Efficacy and Safety of Botulinum Toxin Type A in Treating Patients of Advanced Age with Idiopathic Trigeminal Neuralgia

Objective. To assess the therapeutic efficacy and safety of botulinum toxin type A (BTX-A) for treating idiopathic trigeminal neuralgia (ITN) in patients >= 80 years old. Methods. Selected patients (n = 43) with ITN, recruited from the neurology clinic and inpatient department of the Second Affiliated Hospital of Soochow University between August 2008 and February 2014, were grouped by age, one subset (n = 14) >= 80 years old and another (n = 29) <60 years old. Each group scored similarly in degrees of pain registered by the visual analogue scale (VAS). Dosing, efficacy, and safety of BTX-A injections were compared by group. Results. Mean dosages of BTX-A were 91.3 +/- 25.6 U and 71.8 +/- 33.1 U in older and younger patients, respectively (t = 1.930, p = 0.061). The median of the VAS score in older patients at baseline (8.5) declined significantly at 1 month after treatment (4.5) (p = 0.007), as did that of younger patients (8.0 and 5.0, resp.) (p = 0.001). The median of the D values of the VAS scores did not differ significantly by group (older, 2.5; younger, 0; Z = -1.073, p = 0.283). Two patients in each group developed minor transient side effects (p = 0.825). Adverse reactions in both groups were mild, resolving spontaneously within 3 weeks. Conclusions. BTX-A is effective and safe in treating patients of advanced age (>= 80 years old) with ITN, at dosages comparable to those used in much younger counterparts (<60 years old).