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What Is New and Effective in Treating Refractory Trigeminal Neuralgia?
Raquel Branco1, Bernardo G Silva2, Adriana Pereira3
1Physical Medicine and Rehabilitation, Hospital Do Divino Espírito Santo, Ponta Delgada, PRT.
Cureus
|December 9, 2024
Summary
Botulinum toxin type A (BoNT-A) offers significant pain relief for trigeminal neuralgia (TN) refractory to conventional treatments. This case study shows BoNT-A as a safe and effective adjunctive therapy for managing severe facial pain in complex patients.
Area of Science:
- Neurology
- Pain Management
- Pharmacology
Background:
- Trigeminal neuralgia (TN) is a debilitating facial pain condition often refractory to standard treatments like carbamazepine.
- Secondary TN, particularly in patients with multiple sclerosis (MS), presents unique management challenges.
- Previous pharmacological and surgical interventions failed in a patient with secondary progressive MS and refractory TN.
Observation:
- A 47-year-old female with MS and refractory TN experienced severe pain limiting rehabilitation.
- Botulinum toxin type A (BoNT-A) was administered subcutaneously (100U) to painful facial regions.
- Pain intensity decreased from 8-9/10 to 1/10 on the VAS scale post-BoNT-A injection.
Findings:
- BoNT-A treatment resulted in marked pain reduction and decreased reliance on emergency analgesics.
- The patient reported less frequent pain exacerbations following BoNT-A therapy.
- Transient ipsilateral facial paresis (House-Brackmann grade II) was the sole adverse effect.
Implications:
- BoNT-A shows potential as an effective adjunctive therapy for refractory trigeminal neuralgia.
- This case supports considering BoNT-A in complex TN patients who have exhausted other treatment options.
- Further research is needed to establish standardized guidelines for BoNT-A dosing and administration in TN.
