title: Botulinum Toxin as Monotherapy in Symptomatic Trigeminal Neuralgia.
abstract: BACKGROUND
  Trigeminal neuralgia (TN) is one of the most agonizing facial pain disorders that humans endure. Studies on onabotulinum toxin A (BTX-A) treatment for TN are limited, but promising with respect to TN of no identifiable cause. We aimed to investigate the efficiency and safety of BTX-A treatment in a 60-year-old male with diabetes mellitus who in March 2013 presented with TN caused by an exostosis in Meckel's cave.
  
  
  METHODS
  The patient was medically treatment refractory due to insufficient pain relief and adverse events of hyperglycemia, and surgery was declined due to complex anatomy. As a last resort, BTX-A was injected into the pain trigger zones of the trigeminal nerve (V5).
  
  
  RESULTS
  Complete analgesia was reported 2 weeks after BTX-A injection. Pain medications were discontinued and laboratory values returned to acceptable levels. Regular BTX-A treatment during the next 28 months showed sustained analgesic effect.
  
  
  CONCLUSIONS
  BTX-A has an excellent safety profile and may be efficient for patients with symptomatic TN not suited for conventional therapies.
authors.affiliation: Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway.|Aleris Hospital and Medical Center, Bergen, Norway.|Department of Clinical Medicine, KG Jebsen MS Research Centre, University of Bergen, Bergen, Norway.
authors.forename: Hanne Marie Bøe
authors.initials: HM
authors.lastname: Lunde
authors.affiliation: Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine, KG Jebsen MS Research Centre, University of Bergen, Bergen, Norway.
authors.forename: Øivind
authors.initials: Ø
authors.lastname: Torkildsen
authors.affiliation: Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Bø
authors.affiliation: Aleris Hospital and Medical Center, Bergen, Norway.
authors.forename: Anne Kjørsvik
authors.initials: AK
authors.lastname: Bertelsen
mesh_terms: D000368:Aged; D001905:Botulinum Toxins / Q000627:therapeutic use*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009498:Neurotoxins / Q000627:therapeutic use*; D015898:Tomography Scanners, X-Ray Computed; D014276:Trigeminal Nerve / Q000187:drug effects / Q000503:physiopathology; D014277:Trigeminal Neuralgia / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D009498:Neurotoxins; D001905:Botulinum Toxins
keywords: Meckel's cave; botulinum toxin; facial pain; trigeminal nerve; trigeminal neuralgia