Trigeminal neuralgia (TN) is a clinical condition characterized by paroxysmal attacks of severe and electric shock-like pain along the distribution of one or more branches of the trigeminal nerve. Various medicinal or surgical modalities have been employed in the past with variable success. Newer methods were tried in search of permanent cure or long-lasting pain relief. The purpose of this paper is to present the review of the literature regarding the use of botulinum toxin type-A (BTX-A) in the management of trigeminal neuralgia. 1. Introduction The English philosopher John Locke in 1677 firstly described the trigeminal neuralgia (TN). In 1756, Nicolaus Andre coined the term “tic douloureux” for the condition characterized by trigeminal neuralgia pain as well as muscle spasm. In 1773, John Fothergill gave detailed description of the trigeminal neuralgia [1]. Trigeminal neuralgia (TN) is a painful disorder of the trigeminal nerve characterized by paroxysmal attacks of severe, electric shock-like pain typically present on one side of the face. Pain is unilateral and follows one or more of the distributions of the trigeminal nerve. Mandibular and maxillary divisions are more commonly involved than ophthalmic division. There is a slight predilection for female sex. The right side of the face is more commonly involved than the left side of the face. Trigeminal neuralgia affects approximately 1 person in 25,000 people. It is more prevalent in middle or old age group people [1–3]. Various treatment modalities for trigeminal neuralgia include medicinal management, peripheral nerve injection of local anesthetic or alcohol, peripheral neurectomies, alcohol injection of trigeminal ganglion, and intracranial neurosurgical procedures [4]. 2. Botulinum Toxin (BTX) The botulinum toxin (BTX) is a naturally occurring neurotoxin that is produced by gram-positive anaerobic bacteria Clostridium botulinum. There are seven distinct antigenic subtypes of botulinum toxin. Botulinum toxin type-A (BTX-A) is the most commonly used form for cosmetic purposes [5]. The BTX-A is prepared by Hall strain Clostridium botulinum fermentation. It is precipitated, filtered, and further processed into a vacuum-dried fine powder. A standard vial of BTX-A contains 100 units of toxin, 0.5？mg of human albumin, and 0.9？mg of sodium chloride [6]. 3. Risks Factors and Adverse Effects of Botulinum Toxin (BTX) Botulinum toxin has a high safety profile, reflected by paucity of documented irreversible medical complications [7, 8]. Botulinum toxin is most effective at local injection site. Minute
References
[1]
S. C. Bagheri, F. Farhidvash, and V. J. Perciaccante, “Diagnosis and treatment of patients with trigeminal neuralgia,” Journal of the American Dental Association, vol. 135, no. 12, pp. 1713–1717, 2004.
[2]
S. K. Dufour, “An unusual case of stabbing eye pain: a case report and review of trigeminal neuralgia,” Optometry, vol. 73, no. 10, pp. 626–634, 2002.
[3]
R. Chole, R. Patil, S. S. Degwekar, and R. R. Bhowate, “Drug treatment of trigeminal neuralgia: a systematic review of the literature,” Journal of Oral and Maxillofacial Surgery, vol. 65, no. 1, pp. 40–45, 2007.
[4]
S. J. Scrivani, E. S. Mathews, and R. J. Maciewicz, “Trigeminal neuralgia,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 100, no. 5, pp. 527–538, 2005.
[5]
N. J. Lowe, “Botulinum toxin type A for facial rejuvenation: United States and United Kingdom perspectives,” Dermatologic Surgery, vol. 24, no. 11, pp. 1216–1218, 1998.
[6]
Product Information Package Insert (71390US12J), Irvine, Calif, Allergen, Inc, 2002.
[7]
A. Carruthers, K. Kiene, and J. Carruthers, “Botulinum a exotoxin use in clinical dermatology,” Journal of the American Academy of Dermatology, vol. 34, no. 5 I, pp. 788–797, 1996.
[8]
S. L. Matarasso, “Complications of botulinum A exotoxin for hyperfunctional lines,” Dermatologic Surgery, vol. 24, no. 11, pp. 1249–1254, 1998.
[9]
D. J. Lange, M. Rubin, P. E. Greene et al., “Distant effects of locally injected botulinum toxin: a double-blind study of single fiber EMG changes,” Muscle and Nerve, vol. 14, no. 7, pp. 672–675, 1991.
[10]
A. Matarasso and A. K. Deva, “Botulinum toxin,” Plastic and Reconstructive Surgery, vol. 109, no. 3, pp. 1191–1197, 2002.
[11]
A. Blitzer, W. J. Binder, W. J. Boyd, et al., Management of Facial Lines and Wrinkles, Lipincott Williams & Wilkins, Philadelphia, Pa, USA, 2000.
[12]
A. B. Scott, “Clostridial toxins as therapeutic agents,” in Botulinum Neurotoxin and Tetanus Toxin, L. Simpson, Ed., pp. 399–406, Academic Press, New York, NY, USA, 1989.
[13]
J. Jankovic and M. F. Brin, “Therapeutic uses of botulinum toxin,” The New England Journal of Medicine, vol. 324, no. 17, pp. 1186–1194, 1991.
[14]
A. W. Klein, “The therapeutic potential of botulinum toxin,” Dermatologic Surgery, vol. 30, no. 3, pp. 452–455, 2004.
[15]
S. Mense, “Neurobiological basis for the use of botulinum toxin in pain therapy,” Journal of Neurology, vol. 251, supplement 1, pp. 1–7, 2004.
[16]
M. Costigan and C. J. Woolf, “Pain: molecular mechanisms,” Journal of Pain, vol. 1, no. 3, pp. 35–44, 2000.
[17]
C. J. Woolf and M. Costigan, “Transcriptional and posttranslational plasticity and the generation of inflammatory pain,” Proceedings of the National Academy of Sciences of the United States of America, vol. 96, no. 14, pp. 7723–7730, 1999.
[18]
C. J. Woolf and R. J. Mannion, “Neuropathic pain: aetiology, symptoms, mechanisms, and management,” Lancet, vol. 353, no. 9168, pp. 1959–1964, 1999.
[19]
G. E. Borodic and M. A. Acquadro, “The use of botulinum toxin for the treatment of chronic facial pain,” Journal of Pain, vol. 3, no. 1, pp. 21–27, 2002.
[20]
T. Sycha, M. Graninger, E. Auff, and P. Schnider, “Botulinum toxin in the treatment of Raynaud's phenomenon: a pilot study,” European Journal of Clinical Investigation, vol. 34, no. 4, pp. 312–313, 2004.
[21]
S. Aurora, “Botulinum toxin type A for the treatment of migraine,” Expert Opinion on Pharmacotherapy, vol. 7, no. 8, pp. 1085–1095, 2006.
[22]
H. Wheeler-Aceto, F. Porreca, and A. Cowan, “The rat paw formalin test: comparison of noxious agents,” Pain, vol. 40, no. 2, pp. 229–238, 1990.
[23]
S. M. Carlton, G. L. Hargett, and R. E. Coggeshall, “Localization and activation of glutamate receptors in unmyelinated axons of rat glabrous skin,” Neuroscience Letters, vol. 197, no. 1, pp. 25–28, 1995.
[24]
ü. Türk, S. Ilhan, R. Alp, and H. Sur, “Botulinum toxin and intractable trigeminal neuralgia,” Clinical Neuropharmacology, vol. 28, no. 4, pp. 161–162, 2005.
[25]
P. L. Durham, R. Cady, R. Cady, and A. J. Blumenfeld, “Regulation of calcitonin gene-related peptide secretion from trigeminal nerve cells by botulinum toxin type A: implications for migraine therapy,” Headache, vol. 44, no. 1, pp. 35–43, 2004.
[26]
D. E. Rapp, K. W. Turk, G. T. Bales, and S. P. Cook, “Botulinum toxin type a inhibits calcitonin gene-related peptide release from isolated rat bladder,” Journal of Urology, vol. 175, no. 3, pp. 1138–1142, 2006.
[27]
G. E. Borodic, M. Acquadro, and E. A. Johnson, “Botulinum toxin therapy for pain and inflammatory disorders: mechanisms and therapeutic effects,” Expert Opinion on Investigational Drugs, vol. 10, no. 8, pp. 1531–1544, 2001.
[28]
A. L. Sheffer, N. A. Soter, E. R. McFadden Jr., and K. F. Austen, “Exercise-induced anaphylaxis: a distinct form of physical allergy,” Journal of Allergy and Clinical Immunology, vol. 71, no. 3, pp. 311–316, 1983.
[29]
N. A. Soter, S. I. Wasserman, K. F. Austen, and E. R. McFadden Jr., “Release of mast-cell mediators and alterations in lung function in patients with cholinergic urticaria,” The New England Journal of Medicine, vol. 302, no. 11, pp. 604–608, 1980.
[30]
D. Boghen and M. Flanders, “Effectiveness of botulinum toxin in the treatment of spasmodic torticollis,” European Neurology, vol. 33, no. 3, pp. 199–203, 1993.
[31]
G. E. Borodic, L. Mills, and M. Joseph, “Botulinum A toxin for the treatment of adult-onset spasmodic torticollis,” Plastic and Reconstructive Surgery, vol. 87, no. 2, pp. 285–289, 1991.
[32]
M. A. Acquadro and G. E. Borodic, “Treatment of myofascial pain with botulinum A toxin,” Anesthesiology, vol. 80, no. 3, pp. 705–706, 1994.
[33]
E. J. Piovesan, H. G. Teive, P. A. Kowacs, M. V. Della Coletta, L. C. Werneck, and S. D. Silberstein, “An open study of botulinum-A toxin treatment of trigeminal neuralgia,” Neurology, vol. 65, no. 8, pp. 1306–1308, 2005.
[34]
C. Zú？iga, S. Díaz, F. Piedimonte, and F. Micheli, “Beneficial effects of botulinum toxin type a in trigeminal neuralgia,” Arquivos de Neuro-Psiquiatria, vol. 66, no. 3 A, pp. 500–503, 2008.
[35]
C. J. Wu, Y. J. Lian, Y. K. Zheng, et al., “Botulinum toxin type A for the treatment of trigeminal neuralgias: results from a randomized, double-blind, placebo-controlled trial,” Cephalgia, vol. 32, no. 6, pp. 443–450, 2012.
[36]
W. C. Ngeow and R. Nair, “Injection of botulinum toxin type A (BOTOX) into trigger zone of trigeminal neuralgia as a means to control pain,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 109, no. 3, pp. e47–e50, 2010.
[37]
N. Allam, J. P. Brasil-Neto, G. Brown, and C. Tomaz, “Injections of botulinum toxin type A produce pain alleviation in intractable trigeminal neuralgia,” Clinical Journal of Pain, vol. 21, no. 2, pp. 182–184, 2005.
[38]
Headache Classification Committee of the International Headache Society, “The international classification of headache disorders,” Cephalgia, vol. 1, no. 1, pp. 1–152, 2004.
[39]
T. Nurmikko and G. Cruccu, “Botulinum toxin for trigeminal neuralgia,” European Journal of Neurology, vol. 16, no. 5, p. e104, 2009.
[40]
R. H. Dworkin, D. C. Turk, J. T. Farrar et al., “Core outcome measures for chronic pain clinical trials: IMMPACT recommendations,” Pain, vol. 113, no. 1-2, pp. 9–19, 2005.
[41]
J. M. Zakrzewska, B. C. Lopez, D. Kondziolka, S. J. Haines, and B. Meyerson, “Quality of reporting in evaluations of surgical treatment of trigeminal neuralgia: recommendations for future reports,” Neurosurgery, vol. 53, no. 1, pp. 110–122, 2003.
[42]
J. M. Zakrzewska, J. Cohen, J. Brown et al., “An open study of botulinum-A toxin treatment of trigeminal neuralgia,” Neurology, vol. 66, no. 9, pp. 1458–1459, 2006.
[43]
B. Voller, T. Sycha, B. Gustorff et al., “A randomized, double-blind, placebo controlled study on analgesic effects of botulinum toxin A,” Neurology, vol. 61, no. 7, pp. 940–944, 2003.
