Cases of Surgery failed drug resistant Trigeminal neuralgia were treated with Botox to trigger zones and not only resulted in relief, but also relative cure in some case
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Jul 29. [Epub ahead of print]
Use of botulinum toxin A for drug-refractory trigeminal neuralgia: preliminary report.
Bohluli B, Motamedi MH, Bagheri SC, Bayat M, Lassemi E, Navi F, Moharamnejad N. abstract here
- 15 cases ages 28-67 years (mean 48.9 y)
- the catch appears finding a trigger zone: “All patients had been injected with 1.8 mL lidocaine at the trigger zone, which alleviated the pain while the anesthetic lasted. Trigger zones were stated by the patients and confirmed by clinical examination. Their pain recurred after anesthesia wore off.”
- Botox was made up by adding 3 ml saline into 100 unit bottles. 50- 100 units Botox was injected into each trigger
- “In 7 patients, pain was completely eradicated [~50%] and there was no need for further medication. In 5 patients, nonsteroidal antiinflammatory drugs were enough to alleviate pain attacks, and 3 patients again became responsive to anticonvulsive drugs after injection.” This was a six month after assessment.
- Complications – 2 transient facial nerve paralysis lasting 2 weeks (you would have though that would have been noticed during prior injection of local). “In the third patient the paresis was severe, requiring physiotherapy, and took about 3 months to disappear” – OK so cases are in a lottery and you hope not to be a winner. They had only 2 cases of eye level (opthalmic) zoster – one got some initial paralysis – I could see that level being a more difficult area to do…
Comment – “complete cure” in 1/2 and considerable benefit in the rest at time of writing (6+ months). WOW – that’s fantastic… the paralysis effect still scares me and patients need to be aware they are in a “lottery”.
Any comments?
Greetings!
I’m a GP dentist, 21 years in practice now and i really find this clinicsl trial/research/technique practical,do-able and very promising given the benefits to TN neuralgia patients. I’m confronted with such cases in my practice like 1 in 2 years and find this technique really usable ,only have any researcher/clinical yrialist tried injecting botox sub-mucosally? I’m querrying this since i’m a dentist and more comfortable to work in my area of specialization-intra-orally. I’m aware that botox is basically a dermatologic preparation/application thus my reservations in trying to use it on my patients. Please comment,it would be a great help to those in need both physically/psychologically and financially. Thank you and my Warmest Regards!
Dr. Zafra:
That is an excellent question. At the IASP meeting I heard someone mention injecting a chronically sore tooth might responded to botulinum injections.
With a trigger zone on the gum line, an acrylic sheild can been fabricated to be worn over the area and three of the following items in orabase made up to be put under :
amitriptyline 2%
carbamazepine 2%
lidocaine 5%
capsaicin 0.02%
clonidine 0.2%
ketoprofen 10%
ketamine 2%
gabapentin 6%
If you use ketoprofen, I was told at the IASP congress that you must use the more soluble form – not crushed pills/capsules. I guess it is trial and error to find the right 3 combo.
The paste was re-applied every 4-6 hours
You can read more about this here:
http://painmuse.org/?p=156 (about 1/2 way down)
“Within approximately 10 days the activity of the trigger zone was diminished and remained so for 2 week. The frequency of use of the compound was reduced slowly to twice daily and then discontinued after 8 weeks.” – good luck there
Let us know how things worked for you!
Hi I am a turning fifty in May and have just been diagnosed with TN. My regular doctor new right away when I told him my symptoms and how long it was going on. I went on to go see a neurologist take all kind of test and they were great, he was looking for more serious diseases. Long story short I have this Trigeminal Neuralgia, I am Gabapentin 500mg three times daily do you think that Botox would be worth the risk for my pain? I would appreciate your feedback.
I wrote about options here:
Trigeminal Neuralgia
http://painmuse.org/?p=156
Hard to say – not knowing your condition. Gabapentin is not usually the first line drug choice as only 1/2 as effective as carbamazepine (tegretol) though it is safer and more tolerable. If it works – just stick to it! Botox seems to be used more as a last resort.
You are fairly young and have a lifetime to consider. Many destructive procedures in TN have “expiry dates” (only work for so long) so holding out with medications would be helpful but if you are not getting relief, you might want to see a neurosurgeon. Microvascular surgery apparently can give you 75% longterm relief but can have a 10% rate of persistent unpleasant feeling in face. If surgery fails, meds might recapture control or destructive procedures could be used. Maybe go to your local trigeminal neuralgia group and find out what results have been achieved locally
-admin