OnabotulinumtoxinA for trigeminal neuralgia: a review of the available data.
Trigeminal neuralgia (TN) patients may develop side effects from centrally acting drugs, have contraindications for neurosurgical procedures, or experience relapse during conventional therapies. OnabotulinumtoxinA (BoNT/A) has been reported to be effective for TN, although this finding has been challenged. An overview of the available evidence based on a narrative/qualitative analysis of the literature is presented. About 90% of patients who receive BoNT/A show an improvement, a higher figure than that reported for the placebo effect of BoNT/A for other headaches. Tolerability of BoNT/A is good, and its few side-effects are transient. The articles reviewed were mainly case reports, case series and open-label trials; however, randomized controlled trials have endorsed the efficacy of BoNT/A for TN. This evidence, together with a better understanding of the analgesic mechanisms of BoNT/A and its proven efficacy in treating other pain syndromes, supports the use of this toxin as a therapeutic option for TN.
Instituto de Neurologia de Curitiba, Curitiba, PR, BR.
Pedro A
PA
Kowacs
Serviço de Neurologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, BR.
Marco A T
MA
Utiumi
Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, GD.
Fábio A
FA
Nascimento
Serviço de Neurologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, BR.
Elcio J
EJ
Piovesan
Serviço de Neurologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, BR.
Helio A G
HA
Teive
D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use*; D000818:Animals; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D006801:Humans; D015990:Placebo Effect; D014276:Trigeminal Nerve / Q000187:drug effects; D014277:Trigeminal Neuralgia / Q000188:drug therapy* / Q000503:physiopathology; D064232:Visual Analog Scale
D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A