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


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.

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Botulinum toxin A


Magnetic resonance imaging


Trigeminal neuralgia


Visual Analog Scale


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

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Correspondence to Yajun Lian.

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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.

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The authors declare that they have no conflict of interest.

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Wu, C., Xie, N., Liu, H. et al. A new target for the treatment of trigeminal neuralgia with botulinum toxin type A. Neurol Sci 39, 599–602 (2018).

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  • Fifth cranial nerve
  • Neuropathic pain
  • Gingiva
  • Masseter
  • Intramuscular
  • Subcutaneous