A new treatment paradigm for trigeminal neuralgia using Botulinum toxin type A.

OBJECTIVES: To review the current data for the use of Botulinum toxin type A (BoNT-A) in trigeminal neuralgia (TN) and to describe the preferred injection technique of BoNT-A in TN. To propose a new treatment paradigm for TN incorporating the use BoNT-A. DATA SOURCES: MEDLINE and Google Scholar databases. REVIEW METHODS: The current data on BoNT-A for TN were reviewed and analyzed for outcomes. RESULTS: Seven studies examining the use of BoNT-A were identified: Two randomized double-blind, placebo-controlled studies and five prospective case series. All studies found BoNT-A to be an effective treatment in the majority of patients; and the results of the two randomized double-blind placebo-controlled study showed significant benefit over placebo. The majority of studies used an intradermal or subcutaneous injection technique. The most common side effect was transient facial paresis. CONCLUSIONS: BoNT-A offers a safe, effective, local treatment for TN that is nonablative in nature. BoNT-A should be considered in patients who have failed, become refractory to, or are unable to tolerate first-line pharmacologic treatments. LEVEL OF EVIDENCE: N/A.