

Shuang Li, Ya-Jun Lian, Yuan Chen, Hai-Feng Zhang, Yun-Qing Ma, Cai-Hong He, Chuan-Jie Wu, Nan-Chang Xie, Ya-Ke Zheng, Yi Zhang, Shuang Li, Ya-Jun Lian, Yuan Chen, Hai-Feng Zhang, Yun-Qing Ma, Cai-Hong He, Chuan-Jie Wu, Nan-Chang Xie, Ya-Ke Zheng, Yi Zhang

Abstract

Background: We investigated the long-term effects and safety of botulinum toxin-A (BTX-A) for treating trigeminal neuralgia (TN). We also studied long-term maintenance of this therapeutic effect.

Methods: A visual analog scale (VAS) score, pain attack frequency per day, patient's overall response to treatment and side effects during 14-month follow-up were evaluated in 88 patients with TN receiving BTX-A. The primary endpoints were pain severity (assessed by VAS) and pain attack frequency per day. The secondary endpoint was the patient's overall response to treatment, assessed using the Patient Global Impression of Change. The influence of different doses (≤50, 50-100 and ≥100 U) on the therapeutic effect was evaluated.

Results: Treatment was deemed "effective" within 1 month in 81 patients and at 2 months in 88 patients (100%). The shortest period of effective treatment was 3 months, and complete control of pain was observed in a maximum of 46 patients. The therapeutic effect decreased gradually after 3 months, and the prevalence of effective treatment at 14 months was 38.6%, with complete control of pain seen in 22 patients (25%). There was no significant difference in the prevalence of effective treatment between different dose groups at identical time points (p > 0.05). Three patients showed swelling at injection sites and 10 patients showed facial asymmetry, both of which disappeared spontaneously without special treatment.

Conclusion: Local subcutaneous injection of BTX-A for TN treatment has considerable therapeutic effects lasting several months and is safe for this indication. At least one-quarter of patients maintained complete analgesia. The maintenance period of the therapeutic effect may be related to the reduction in the VAS score after the first injection of BTX-A.

References

    1. Hall GC, Carroll D, Parry D, McQuay HJ. Epidemiology and treatment of neuropathic pain: the UK primary care perspective [J] Pain. 2006;15(1-2):156–162.
    1. Lian YJ, Wei HL, Zhang BA, Liu HB, Xu YM, Fang SY, Li ZF, Fang GY, Lu H, Jia YJ, Zhao XY, Wei JK, Zhang L, Song B. Treatment of 795 facial spasm and local dystonia with Botulinum toxin A. J Zhengzhou Univ (Med Sci) 2009;15(2):440–442.
    1. Bowen ME, Weninger K, Bnmger AT. Single molecule observation of liposome-bilayer fusion thermally induced by soluble Nethyl maleimide sensitive factor attachment protein receptors (SNAREs) Biophys J. 2004;15:3569–3584.
    1. Micheli F, Scorticati MC, Raina G. Beneficial effects of botulinum toxin type A for patients with painful tic convulsif. Clin Neuropharmacol. 2002;15:260–262.
    1. Wu CJ, Lian YJ, Zheng YK. Botulinum toxin type A for the treatment of trigeminal neuralgia: results from a randomized, double-blind, placebo-controlled trial. Cephalalgia. 2012;15:443–450.
    1. Shen JH, Lian YJ, Zheng YK, Xie YY, Wei HL. Treatment of primary trigeminal neuralgia with botulinum toxin type A. China J Rehabil Med. 2011;15(5):483–484.
    1. Bohluli B, Motamedi MH, Bagheri SC, Bayat M, Lassemi E, Navi F, Moharamnejad N. Use of botulinum toxin A for drug-refractory trigeminal neuralgia: preliminary report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;15:47–50.
    1. Zhu TG, Zhang QL, Luo WF, Mao CJ, Hu WD, Liu CF. Clinical treatment of refractory trigeminal neuralgia with botulinum toxin type A. China Clinical Neuroscience. 2011;15(1):32–35.
    1. Gustavo F, Jose DA, Villanueva P, Asensio-Samper JM. Subcutaneous and perineural Botulinum Toxin Type A For Neuropathic Pain. Clin J Pain. 2013. [Epub ahead of print]
    1. Xiao L, Mackey S, Hui H, Xong D, Zhang Q, Zhang D. Subcutaneous injection of botulium toxin A is beneficial in postherpetic neuralgia. Pain Med. 2011;15:1827–1833.
    1. Yuan RY, Sheu JJ, Yu JM, Chen WT, Tseng IJ, Chang HH, Hu CJ. Botulinum toxin for diabetic neuropathic pain:a randomized double-blind crossover trial. Neurology. 2009;15:1456–1478.
    1. Taylor M, Silva S, Cottrell C. Botulinum toxin type A in the treatment of occipital neuralgia: a pilot study. Headache. 2008;15:1476–1481.
    1. Wu CJ, Lian YJ. Botulium toxin type A for trigeminal neuralgia-we have the prima facie evidence. Cephalagia. 2012;15(15):1156–1157.
    1. Borodic GE, Acquadro MA. The use of botulinum toxin for the treatment of chronic facial pain. J Pain J Pain. 2002;15:21–27.
    1. Turk U, Ilhan S, Alp R, Sur H. Botulinum toxin and intractable trigeminal neuralgia. Clin Neuropharmacol. 2005;15:161–162.
    1. Zuniga C, Diaz S, Piedimonte F, Micheli F. Beneficial effects of botulinum toxin type A in trigeminal neuralgia. Arq Neuropsiquiatr. 2008;15:500–503.
    1. Aoki KR. Review of a proposed mechanism for the antinociceptive action of botulinum toxin type A. Neurotoxicology. 2005;15:785–793.
    1. Gazerani P, Pedersen NS, Staahl C, Drewes AM, Arendt-Nielsen L. Subcutaneous botulinum toxin type A reduces capsaicin-indecd trigeminal pain and vasomotor reactions in human skin. Pain. 2009;15:60–69.
    1. Meng J, Ovsepian SV, Wang J. Activation of TRPV1 mediates calcitonin generelated peptide release, which excites trigeminal sensory neurons and is attenuated by a retargeted botulinum boxin with anti-nociceptive potential. J Neurosci. 2009;15:4981–4992.
    1. Woolf CJ, Costigan M. Transcriptional and posttranslational plasticity and the generation of inflammatory pain. Proc Natl Acad Sci. 1999;15:7723–7730.

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