The efficacy of botulinum toxin for the treatment of trigeminal and postherpetic neuralgia: a systematic review with meta-analyses

A selection of abstracts of clinically relevant papers from other journals. The abstracts on this page have been chosen and edited by John R. Radford.

Abstract

There is moderate evidence as to the efficacy of the use of botulinum toxin to treat trigeminal neuralgia and postherpetic neuralgia.

Main

Shackleton T, Ram S et al. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122: 61–71

Pharmacotherapy is the treatment of choice for most 'neuralgias' as it is less invasive than surgery. However, such medication is associated with ataxia, dizziness, nausea, fatigue, rash and drowsiness. Botulinum toxin type A (BoTN-A) is a neurotoxin that blocks acetylcholine release from presynaptic nerve endings. It has analgesic effects independent of its action on muscle tone.

In this systematic review and meta-analysis, 179 references were identified. Following exclusion, 19 texts were interrogated resulting in six studies that were included in this qualitative synthesis. All six studies were double-blinded, randomised, placebo-controlled studies. The overall strength of the evidence was moderate because of the small number of studies and risk of bias. 'Patients treated with BoTN-A were about 2.9 times more likely to have a 50% or more reduction in pain compared with the placebo group (95% CI 1.726–4.848; P <0.001).' This finding is particularly welcome as all the patients had had a suboptimal response to conventional medical management.