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Tereshko Y, Valente M, Belgrado E, Dalla Torre C, Dal Bello S, Merlino G, Gigli GL, Lettieri C. The Therapeutic Effect of Botulinum Toxin Type A on Trigeminal Neuralgia: Are There Any Differences between Type 1 versus Type 2 Trigeminal Neuralgia? Toxins (Basel) 2023; 15:654. [PMID: 37999517 PMCID: PMC10675382 DOI: 10.3390/toxins15110654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/03/2023] [Accepted: 11/11/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Botulinum toxin type A is an effective treatment for trigeminal neuralgia. Moreover, its efficacy in type 2 trigeminal neuralgia and comparative studies between type 1 and type 2 trigeminal neuralgia (TN) still need to be improved. METHODS We treated 40 TN patients with onabotulinumtoxinA; 18 had type 1 TN, and 22 had type 2 TN. We compared the baseline pain score with the Visual Analogue Scale (VAS) and paroxysm frequency (number per week) at the baseline with those obtained at 1-month and 3-month follow-ups. Nonetheless, we compared the baseline Penn Facial Pain Scale with the scores obtained at the 1-month follow-up. RESULTS BoNT/A effectively reduced pain intensity and frequency at the 1-month and 3-month follow-ups. Moreover, the type 1 TN and type 2 TN groups had baseline pain scores of 7.8 ± 1.65 and 8.4 ± 1.1, respectively. Pain significantly improved (p < 0.001) in both groups to 3.1 ± 2.3 (type 1 TN) and 3.5 ± 2.3 (type 2 TN) at the 1-month follow-up and to 3.2 ± 2.5 (type 1 TN) and 3.6 ± 2.5 (type 2 TN) at the 3-month follow-up. There was no difference between the two groups (p 0.345). The baseline paroxysm frequencies (number per week) were 86.7 ± 69.3 and 88.9 ± 62.2 for the type 1 and type 2 TN groups, respectively; they were significantly reduced in both groups at the 1-month and 3-month follow-ups without significant differences between the two groups (p 0.902). The Pain Facial Pain Scale improved at the 1-month follow-up, and no significant differences were found between the two groups. There was a strong correlation between background pain and paroxysm pain intensity (r 0.8, p < 0.001). CONCLUSIONS Botulinum toxin type A effectively reduced the pain, paroxysm frequency, and PFPS scores of type 1 and type 2 trigeminal neuralgia patients without statistically significant differences. Facial asymmetry was the only adverse event.
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Affiliation(s)
- Yan Tereshko
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; (Y.T.); (G.M.); (C.L.)
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy;
| | - Mariarosaria Valente
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; (Y.T.); (G.M.); (C.L.)
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy;
| | - Enrico Belgrado
- Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; (E.B.); (C.D.T.)
| | - Chiara Dalla Torre
- Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; (E.B.); (C.D.T.)
| | - Simone Dal Bello
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; (Y.T.); (G.M.); (C.L.)
| | - Giovanni Merlino
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; (Y.T.); (G.M.); (C.L.)
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy;
| | - Gian Luigi Gigli
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy;
| | - Christian Lettieri
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; (Y.T.); (G.M.); (C.L.)
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy;
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Pareja JA, López-Ruiz P, Mayo D, Villar-Quiles RN, Cárcamo A, Gutiérrez-Viedma Á, Lastarria CP, Romeral M, Yangüela J, Cuadrado ML. Supratrochlear Neuralgia: A Prospective Case Series of 15 Patients. Headache 2017; 57:1433-1442. [PMID: 28833061 DOI: 10.1111/head.13158] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/11/2017] [Accepted: 04/11/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to describe clinical features unique to supratrochlear neuralgia. BACKGROUND The supratrochlear nerve supplies the medial aspect of the forehead. Due to the intricate relationship between supraorbital and supratrochlear nerves, neuralgic pain in this region has been traditionally attributed to supraorbital neuralgia. No cases of supratrochlear neuralgia have been reported so far. METHODS From 2009 through 2016, we prospectively recruited patients with pain confined to the territory of the supratrochlear nerve. RESULTS Fifteen patients (13 women, 2 men; mean age 51.4 years, standard deviation 14.9) presented with pain in the lower paramedian forehead, extending to the eyebrow in two patients and to the internal angle of the orbit in another. Pain was unilateral in 11 patients (six on the right, five on the left), and bilateral in four. Six patients had continuous pain and nine described intermittent pain. Palpation of the supratrochlear nerve at the medial third of the supraorbital rim resulted in hypersensitivity in all cases. All but one patient exhibited sensory disturbances within the painful area. Fourteen patients underwent anesthetic blockades of the supratrochlear nerve, with immediate relief in all cases and long-term remission in three. Six of them had received unsuccessful anesthetic blocks of the supraorbital nerve. Five patients were treated successfully with oral drugs and one patient was treated with radiofrequency. CONCLUSIONS Supratrochlear neuralgia is an uncommon disorder causing pain in the medial region of the forehead. It may be differentiated from supraorbital neuralgia and other similar headaches and neuralgias based on the topography of the pain and the response to anesthetic blockade.
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Affiliation(s)
- Juan A Pareja
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Pedro López-Ruiz
- Department of Neurology, Hospital Universitario Quironsalud Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Diego Mayo
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Rocío-Nur Villar-Quiles
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Alba Cárcamo
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.,Pain Clinic, Department of Anesthesiology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Álvaro Gutiérrez-Viedma
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Carlo P Lastarria
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
| | - María Romeral
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Julio Yangüela
- Department of Ophthalmology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - María-Luz Cuadrado
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, Treede RD, Zakrzewska JM, Nurmikko T. Trigeminal neuralgia: New classification and diagnostic grading for practice and research. Neurology 2016; 87:220-8. [PMID: 27306631 PMCID: PMC4940067 DOI: 10.1212/wnl.0000000000002840] [Citation(s) in RCA: 256] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/01/2016] [Indexed: 01/03/2023] Open
Abstract
Trigeminal neuralgia (TN) is an exemplary condition of neuropathic facial pain. However, formally classifying TN as neuropathic pain based on the grading system of the International Association for the Study of Pain is complicated by the requirement of objective signs confirming an underlying lesion or disease of the somatosensory system. The latest version of the International Classification of Headache Disorders created similar difficulties by abandoning the term symptomatic TN for manifestations caused by major neurologic disease, such as tumors or multiple sclerosis. These diagnostic challenges hinder the triage of TN patients for therapy and clinical trials, and hamper the design of treatment guidelines. In response to these shortcomings, we have developed a classification of TN that aligns with the nosology of other neurologic disorders and neuropathic pain. We propose 3 diagnostic categories. Classical TN requires demonstration of morphologic changes in the trigeminal nerve root from vascular compression. Secondary TN is due to an identifiable underlying neurologic disease. TN of unknown etiology is labeled idiopathic. Diagnostic certainty is graded possible when pain paroxysms occur in the distribution of the trigeminal nerve branches. Triggered paroxysms permit the designation of clinically established TN and probable neuropathic pain. Imaging and neurophysiologic tests that establish the etiology of classical or secondary TN determine definite neuropathic pain.
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Affiliation(s)
- Giorgio Cruccu
- From the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain (G.C., N.B.F., T.S.J., J.S., R.-D.T., T.N.), Washington, DC; Scientific Panel Pain of the European Academy of Neurology (G.C., T.S.J., T.N.), Vienna, Austria; Department of Neurology and Psychiatry (G.C.), Sapienza University, Rome, Italy; Danish Pain Research Centre, Department of Clinical Medicine (N.B.F., T.S.J.), and Section of Orofacial Pain and Jaw Function, Department of Dentistry (P.S.), Aarhus University, Denmark; Departments of Anesthesiology and Pharmacology (J.S.), Columbia University Medical Center, New York, NY; Department of Neurosurgery (M.S.), Hôpital Neurologique "Pierre Wertheimer," University of Lyon 1, Lyon, France; Center for Biomedicine and Medical Technology Mannheim (CBTM) (R.-D.T.), Heidelberg University, Mannheim, Germany; Facial Pain Unit, University College London Hospitals NHS Foundation Trust (J.M.Z.); and Pain Relief (T.N.), Neuroscience Research Centre, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Nanna B Finnerup
- From the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain (G.C., N.B.F., T.S.J., J.S., R.-D.T., T.N.), Washington, DC; Scientific Panel Pain of the European Academy of Neurology (G.C., T.S.J., T.N.), Vienna, Austria; Department of Neurology and Psychiatry (G.C.), Sapienza University, Rome, Italy; Danish Pain Research Centre, Department of Clinical Medicine (N.B.F., T.S.J.), and Section of Orofacial Pain and Jaw Function, Department of Dentistry (P.S.), Aarhus University, Denmark; Departments of Anesthesiology and Pharmacology (J.S.), Columbia University Medical Center, New York, NY; Department of Neurosurgery (M.S.), Hôpital Neurologique "Pierre Wertheimer," University of Lyon 1, Lyon, France; Center for Biomedicine and Medical Technology Mannheim (CBTM) (R.-D.T.), Heidelberg University, Mannheim, Germany; Facial Pain Unit, University College London Hospitals NHS Foundation Trust (J.M.Z.); and Pain Relief (T.N.), Neuroscience Research Centre, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Troels S Jensen
- From the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain (G.C., N.B.F., T.S.J., J.S., R.-D.T., T.N.), Washington, DC; Scientific Panel Pain of the European Academy of Neurology (G.C., T.S.J., T.N.), Vienna, Austria; Department of Neurology and Psychiatry (G.C.), Sapienza University, Rome, Italy; Danish Pain Research Centre, Department of Clinical Medicine (N.B.F., T.S.J.), and Section of Orofacial Pain and Jaw Function, Department of Dentistry (P.S.), Aarhus University, Denmark; Departments of Anesthesiology and Pharmacology (J.S.), Columbia University Medical Center, New York, NY; Department of Neurosurgery (M.S.), Hôpital Neurologique "Pierre Wertheimer," University of Lyon 1, Lyon, France; Center for Biomedicine and Medical Technology Mannheim (CBTM) (R.-D.T.), Heidelberg University, Mannheim, Germany; Facial Pain Unit, University College London Hospitals NHS Foundation Trust (J.M.Z.); and Pain Relief (T.N.), Neuroscience Research Centre, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Joachim Scholz
- From the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain (G.C., N.B.F., T.S.J., J.S., R.-D.T., T.N.), Washington, DC; Scientific Panel Pain of the European Academy of Neurology (G.C., T.S.J., T.N.), Vienna, Austria; Department of Neurology and Psychiatry (G.C.), Sapienza University, Rome, Italy; Danish Pain Research Centre, Department of Clinical Medicine (N.B.F., T.S.J.), and Section of Orofacial Pain and Jaw Function, Department of Dentistry (P.S.), Aarhus University, Denmark; Departments of Anesthesiology and Pharmacology (J.S.), Columbia University Medical Center, New York, NY; Department of Neurosurgery (M.S.), Hôpital Neurologique "Pierre Wertheimer," University of Lyon 1, Lyon, France; Center for Biomedicine and Medical Technology Mannheim (CBTM) (R.-D.T.), Heidelberg University, Mannheim, Germany; Facial Pain Unit, University College London Hospitals NHS Foundation Trust (J.M.Z.); and Pain Relief (T.N.), Neuroscience Research Centre, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Marc Sindou
- From the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain (G.C., N.B.F., T.S.J., J.S., R.-D.T., T.N.), Washington, DC; Scientific Panel Pain of the European Academy of Neurology (G.C., T.S.J., T.N.), Vienna, Austria; Department of Neurology and Psychiatry (G.C.), Sapienza University, Rome, Italy; Danish Pain Research Centre, Department of Clinical Medicine (N.B.F., T.S.J.), and Section of Orofacial Pain and Jaw Function, Department of Dentistry (P.S.), Aarhus University, Denmark; Departments of Anesthesiology and Pharmacology (J.S.), Columbia University Medical Center, New York, NY; Department of Neurosurgery (M.S.), Hôpital Neurologique "Pierre Wertheimer," University of Lyon 1, Lyon, France; Center for Biomedicine and Medical Technology Mannheim (CBTM) (R.-D.T.), Heidelberg University, Mannheim, Germany; Facial Pain Unit, University College London Hospitals NHS Foundation Trust (J.M.Z.); and Pain Relief (T.N.), Neuroscience Research Centre, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Peter Svensson
- From the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain (G.C., N.B.F., T.S.J., J.S., R.-D.T., T.N.), Washington, DC; Scientific Panel Pain of the European Academy of Neurology (G.C., T.S.J., T.N.), Vienna, Austria; Department of Neurology and Psychiatry (G.C.), Sapienza University, Rome, Italy; Danish Pain Research Centre, Department of Clinical Medicine (N.B.F., T.S.J.), and Section of Orofacial Pain and Jaw Function, Department of Dentistry (P.S.), Aarhus University, Denmark; Departments of Anesthesiology and Pharmacology (J.S.), Columbia University Medical Center, New York, NY; Department of Neurosurgery (M.S.), Hôpital Neurologique "Pierre Wertheimer," University of Lyon 1, Lyon, France; Center for Biomedicine and Medical Technology Mannheim (CBTM) (R.-D.T.), Heidelberg University, Mannheim, Germany; Facial Pain Unit, University College London Hospitals NHS Foundation Trust (J.M.Z.); and Pain Relief (T.N.), Neuroscience Research Centre, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Rolf-Detlef Treede
- From the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain (G.C., N.B.F., T.S.J., J.S., R.-D.T., T.N.), Washington, DC; Scientific Panel Pain of the European Academy of Neurology (G.C., T.S.J., T.N.), Vienna, Austria; Department of Neurology and Psychiatry (G.C.), Sapienza University, Rome, Italy; Danish Pain Research Centre, Department of Clinical Medicine (N.B.F., T.S.J.), and Section of Orofacial Pain and Jaw Function, Department of Dentistry (P.S.), Aarhus University, Denmark; Departments of Anesthesiology and Pharmacology (J.S.), Columbia University Medical Center, New York, NY; Department of Neurosurgery (M.S.), Hôpital Neurologique "Pierre Wertheimer," University of Lyon 1, Lyon, France; Center for Biomedicine and Medical Technology Mannheim (CBTM) (R.-D.T.), Heidelberg University, Mannheim, Germany; Facial Pain Unit, University College London Hospitals NHS Foundation Trust (J.M.Z.); and Pain Relief (T.N.), Neuroscience Research Centre, The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | - Joanna M Zakrzewska
- From the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain (G.C., N.B.F., T.S.J., J.S., R.-D.T., T.N.), Washington, DC; Scientific Panel Pain of the European Academy of Neurology (G.C., T.S.J., T.N.), Vienna, Austria; Department of Neurology and Psychiatry (G.C.), Sapienza University, Rome, Italy; Danish Pain Research Centre, Department of Clinical Medicine (N.B.F., T.S.J.), and Section of Orofacial Pain and Jaw Function, Department of Dentistry (P.S.), Aarhus University, Denmark; Departments of Anesthesiology and Pharmacology (J.S.), Columbia University Medical Center, New York, NY; Department of Neurosurgery (M.S.), Hôpital Neurologique "Pierre Wertheimer," University of Lyon 1, Lyon, France; Center for Biomedicine and Medical Technology Mannheim (CBTM) (R.-D.T.), Heidelberg University, Mannheim, Germany; Facial Pain Unit, University College London Hospitals NHS Foundation Trust (J.M.Z.); and Pain Relief (T.N.), Neuroscience Research Centre, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Turo Nurmikko
- From the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain (G.C., N.B.F., T.S.J., J.S., R.-D.T., T.N.), Washington, DC; Scientific Panel Pain of the European Academy of Neurology (G.C., T.S.J., T.N.), Vienna, Austria; Department of Neurology and Psychiatry (G.C.), Sapienza University, Rome, Italy; Danish Pain Research Centre, Department of Clinical Medicine (N.B.F., T.S.J.), and Section of Orofacial Pain and Jaw Function, Department of Dentistry (P.S.), Aarhus University, Denmark; Departments of Anesthesiology and Pharmacology (J.S.), Columbia University Medical Center, New York, NY; Department of Neurosurgery (M.S.), Hôpital Neurologique "Pierre Wertheimer," University of Lyon 1, Lyon, France; Center for Biomedicine and Medical Technology Mannheim (CBTM) (R.-D.T.), Heidelberg University, Mannheim, Germany; Facial Pain Unit, University College London Hospitals NHS Foundation Trust (J.M.Z.); and Pain Relief (T.N.), Neuroscience Research Centre, The Walton Centre NHS Foundation Trust, Liverpool, UK
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