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Botulinum Toxin Type A for refractory trigeminal neuralgia in older patients: a better therapeutic effect

Authors Wu S, Lian Y, Zhang H, Chen Y, Wu C, Li S, Zheng Y, Wang Y, Cheng W, Huang Z

Received 15 February 2019

Accepted for publication 27 May 2019

Published 17 July 2019 Volume 2019:12 Pages 2177—2186


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Katherine Hanlon

Shouyi Wu,1 Yajun Lian,1 Haifeng Zhang,1 Yuan Chen,1 Chuanjie Wu,2 Shuang Li,1 Yake Zheng,1 Yuhan Wang,1 Wenchao Cheng,1 Zhi Huang1

1Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People’s Republic of China; 2Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China

Background: Some studies have indicated that a local injection of Botulinum Toxin Type A (BTX-A) is a promising therapy for trigeminal neuralgia (TN). However, BTX-A treatment is still ineffective for approximately 10–43% of patients. We therefore investigated which factors are associated with the therapeutic effect in BTX-A treatment of medically refractory, classical TN.
Methods: We performed a retrospective cohort study with a total of 104 patients who were receiving BTX-A injection for medically refractory classical TN between August 2013 and October 2016. A VAS score, pain attack frequency per day as well as patients’ overall response to treatment and side effects were evaluated in 104 patients with TN who were receiving BTX-A.
Results: A total of 87 patients reported successful results; 41 stated that their pain was completely controlled while 46 reported adequate pain relief, totaling 83.7%. Our study suggests that treatment success was higher in patients 50 or older (OR=3.66, 95% CI: 1.231–10.885). Univariate and multivariate analyses demonstrated that the patient’s age was independently associated with treatment outcome (OR=1.72, 95% CI: 1.063–2.282), with ≥50 years being a significant predictor of pain relief (P=0.020 and P=0.033, respectively). Seventeen patients (16.3%) reported mild side effects.
Conclusion: A local injection of BTX-A may be a safe and efficient treatment for classical TN which lasts for several months. BTX-A is a novel strategy which is particularly worth trying for particularly middle-aged and elderly patients who cannot tolerate drug side effects and may be afraid of serious complications from microvascular decompression.

Keywords: trigeminal neuralgia, Botulinum Toxin Type A, age, local injection, therapeutic effect

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