{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:13:25Z","timestamp":1785510805369,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T00:00:00Z","timestamp":1693440000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>We sought to assess the efficacy of combining onabotulinumtoxinA (BoNTA) as add-on therapy to carbamazepine or oxcarbazepine in treatment-refractory patients with trigeminal neuralgia (TGN) who failed to respond (less than 30% response rate) to adequate monotherapy. We conducted a retrospective study on 15 patients with a definite diagnosis of TGN, according to the established criteria, and underwent BoNTA as part of their treatment plan. A single BoNTA session was administered subcutaneously, according to patients\u2019 perceived zone of pain, at different dosages ranging from 30 to 200\u2009units (mean \u00b1 standard deviation: 87.3 \u00b1 39.2). All patients (15\/15; 100%) reported large reductions in the severity of their TGN-related neuropathic pain. The mean pain score on the VAS scale significantly decreased from 9.3 \u00b1 1.1 to 3.7 \u00b1 1.2 at 2 weeks after injecting BoNTA (p &lt; 0.001) and remained stable at 4 and 24 weeks post-injection. Regarding the impact of BoNTA on patients\u2019 health-related quality of life, there were significant improvements in both the physical and mental health domains (p &lt; 0.05) of SF-36 tool. BoNTA may be a safe and effective treatment option for patients with refractory TGN when added on to carbamazepine or oxcarbazepine. The use of a single BoNTA session for TGN treatment may be an alternative to surgical interventions and as add-on treatment to oral medications, providing patients with a minimally invasive, effective, safe and well-tolerated option.<\/jats:p>","DOI":"10.3390\/toxins15090539","type":"journal-article","created":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T11:41:18Z","timestamp":1693482078000},"page":"539","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Single OnabotulinumtoxinA Session Add-On to Carbamazepine or Oxcarbazepine in Treatment-Refractory Trigeminal Neuralgia: A Case Series with 24-Week Follow Up"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7162-3588","authenticated-orcid":false,"given":"Georgia","family":"Xiromerisiou","sequence":"first","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8956-2178","authenticated-orcid":false,"given":"Ioannis C.","family":"Lampropoulos","sequence":"additional","affiliation":[{"name":"Respiratory Medicine Department, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9275-0076","authenticated-orcid":false,"given":"Emmanouil V.","family":"Dermitzakis","sequence":"additional","affiliation":[{"name":"Euromedica General Clinic, 54645 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2715-7898","authenticated-orcid":false,"given":"Michail","family":"Vikelis","sequence":"additional","affiliation":[{"name":"Headache Clinic, Mediterraneo Hospital, 16675 Glyfada, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5979-9916","authenticated-orcid":false,"given":"Chrysoula","family":"Marogianni","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7743-995X","authenticated-orcid":false,"given":"Dimitris","family":"Mysiris","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2131-7114","authenticated-orcid":false,"given":"Andreas A.","family":"Argyriou","sequence":"additional","affiliation":[{"name":"Headache Outpatient Clinic, Department of Neurology, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2058738419838383","DOI":"10.1177\/2058738419838383","article-title":"The neuropathic pain: An overview of the current treatment and future therapeutic approaches","volume":"33","author":"Cavalli","year":"2019","journal-title":"Int. J. Immunopathol. Pharmacol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1152\/physrev.00045.2019","article-title":"Neuropathic pain: From mechanisms to treatment","volume":"101","author":"Finnerup","year":"2021","journal-title":"Physiol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1097\/j.pain.0000000000000853","article-title":"Evaluating the impact of trigeminal neuralgia","volume":"158","author":"Zakrzewska","year":"2017","journal-title":"Pain"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1177\/0333102417721677","article-title":"Triggering trigeminal neuralgia","volume":"38","author":"Maarbjerg","year":"2018","journal-title":"Cephalalgia"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1111\/head.12441","article-title":"Trigeminal Neuralgia\u2014A Prospective Systematic Study of Clinical Characteristics in 158 Patients","volume":"54","author":"Maarbjerg","year":"2014","journal-title":"Headache"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1056\/NEJMra1914484","article-title":"Trigeminal Neuralgia","volume":"383","author":"Cruccu","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.jpain.2018.10.002","article-title":"AAPT Diagnostic Criteria for Peripheral Neuropathic Pain: Focal and Segmental Disorders","volume":"20","author":"Freeman","year":"2019","journal-title":"J. Pain"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1111\/head.14414","article-title":"Treatment of multiple sclerosis\u2013related trigeminal neuralgia with onabotulinumtoxinA","volume":"62","author":"Asan","year":"2022","journal-title":"Headache"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1212\/01.wnl.0000269670.30045.6b","article-title":"Impaired trigeminal nociceptive processing in patients with trigeminal neuralgia","volume":"69","author":"Obermann","year":"2007","journal-title":"Neurology"},{"key":"ref_10","first-page":"30","article-title":"Microvascular Decompression for Trigeminal Neuralgia: A regional unit\u2019s experience","volume":"87","author":"Hannan","year":"2018","journal-title":"Ulst. Med. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1007\/s40265-018-0964-9","article-title":"Current and Innovative Pharmacological Options to Treat Typical and Atypical Trigeminal Neuralgia","volume":"78","author":"Truini","year":"2018","journal-title":"Drugs"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1080\/14737175.2021.1958677","article-title":"Beyond chronic migraine: A systematic review and expert opinion on the off-label use of botulinum neurotoxin type-A in other primary headache disorders","volume":"21","author":"Argyriou","year":"2021","journal-title":"Expert Rev. Neurother."},{"key":"ref_13","first-page":"327","article-title":"Botulinum toxin type A as an alternative way to treat trigeminal neuralgia: A systematic review","volume":"53","author":"Ostrowski","year":"2019","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1111\/ene.13950","article-title":"European Academy of Neurology guideline on trigeminal neuralgia","volume":"26","author":"Bendtsen","year":"2019","journal-title":"Eur. J. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Bista, P., and Imlach, W.L. (2019). Pathological Mechanisms and Therapeutic Targets for Trigeminal Neuropathic Pain. Medicines, 6.","DOI":"10.3390\/medicines6030091"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/j.jpain.2009.06.012","article-title":"Central Sensitization: A Generator of Pain Hypersensitivity by Central Neural Plasticity","volume":"10","author":"Latremoliere","year":"2009","journal-title":"J. Pain"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1097\/00002826-200209000-00006","article-title":"Beneficial Effects of Botulinum Toxin Type A for Patients With Painful Tic Convulsif","volume":"25","author":"Micheli","year":"2002","journal-title":"Clin. Neuropharmacol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Matak, I., B\u00f6lcskei, K., Rojecky, B., and Helyes, Z. (2019). Mechanisms of Botulinum Toxin Type A Action on Pain. Toxins, 11.","DOI":"10.3390\/toxins11080459"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3689","DOI":"10.1523\/JNEUROSCI.0375-08.2008","article-title":"Long-distance retrograde effects of botulinum neurotoxin A","volume":"28","author":"Antonucci","year":"2008","journal-title":"J. Neurosci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1111\/j.1600-0854.2012.01369.x","article-title":"Botulinum Neurotoxin A Impairs Neurotransmission Following Retrograde Transynaptic Transport","volume":"13","author":"Restani","year":"2012","journal-title":"Traffic"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Huang, P.P., Khan, I., Suhail, M.S., Malkmus, S., and Yaksh, T.L. (2011). Spinal botulinum neurotoxin B: Effects on afferent transmitter release and nociceptive processing. PLoS ONE, 6.","DOI":"10.1371\/annotation\/1fe31fa2-e930-4a72-a208-64eb42d99f02"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1093\/pm\/pnaa028","article-title":"CGRP Plasma Levels Decrease in Classical Trigeminal Neuralgia Patients Treated with Botulinum Toxin Type A: A Pilot Study","volume":"21","author":"Zhang","year":"2020","journal-title":"Pain Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1046\/j.1526-4610.43.7s.3.x","article-title":"Evidence for Antinociceptive Activity of Botulinum Toxin Type A in Pain Management","volume":"43","author":"Aoki","year":"2003","journal-title":"Headache"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/1129-2377-14-92","article-title":"Botulinum toxin-type A: Could it be an effective treatment option in intractable trigeminal neuralgia?","volume":"14","author":"Shehata","year":"2013","journal-title":"J. Headache Pain"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1177\/0333102412441721","article-title":"Botulinum toxin type A for the treatment of trigeminal neuralgia: Results from a randomized, double-blind, placebo-controlled trial","volume":"32","author":"Wu","year":"2012","journal-title":"Cephalalgia"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/1129-2377-15-65","article-title":"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","volume":"15","author":"Zhang","year":"2014","journal-title":"J. Headache Pain"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1097\/WNF.0b013e31829cb60e","article-title":"Acute Treatment of Trigeminal Neuralgia With Onabotulinum Toxin A","volume":"36","author":"Piedimonte","year":"2013","journal-title":"Clin. Neuropharmacol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e01409","DOI":"10.1002\/brb3.1409","article-title":"The efficacy and safety of botulinum toxin type A in treatment of trigeminal neuralgia and peripheral neuropathic pain: A meta-analysis of randomized controlled trials","volume":"9","author":"Wei","year":"2019","journal-title":"Brain Behav."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Pearl, C., Moxley, B., Perry, A., Demian, N., and Dallaire-Giroux, C. (2022). Management of Trigeminal Neuralgia with Botulinum Toxin Type A: Report of Two Cases. Dent. J., 10.","DOI":"10.3390\/dj10110207"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1097\/WNF.0000000000000399","article-title":"Trigeminal Neuralgia with Extraoral Trigger Zone Successfully Treated with Intraoral Injections of Botulinum Toxin: A Case Report","volume":"43","author":"Dinan","year":"2020","journal-title":"Clin. Neuropharmacol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/1129-2377-15-43","article-title":"Therapeutic effect of Botulinum toxin-A in 88 patients with Trigeminal Neuralgia with 14-month follow-up","volume":"15","author":"Li","year":"2014","journal-title":"J. Headache Pain"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s10194-017-0744-z","article-title":"Botulinum neurotoxin type A for the treatment of pain: Not just in migraine and trigeminal neuralgia","volume":"18","author":"Sandrini","year":"2017","journal-title":"J. Headache Pain"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Headache Classification Committee of the International Headache Society (IHS) (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38, 1\u2013211.","DOI":"10.1177\/0333102417738202"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med. Care"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.1007\/s11136-005-3866-8","article-title":"Construct Validation of the Greek SF-36 Health Survey","volume":"14","author":"Anagnostopoulos","year":"2005","journal-title":"Qual. Life Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jmpt.2003.11.003","article-title":"Assessing the clinical significance of change scores recorded on subjective outcome measures","volume":"27","author":"Hurst","year":"2004","journal-title":"J. Manip. Physiol. Ther."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/15\/9\/539\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:44:14Z","timestamp":1760129054000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/15\/9\/539"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,31]]},"references-count":36,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["toxins15090539"],"URL":"https:\/\/doi.org\/10.3390\/toxins15090539","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,31]]}}}