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Marcolla IMG, Camargo CHF, Coutinho L, Ferreira MG, Tiburtino Meira A, Piovesan EJ, Ghizoni Teive HA. Treatment of occipital neuralgia using onabotulinum toxin A. Acta Neurol Scand 2022; 145:193-199. [PMID: 34542909 DOI: 10.1111/ane.13533] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the effectiveness of botulinum toxin in a sample of patients diagnosed with greater occipital nerve neuralgia. MATERIAL AND METHODS Twenty-nine patients (28 females, 1 male) were treated for greater occipital nerve neuralgia with onabotulinum toxin type A; the Visual Analog Pain Scale was used to determine pain severity at treatment and again 12 weeks after application. RESULTS Average doses of onabotulinum toxin type A of 18.66±6.44 U per nerve and 35.96±12.89 U per patient were utilized. Average pain severity among the sample was 9.81±0.89 prior to botulinum toxin application and 3.68±2.31 points (p<0.0001) twelve weeks after application. Pain frequency decreased from 29.93±0.37 to 12.17±11.05 days with pain per month (p<0.0001). Six patients reported absence of pain after application (p=0.023). Dose did not correlate with the degree of clinical response observed, and no side effects were reported. CONCLUSION Our findings suggest onabotulinum toxin type A is a safe and effective treatment alternative for patients suffering from refractory greater occipital nerve neuralgia.
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Affiliation(s)
- Isabela Maria Garcia Marcolla
- Movement Disorders Unit Neurology Service Internal Medicine Department, Hospital de Clínicas Federal University of Paraná Curitiba Brazil
| | - Carlos Henrique Ferreira Camargo
- Neurological Diseases Group Post‐Graduate Program in Internal Medicine Internal Medicine Department, Hospital de Clínicas Federal University of Paraná Curitiba Brazil
| | - Léo Coutinho
- Movement Disorders Unit Neurology Service Internal Medicine Department, Hospital de Clínicas Federal University of Paraná Curitiba Brazil
| | - Matheus Gomes Ferreira
- Neurological Diseases Group Post‐Graduate Program in Internal Medicine Internal Medicine Department, Hospital de Clínicas Federal University of Paraná Curitiba Brazil
| | - Alex Tiburtino Meira
- Neurological Diseases Group Post‐Graduate Program in Internal Medicine Internal Medicine Department, Hospital de Clínicas Federal University of Paraná Curitiba Brazil
| | - Elcio Juliato Piovesan
- Neurological Diseases Group Post‐Graduate Program in Internal Medicine Internal Medicine Department, Hospital de Clínicas Federal University of Paraná Curitiba Brazil
- Headache and Pain Unit Neurology Service Internal Medicine Department, Hospital de Clínicas Federal University of Paraná Curitiba Brazil
| | - Hélio A. Ghizoni Teive
- Movement Disorders Unit Neurology Service Internal Medicine Department, Hospital de Clínicas Federal University of Paraná Curitiba Brazil
- Neurological Diseases Group Post‐Graduate Program in Internal Medicine Internal Medicine Department, Hospital de Clínicas Federal University of Paraná Curitiba Brazil
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Zhang H, Lian Y, Xie N, Chen C, Zheng Y. Single-dose botulinum toxin type a compared with repeated-dose for treatment of trigeminal neuralgia: a pilot study. J Headache Pain 2017; 18:81. [PMID: 28799056 PMCID: PMC5552618 DOI: 10.1186/s10194-017-0793-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/04/2017] [Indexed: 11/25/2022] Open
Abstract
Background Several RCT studies including ours, seem to prove the role of Botulinum toxin type A (BTX-A) in the treatment of trigeminal neuralgia (TN), but no standardized dosing regimen has been established. In our study, we compare two different methods of administration: single-dose or repeated-dose strategy which was most frequently applied over the years in our centre. Methods An open-label trail was conducted. One hundred patients with classic TN symptoms were recruited, and randomly and equally apportioned to single- or repeated-dose group. Patients in the single-dose group received a local BTX-A injection of 70 to 100 U. The repeated-dose group received an initial BTX-A injection of 50 to 70 U and then another of equal volume 2 weeks later. All patients were followed for 6 months. Results In the single- and repeated-dose groups, 44 and 37, respectively, completed the entire study. The groups were statistically similar in TN frequency, time between treatment and effect, time to peak effect, VAS scores, and rates of adverse reactions (latency and duration). However, the single-dose group experienced significantly longer duration of effect (P = 0.032). Conclusions The single- and repeated-dosing BTX-A regimens were largely comparable in efficacy and safety. This study suggests that repeated dosing has no advantage over single dosing of BTX-A for TN. Dosing should be adjusted for the individual patient.
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Affiliation(s)
- Haifeng Zhang
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East R, Zhengzhou City, HeNan Province, 450052, People's Republic of China
| | - Yajun Lian
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East R, Zhengzhou City, HeNan Province, 450052, People's Republic of China.
| | - Nanchang Xie
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East R, Zhengzhou City, HeNan Province, 450052, People's Republic of China
| | - Chen Chen
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East R, Zhengzhou City, HeNan Province, 450052, People's Republic of China
| | - Yake Zheng
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East R, Zhengzhou City, HeNan Province, 450052, People's Republic of China
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Piovesan EJ, Oshinsky M, Silberstein S, Kowacs PA, Novak EM, Werneck LC. Botulinum neurotoxin type-A when utilized in animals with trigeminal sensitization induced a antinociceptive effect. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 74:462-9. [PMID: 27332071 DOI: 10.1590/0004-282x20160067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 04/01/2016] [Indexed: 01/03/2023]
Abstract
METHOD Neuropathic pain was induced by surgical constriction of the infraorbital nerve in rats. A control group underwent a sham procedure consisting of surgical exposure of the nerve. Subgroups of each group received either BoNT/A or isotonic saline solution. The clinical response was assessed with the -20°C test. Animals that underwent nerve constriction developed sensitization; the sham group did not. RESULTS The sensitization was reversed by BoNT/A treatment evident 24 hours following application. Pronociceptive effect was observed in the sham group following BoNT/A. CONCLUSION BoNT/A has an antinociceptive effect in sensitized animals and a pronociceptive effect in non-sensitized animals.
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Affiliation(s)
- Elcio J Piovesan
- Universidade Federal do Paraná, Universidade Federal do Paraná, Curitiba PR , Brasil, Universidade Federal do Paraná, Hospital das Clínicas, Serviço de Neurologia, Curitiba PR, Brasil;,Universidade Federal do Paraná, Universidade Federal do Paraná, Curitiba PR , Brasil, Universidade Federal do Paraná, Departmento de Ciências da Saúde, Laboratório Experimental, Curitiba PR, Brasil
| | - Michael Oshinsky
- Thomas Jefferson University, Thomas Jefferson University, Philadephia PA , USA, Thomas Jefferson University, Jefferson Headache Center, Philadephia PA, USA
| | - Stephen Silberstein
- Thomas Jefferson University, Thomas Jefferson University, Philadephia PA , USA, Thomas Jefferson University, Jefferson Headache Center, Philadephia PA, USA
| | - Pedro Andre Kowacs
- Universidade Federal do Paraná, Universidade Federal do Paraná, Curitiba PR , Brasil, Universidade Federal do Paraná, Hospital das Clínicas, Serviço de Neurologia, Curitiba PR, Brasil
| | - Edison Matos Novak
- Universidade Federal do Paraná, Universidade Federal do Paraná, Curitiba PR , Brasil, Universidade Federal do Paraná, Hospital das Clínicas, Serviço de Neurologia, Curitiba PR, Brasil
| | - Lineu Cesar Werneck
- Universidade Federal do Paraná, Universidade Federal do Paraná, Curitiba PR , Brasil, Universidade Federal do Paraná, Hospital das Clínicas, Serviço de Neurologia, Curitiba PR, Brasil
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Kowacs PA, Utiumi MAT, Nascimento FA, Piovesan EJ, Teive HAG. OnabotulinumtoxinA for trigeminal neuralgia: a review of the available data. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:877-84. [PMID: 26291995 DOI: 10.1590/0004-282x20150109] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/12/2015] [Indexed: 11/21/2022]
Abstract
Trigeminal neuralgia (TN) patients may develop side effects from centrally acting drugs, have contraindications for neurosurgical procedures, or experience relapse during conventional therapies. OnabotulinumtoxinA (BoNT/A) has been reported to be effective for TN, although this finding has been challenged. An overview of the available evidence based on a narrative/qualitative analysis of the literature is presented. About 90% of patients who receive BoNT/A show an improvement, a higher figure than that reported for the placebo effect of BoNT/A for other headaches. Tolerability of BoNT/A is good, and its few side-effects are transient. The articles reviewed were mainly case reports, case series and open-label trials; however, randomized controlled trials have endorsed the efficacy of BoNT/A for TN. This evidence, together with a better understanding of the analgesic mechanisms of BoNT/A and its proven efficacy in treating other pain syndromes, supports the use of this toxin as a therapeutic option for TN.
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Affiliation(s)
| | - Marco A T Utiumi
- Serviço de Neurologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, BR
| | - Fábio A Nascimento
- Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, GD
| | - Elcio J Piovesan
- Serviço de Neurologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, BR
| | - Helio A G Teive
- Serviço de Neurologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, BR
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Lin JJ, Du Y, Cai WK, Kuang R, Chang T, Zhang Z, Yang YX, Sun C, Li ZY, Kuang F. Toll-like receptor 4 signaling in neurons of trigeminal ganglion contributes to nociception induced by acute pulpitis in rats. Sci Rep 2015. [PMID: 26224622 PMCID: PMC4519790 DOI: 10.1038/srep12549] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Pain caused by acute pulpitis (AP) is a common symptom in clinical settings. However, its underlying mechanisms have largely remained unknown. Using AP model, we demonstrated that dental injury caused severe pulp inflammation with up-regulated serum IL-1β. Assessment from head-withdrawal reflex thresholds (HWTs) and open-field test demonstrated nociceptive response at 1 day post injury. A consistent up-regulation of Toll-like receptor 4 (TLR4) in the trigeminal ganglion (TG) ipsilateral to the injured pulp was found; and downstream signaling components of TLR4, including MyD88, TRIF and NF-κB, and cytokines such as TNF-α and IL-1β, were also increased. Retrograde labeling indicated that most TLR4 positve neuron in the TG innnervated the pulp and TLR4 immunoreactivity was mainly in the medium and small neurons. Double labeling showed that the TLR4 expressing neurons in the ipsilateral TG were TRPV1 and CGRP positive, but IB4 negative. Furthermore, blocking TLR4 by eritoran (TLR4 antagonist) in TGs of the AP model significantly down-regulated MyD88, TRIF, NF-κB, TNF-α and IL-1β production and behavior of nociceptive response. Our findings suggest that TLR4 signaling in TG cells, particularly the peptidergic TRPV1 neurons, plays a key role in AP-induced nociception, and indicate that TLR4 signaling could be a potential therapeutic target for orofacial pain.
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Affiliation(s)
- Jia-Ji Lin
- 1] Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710004, China [2] Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, 710032, China
| | - Yi Du
- 1] State Key Laboratory of Military Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032,China [2] Department of Endodontics, Jinan Stomatological Hospital, Jinan, 250001, China
| | - Wen-Ke Cai
- 1] Department of Cardio-Thoracic Surgery, Kunming General Hospital of Chengdu Military Region, Kunming, 650000, China [2] Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710004, China
| | - Rong Kuang
- State Key Laboratory of Military Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032,China
| | - Ting Chang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710004, China
| | - Zhuo Zhang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710004, China
| | - Yong-Xiang Yang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710004, China
| | - Chao Sun
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710004, China
| | - Zhu-Yi Li
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710004, China
| | - Fang Kuang
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, 710032, China
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Zhang H, Lian Y, Ma Y, Chen Y, He C, Xie N, Wu C. Two doses of botulinum toxin type A for the treatment of trigeminal neuralgia: observation of therapeutic effect from a randomized, double-blind, placebo-controlled trial. J Headache Pain 2014; 15:65. [PMID: 25263254 PMCID: PMC4194456 DOI: 10.1186/1129-2377-15-65] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 09/22/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND In the majority of cases, trigeminal neuralgia (TN) is a unilateral condition with ultra-short stabbing pain located along one or more branches of the trigeminal nerve. Although prophylactic pharmacological treatment is first choise, considering of insufficient effect or unacceptable side effects, neurosurgical treatment or lesion treatment should be considered. In addition to all these procedures mentioned above, one approach has been based on local intradermal and/or submucosal injections of Botulinum Toxin Type A (BTX-A). METHODS We conducted a randomized, double-blind, placebo-controlled since November 2012, and adopted local multi-point injection in 84 cases of classical TN with different doses of BTX-A. Eighty four patients were randomized into following groups: placebo (n = 28); BTX-A 25U (n = 27); BTX-A 75U (n = 29). Follow-up visits were conducted every week after the injection, and the overall duration of the study for each patient were 8 weeks to observe the pain severity, efficacy and adverse reactions at endpoint. RESULTS The visual analogue scale (VAS) scores of 25U and 75U groups reduced significantly compared to placebo as early as week 1, and sustained until week 8 throughout the study. There was no significant difference in VAS between 25U and 75U groups throughout the study. The response rates of 25U group (70.4%) and 75U group (86.2%) were significantly higher than placebo group (32.1%) at week 8, and there was no significant difference between 25U and 75U groups. Evaluation of the Patient Global Impression of Change (PGIC) demonstrated that 66.7% (25U group) and 75.9% (75U group) of the patients reported that their pain symptoms were 'much improved' or 'very much improved' versus 32.1% of the placebo group, and there was also no significant difference between 25U and 75U groups. All adverse reactions were graded as mild or moderate. CONCLUSIONS BTX-A injection in TN is safe and efficient. It is a useful treatment for refractory TN. Lower dose (25U) and high dose (75U) were similar in efficacy in short-term.
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Affiliation(s)
| | - Yajun Lian
- Department of Neurology, the First Affiliated Hospital, Zhengzhou University, 1 Jianshe East R, Zhengzhou City, HeNan Province 450052, People's Republic of China.
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Antipova V, Hawlitschka A, Mix E, Schmitt O, Dräger D, Benecke R, Wree A. Behavioral and structural effects of unilateral intrastriatal injections of botulinum neurotoxin a in the rat model of Parkinson's disease. J Neurosci Res 2013; 91:838-47. [PMID: 23553727 DOI: 10.1002/jnr.23210] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 10/29/2012] [Accepted: 01/07/2013] [Indexed: 12/25/2022]
Abstract
Botulinum neurotoxin (BoNT) inhibits the release of acetylcholine from presynaptic vesicles through its proteinase activity cleaving the SNARE complex. Parkinson's disease (PD) is associated with locally increased cholinergic activity in the striatum. Therefore, the present study investigates the effect of unilateral intrastriatal BoNT-A injection in naïve rats on striatal morphology; i.e., the total number of Nissl-stained neurons and the volume of caudate-putamen (CPu) were estimated. Furthermore, stainings for markers of gliosis (glial fibrillary acidic protein) and microglia (Iba1) were performed. In addition, the potential beneficial effects of a unilateral intrastriatal injection of BoNT-A on motor activity in the rat model of hemi-PD were evaluated. Hemi-PD was induced by unilateral injection of 6-hydroxydopamine (6-OHDA) into the right medial forebrain bundle. Six weeks later, rats received an ipsilateral intrastriatal injection of BoNT-A. Behaviorally, motor performance was tested. The total number of CPu neurons and the striatal volume were not significantly different between the BoNT-A-injected right and the intact left hemispheres of naïve rats. In hemi-PD rats, intrastriatal BoNT-A abolished apomorphine-induced rotations, increased amphetamine-induced rotations, and tended to improve left forelimb usage. Forced motor function in the accelerod test was not significantly changed by BoNT-A, and open field activity was also unaltered compared with sham treatment. Thus, intrastriatal BoNT-A affects spontaneous motor activity of hemi-PD rats to a minor degree compared with drug-induced motor function. In the future, tests assessing the cognitive and emotional performance should be performed to ascertain finally the potential therapeutic usefulness of intrastriatal BoNT-A for PD.
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Abstract
Background: Two decades ago, botulinum neurotoxin (BoNT) type A was introduced to the commercial market. Subsequently, the toxin was approved by the FDA to address several neurological syndromes, involving muscle, nerve, and gland hyperactivity. These syndromes have typically been associated with abnormalities in cholinergic transmission. Despite the multiplicity of botulinal serotypes (designated as types A through G), therapeutic preparations are currently only available for BoNT types A and B. However, other BoNT serotypes are under study for possible clinical use and new clinical indications; Objective: To review the current research on botulinum neurotoxin serotypes A-G, and to analyze potential applications within basic science and clinical settings; Conclusions: The increasing understanding of botulinal neurotoxin pathophysiology, including the neurotoxin’s effects on specific neuronal populations, will help us in tailoring treatments for specific diagnoses, symptoms and patients. Scientists and clinicians should be aware of the full range of available data involving neurotoxin subtypes A-G.
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Matak I, Stracenski I, Lacković Z. Comparison of analgesic effects of single versus repeated injection of botulinum toxin in orofacial formalin test in rats. J Neural Transm (Vienna) 2012; 120:141-4. [DOI: 10.1007/s00702-012-0846-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 06/02/2012] [Indexed: 12/19/2022]
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