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”.