The Use of Botulinum Toxin A in the Management of Trigeminal Neuralgia: a Systematic Literature Review.

Objectives: The purpose of this article is to systematically review the use, efficacy, differences between botulinum toxin type A doses and side effects of botulinum toxin type A therapy in patients with trigeminal neuralgia.

Material and methods: The search for the performed reviews was done in PubMed and Cochrane library in English language from January 2010 up to February 2020. Inclusion criteria: full-text studies in English language, in which visual assessment scale (VAS) was present, in which patients with trigeminal neuralgia (TN) were participated and the comparison between botulinum toxin type A (BT-A) and saline was done.

Results: The review included 4 randomized, double-blind, placebo-controlled trials with 8 to 12 weeks follow-up to observe changes in VAS and in frequency of TN attacks, differences between dosages of BT-A in therapy and side effects. Mean VAS of BT-A group decreased by approximately 68% and of palcebo group decreased by approximately 21.6% after the therapy. Mean frequency of TN attacks in 3 studies of BT-A group decreased by 85%, while in palcebo by only 15.9%.

Conclusions: Botulinum toxin type A injection therapy is a safe and effective method in management of trigeminal neuralgia. No differences between dosages of botulinum toxin type A were found. Maximum efficacy was noticed between 6 weeks and 3 months after the procedure. Side effects were mostly facial asymmetry after injection, headaches, haematoma, which disappeared in one week.