Year: 2026
Type: article
Study design: Observational Study
Abstract: ObjectiveTo evaluate the efficacy and safety of botulinum toxin type A (BoNT-A) in patients with refractory or inadequately controlled trigeminal neuralgia treated at a specialized outpatient clinic.MethodsRetrospective, observational, descriptive study was conducted through a review of electronic medical records of patients diagnosed with trigeminal neuralgia and treated at the Neuromuscular Blockade Outpatient Clinic of the Municipal Health Department of Joinville, Santa Catarina, Brazil, between 2019 and 2022. Patients who received BoNT-A injections and had documented clinical follow-up were included. As this was a retrospective review of previously existing medical records, with no prospective intervention or direct patient enrollment, no ethics committee approval was obtained for the present chart-based analysis. Patients who were already receiving pharmacological treatment for pain continued their prescribed medications during follow-up, with BoNT-A administered as an adjunctive treatment. Pain intensity was routinely assessed using the Visual Analog Scale (VAS). The observation period for treatment response and recurrence was 12 months.ResultsNineteen patients were included in the final analysis. The mean age was 67.9 years (range, 27–87 years). Most patients presented severe baseline pain, with VAS scores ranging from 8 to 10. BoNT-A doses ranged from 20 to 180 U. Following treatment, 18 of 19 patients (94.7%) achieved a clinically significant response, defined as a reduction of more than 50% in pain intensity. Several patients experienced complete or near-complete remission, maintaining VAS scores between 0 and 3 during follow-up. Pain recurrence was observed predominantly in patients in whom reinjection was delayed or follow-up intervals were prolonged. Because the study was retrospective, the precise timing and clinical reasons for delayed reinjection could not always be determined. One patient developed transient facial paresis, which resolved completely without permanent sequelae. No serious adverse events were documented.ConclusionIn this retrospective case series, BoNT-A was associated with substantial pain reduction and a favorable safety profile in patients with refractory or inadequately controlled trigeminal neuralgia. However, the concomitant use of previous pharmacological treatments, the absence of a standardized injection protocol, and the retrospective nature of the study prevent attribution of the observed clinical response exclusively to BoNT-A. Prospective controlled studies with standardized injection protocols, dilution, injection depth, technique, and predefined reinjection intervals are warranted.
Institution: Universidade da Região de Joinville
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225582105