Could Botulinum Toxin A be a treatment for trigeminal neuralgia and temporomandibular joint dysfunction?
This summary is based on the Rapid Response Report developed by the Canadian Agency for Drugs and Technologies in Health: Botulinum Toxin A for the treatment of trigeminal neuralgia and temporomandibular joint dysfunction: a review of the clinical effectiveness
Temporomandibular joint dysfunction (TMD) is a musculoskeletal and rheumatologic disorder of the temporomandibular joint, which may result in jaw deformities, malocclusion, inflammation, and compression of the bilaminar tissue, with pain and dysfunction being the most prominent clinical features.
Trigeminal neuralgia (TN) is a disorder caused by proximal compression of trigeminal nerve root, which may bring about electric shock-like pain that occurs with or without stimulation.
For patients with TMD, current treatment options include occlusal therapies and use of pharmacologics, such as non-steroidal anti-inflammatory drugs, corticosteroids, antidepressants, muscle relaxants, sedative-hypnotics, and capsaicin. Current recommended treatment options for patients with TN include the use of carbamazepine, with additional pharmacologic approaches such as baclofen, phenytoin, gabapentin, clonazepam, and valproic acid.
Neurosurgical options for TN include glycerol instillation or balloon compression of the gasserian ganglion, or ablative procedures.
Botulinum toxin is a neurotoxin that inhibits the release of the neurotransmitter acetycholine at the neuromuscular junction. Botulinum toxin A is currently available in Canada as Botox, and Botox Cosmetic by Allergan Inc., and Xeomin by Merz Pharmaceuticals. However, botulinum toxin A is not currently indicated for the management of TN and TMD. To better guide potential off-label coverage decisions, information is required on the clinical benefits and harm of botulinum toxin A when used for the management of TN and TMD.
What is the clinical-effectiveness of botulinum toxin A for the treatment of trigeminal neuralgia (TN) and temporomandibular joint dysfunction (TMD)?
The JCDA Oasis Team is collaborating with the Canadian Agency for Drugs and Technologies in Health to provide you with the latest clinical information.
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