Neurological Sciences

, Volume 39, Issue 3, pp 599–602 | Cite as

A new target for the treatment of trigeminal neuralgia with botulinum toxin type A

  • Chuanjie Wu
  • Nanchang Xie
  • Hongbo Liu
  • Haifeng Zhang
  • Lu Zhang
  • Yajun Lian
Quiz Cases


Trigeminal neuralgia (TN) is typically treated pharmacologically with anticonvulsants, but these can be ineffective, or can lose their effectiveness over time. In recent years, botulinum toxin type A (BoNT-A), when injected subcutaneously across multiple sites, can effectively treat TN. However, approximately 30% of TN cases are refractory to subcutaneous BoNT-A treatment. We report here the case of a 79-year-old female patient with TN presenting as severe, episodic pain in the lower left gingival area. She was on anticonvulsant therapy (carbamazepine) for about 3 years prior to BoNT-A treatment. Despite initial relief, the pain not only recurred, but also began to worsen, even as her carbamazepine dose was increased substantially. We injected 50 U of BoNT-A into the oral mucosa of the painful gingival area, but the patient’s pain was unaffected. We then changed to an intramuscular injection protocol and injected the same dose of BoNT-A into the left masseter, which produced a good therapeutic effect for about 5 months; she was then administered a second treatment (intra-masseter), and at a 2-week follow-up, still reported being pain-free. This case and a survey of the literature suggest that BoNT-A injection protocols maybe closely correlated with their clinical efficacy in cases of TN, possibly due to the ability of BoNT-A to be transported retrogradely along trigeminal nerve axons. We believe that finding the optimal BoNT-A therapy injection protocol(s) will significantly reduce the number of refractory cases of TN.


Fifth cranial nerve Neuropathic pain Gingiva Masseter Intramuscular Subcutaneous 



Botulinum toxin A


Magnetic resonance imaging


Trigeminal neuralgia


Visual Analog Scale



This work was supported by a grant from National Natural Science Foundation of China (No. U1404809, 81571260).

Compliance with ethical standards

Ethics approval

This study was approved by The First Affiliated Hospital of Zhengzhou University. Written informed consent was obtained from the patient for publication of this case report.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Italia S.r.l. 2017

Authors and Affiliations

  1. 1.Department of NeurologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
  2. 2.Department of NeurosurgeryXuanwu Hospital Capital Medical UniversityBeijingChina

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