18th European Headache Congress

Professor

Chair

Diagnostic difficulties in trigeminal neuralgia

Invited speaker

Invited lecture

Neuroimaging in trigeminal neuralgia in daily clinical practice

How to treat patients with trigeminal neuralgia based on most recent evidence

Prof.

Non-paralytic botulinum toxin A in trigeminal neuralgia

Trigeminal neuralgia

Trigeminal neuralgia (TN) is the most common type of craniofacial chronic neuropathic pain. TN is characterized by short electric shock-like pain paroxysms in areas enervated by the trigeminal nerve. Acute treatments are ineffective, and preventative drugs lack specificity, efficacy, and often have severe side effects. To address these limitations, recombinant botulinum toxin-based molecules with retained analgesic effects and minimal paralytic side effects have been developed. This study aims to investigate the efficacy of a non-paralytic recombinant botulinum toxin A (BoNT/A) molecule - el-Bitox/A, compared to native BoNT/A in a model of TN.Nociceptive behavioral responses in a rat infraorbital nerve chronic constriction injury (IoN-CCI) model of TN were measured for 7 weeks post-surgery. von Frey filaments were used to assess the efficacy of el-Bitox/A (20ng) and BoNT/A (5U) in reversing mechanical allodynia. Compounds were injected subcutaneously into the ipsilateral side. Bodyweight was monitored as an indirect measure of facial paralysis.Both el-Bitox/A (n=7; P&lt;0.05) and BoNT/A (n=6; P&lt;0.05) reversed IoN-CCI-induced mechanical allodynia, while vehicle had no effect (n=6; P&lt;0.05). This effect lasted for both botulinum toxins for at least 30 days after injections. Injections into the cheek could cause paralysis, reducing jaw strength, impairing food consumption, and leading to significant bodyweight loss. BoNT/A injections resulted in significant bodyweight loss (P&lt;0.05), while el-Bitox/A injections had no effect on bodyweight (P=0.2), confirming the non-paralytic profile of el-Bitox/A.Both BoNT/A and el-Bitox/A can reverse mechanical hypersensitivity caused by the TN model for prolonged periods. However, BoNT/A has significant serious side effects that can be avoided by using the non-paralytic el-Bitox/A, highlighting its potential as an innovative treatment for neuropathic pain conditions.

Abstract lecture

Breakout room 1

Trigeminal neuralgia – Update

Parallel session

Trigeminal neuralgia – Update

Appointment

Chair

Programme