Drug-Refractory Trigeminal Neuralgia: Treatment via Botulinum Toxin Type A

Trigeminal neuralgia (TN) is a disorder characterized by severe abrupt lancinating pains, limited to areas of distribution of the fifth cranial nerve—the trigeminal nerve. Numerous modals have been used to reduce or alleviate the intensity and frequency of pain. Drug therapy with anticonvulsive drugs is still the first choice. Migraine and occipital neuralgia have been treated via botulinum toxin type A (BTX-A). Symptoms of TN (pain duration, initiating factors, affected nerve branch, frequency of attacks, and severity of pain) are assessed before injections, and evaluated 1 week, 1 month, and 6 months after injection of 50 U reconstituted BTX-A solution in the trigger zones. Patients generally improve with regard to frequency and severity of pain attacks and in many, the pain is completely eradicated and there is no need for further medication. In some patients, nonsteroidal anti-inflammatory drugs (NSAIDs) may be needed to alleviate pain attacks. All patients develop higher pain thresholds after injections. Complications of BTX therapy include transient paresis of the facial nerve. BTX-A therapy is a minimally invasive method that can play a role in treating TN before other more invasive therapies, i.e., radiofrequency and surgery, are sought. In this chapter, we discuss the indication and method to treat TN via BTX-A in patients refractory to medical treatment