Botulinum Toxin A in Postherpetic Neuralgia: A Parallel, Randomized, Double-Blind, Single-Dose, Placebo-controlled Trial Botulinum toxin type A for the treatment of trigeminal neuralgia: results from a randomized, double-blind, placebo-controlled trial Botulinum toxin-type A: could it be an effective treatment option in intractable trigeminal neuralgia? Repetitive transcranial magnetic stimulation versus botulinum toxin injection in chronic migraine prophylaxis: a pilot randomized trial The safety and efficacy of botulinum toxin type B in the treatment of patients with cervical dystonia: summary of three controlled clinical trials. Botulinum toxin type A for upper limb spasticity following stroke: an open-label study with individualised, flexible injection regimens Acute Treatment of Trigeminal Neuralgia With Onabotulinum Toxin A Botulinum toxin type-A (BOTOX) in the treatment of occipital neuralgia: a pilot study. Botulinum Toxin Type A in Prophylactic Treatment of Migraine 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 Botulinum toxin type a is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study. Clinico-immunologic aspects of botulinum toxin type B treatment of cervical dystonia Subcutaneous injection of botulinum toxin a is beneficial in postherpetic neuralgia. Botulinum toxin type-a in the prevention of migraine: a double-blind controlled trial. A prospective study to evaluate the safety, tolerability, efficacy and durability of response of intravesical injection of botulinum toxin type A into detrusor muscle in patients with refractory idiopathic detrusor overactivity A pilot study of botulinum toxin A for male chronic pelvic pain syndrome Distant effects of locally injected botulinum toxin: a double-blind study of single fiber EMG changes.
Objectives : Cumulative evidence support a beneficial effect of botulinum toxin A ( BTX-A ) in postherpetic neuralgia ( PHN ) . We aim ed to assess efficacy , safety , and tolerability of BTX-A in the management of PHN , performing a r and omized , double-blind , single-dose , placebo-controlled trial . Methods : Thirty adults with PHN were r and omized either to BTX-A or placebo .  Severity of pain was evaluated by patients using a visual analogue scale ( VAS ) and quality of sleep was assessed using a 5-item question naire . Primary outcome was reduction in VAS score , with a greater than 50 % reduction being considered clinical ly significant . Secondary outcomes were reduction in sleep score and maintenance of VAS score after treatment , with over 50 % maintenance considered clinical ly meaningful . Results : Thirteen patients from the experimental arm achieved an at least 50 % reduction in VAS score , compared with none of the placebo patients ( NNT=1.2 , 95 % CI , 2 - 1 ; ARR=0.87 , 95 % CI , 055 - 096 ; P<0.001 ) . BTX-A patients showed significant reduction in VAS pain scores between baseline and week 2 , which persisted for a median period of 16 weeks . BTX-A patients showed significant reduction in sleep scores between baseline and week 2 , which remained unchanged until 16th week ( P<0.001 ) . Treatment was well tolerated . Discussion : Data confirm that BTX-A is effective and well tolerated in the treatment of PHN Aim : To investigate the efficacy , safety and tolerability of intradermal and /or submucosal administration of botulinum toxin type A ( BTX-A ) for patients with trigeminal neuralgia ( TN ) . Methods : In this r and omized , double-blind , placebo-controlled study , 42 TN patients were r and omly allocated into two groups , namely , intradermal and /or submucosal injection of BTX-A ( 75 U/1.5 mL ; n = 22 ) or saline ( 1.5 mL ; n = 20 ) in the skin and /or mucosa where pain was experienced . The primary endpoints were pain severity ( assessed by the visual analogue scale ) and pain attack frequency per day . The secondary endpoint was the patient ’s overall response to treatment , assessed using the Patient Global Impression of Change scale . Patients with ≥ 50 % reduction in mean pain score at week 12 were defined as responders . Results : A total of 40 patients completed the study .  BTX-A significantly reduced pain intensity at week 2 and pain attack frequency at week 1 . The efficacy was maintained throughout the course of the study . More BTX-A treated patients reported that pain had improved by the end of the study . Significantly more responders were present in the BTX-A group ( 68.18 % ) than in the placebo group ( 15.00 % ) . BTX-A was well tolerated , with few treatment-related adverse events . Conclusions : BTX-A may be an efficient , safe and novel strategy for TN treatment Background Botulinum toxin type A ( BTX-A ) has been reported to have analgesic effects independent of its action on muscle tone , mostly by acting on neurogenic inflammatory mediators and controlling the neurotransmitter release of sensory and autonomic nerve terminals that are involved in many chronic painful conditions as chronic intractable trigeminal neuralgia (TN).The aim of our work was evaluating the efficacy , safety , and tolerability of BTX-A for the treatment of intractable idiopathic TN . Methods This was a r and omized , single-blinded , placebo-control study carried out on 20 Egyptian patients with intractable TN . Patients received a one-time subcutaneous administration of BTX-A using “ follow the pain ” method . The primary efficacy measure was reduction in pain severity on the 10-cm VAS score as well as in paroxysms frequency from the baseline to week 12 ( endpoint last observation carried forward [ LOCF ] ) . Secondary efficacy measures included QoL assessment and number of acute medications received from baseline to the endpoint . Results Pain reduction at the 12-week endpoint was significant in BTX-A group ( p<0.0001 ) ; VAS scores at endpoint LOCF relative to baseline for BTX-A group showed a decrease of 6.5 compared with a decrease of 0.3 for placebo , also there was a significant decrease in the number of acute medications and an increase in QoL functioning scale . Conclusion These results indicate that BTX-A has a direct analgesic effect in patients with TN and can represent a therapeutic option for intractable cases Background Chronic migraine is a prevalent disabling disease , with major health-related burden and poor quality of life . Long-term use of preventive medications carries risk of side effects . Objectives The aim of this study was to compare repetitive transcranial magnetic stimulation ( rTMS ) to botulinum toxin-A ( BTX-A ) injection as preventive therapies for chronic migraine . Methods A pilot , r and omized study was conducted on a small-scale sample of 29 Egyptian patients with chronic migraine , recruited from Kasr Al-Aini teaching hospital outpatient clinic and diagnosed according to ICHD-III ( beta version ) . Patients were r and omly assigned into two groups ; 15 patients received BTX-A injection following the Phase III Research Evaluating Migraine Prophylaxis Therapy injection paradigm and 14 patients were subjected to 12 rTMS sessions delivered at high frequency ( 10 Hz ) over the left motor cortex ( MC , M1 ) . All the patients were requested to have their 1-month headache calendar , and they were subjected to a baseline 25-item ( beta version ) Henry Ford Hospital Headache Disability Inventory ( HDI ) , Headache Impact Test ( HIT-6 ) , and visual analogue scale assessment of headache intensity . The primary efficacy measures were headache frequency and severity ; secondary measures were 25-item HDI , HIT-6 , and number of acute medications . Follow-up visits were scheduled at weeks 4 , 6 , 8 , 10 , and 12 after baseline visit . Results A reduction in all outcome measures was achieved in both the groups . However , this improvement was more sustained in the BTX-A group , and both the therapies were well tolerated . Conclusion BTX-A injection and rTMS have favorable efficacy and safety profiles in chronic migraineurs . rTMS is of comparable efficacy to BTX-A injection in chronic migraine therapy , but with less sustained effect Cervical dystonia ( CD ) is characterized by abnormal , involuntary contractions of the cervical and /or shoulder muscles . Direct injection of Botulinum toxin type A ( BTX-A ) into the affected muscles has been used successfully to treat this condition . However , clinical resistance to BTX-A therapy develops in a limited number of patients . Moreover , an unknown proportion of treated patients have a suboptimal response to their present therapy . BTX-B is antigenically distinct from BTX-A and possesses a different mechanism of action . Three r and omized , double-blind , placebo-controlled clinical trials evaluated the safety and efficacy of BTX-B ( Elan 's BTX-B evaluated as NeuroBloc ) as a treatment for patients with CD . Patients received a single dose of BTX-B ranging from 2,500 to 10,000 U. The primary efficacy evaluation for each of these studies used the Toronto Western Spasmodic Torticollis Rating Scale ( TWSTRS ) total score . Additional efficacy measures included the TWSTRS severity , disability , and pain subscale scores , as well as the Patient Analog Pain Assessment and Patient 's and Physician 's Global Assessment s of Change . In all three studies , groups receiving BTX-B displayed statistically significant improvements in TWSTRS total score and other efficacy end points compared with those who received placebo treatment . The clinical benefits after BTX-B treatment lasted 12 to 16 weeks and were observed in both BTX-A-responsive and BTX-A-resistant patients . In general , treatment with BTX-B was well tolerated and most of the reported adverse events were of short duration , mild to moderate in severity , and anticipated . The results from the three controlled clinical trials demonstrate the safety and efficacy of BTX-B in the treatment of patients with CD , including those who are resistant to BTX-A treatment Current antispastic medications are unsatisfactory for spasticity treatment , but botulinum toxin type A ( BTX-A ) shows promise as a new therapeutic option . This open-label , prospect i ve study aim ed to assess the effectiveness of BTX-A in improving functional mobility in the early post-stroke population using an individualised , flexible range of doses and targeted muscle groups . Twenty-one stroke patients ( 13 male , 8 female ) were enrolled and injected with BTX-A ( Botox , Allergan , mean dose : 255 U ; range : 185–300 ) according to individual spasticity patterns . Assessment s were made at baseline and weeks 2 , 4 , 6 , 10 and 16 post-treatment . Outcome measures comprised : Modified Ashworth Scale ( MAS ) , finger flexion scale ( Bhakta ) , MRC scale , Physician ’s Rating Scale ( PRS ) , Nine Hole Peg Test ( 9HPT ) , Motor Assessment Scale , Clinical Global Impression ( CGI ) , Global Assessment of Spasticity ( GASS ) and Visual Analogue Scale ( VAS ) for pain assessment . Statistically significant improvements in muscle tone as determined by the MAS were found in all areas ( except arm ) till week 16 ( p<0.05 ) . Finger positioning improved for the study duration , whilst muscle power increased only slightly in specific muscles . PRS revealed significant improvements to week 10 and slight improvement in 9HPT performance in selected patients was observed . Motor Assessment Scale results were statistically significant for arm , h and and advanced h and functions , although the overall functional benefit was mild . GASS and CGI results also showed improvement . Pain was present only in 11 patients and did not significantly improve following treatment . Individualised BTX-A injection regimens may be an effective , reversible and safe new treatment option for patients with spasticity . Nevertheless , functional improvement may be reached only in selected patients Abstract A double-blind , r and omized , placebo-controlled study of patients with essential trigeminal neuralgia and treatment with a single injection of onabotulinum toxin A ( BTX )  was carried out . The efficacy , safety , and tolerability of either 1 mL 0.9 % saline plus 50 U of BTX or only 1 mL of 0.9 % saline injected subcutaneously in the affected area were evaluated . Cases with involvement of the third branch of the trigeminal nerve also received intramuscularly either 10 U of BTX or matching placebo in the masseter muscle , ipsilateral to the pain location . Pain was assessed with the visual analog scale ( VAS ) . Twenty subjects were administered BTX , and 16 subjects received placebo .  Two months after the intervention , a trend to statistical significance was observed for the VAS mean values in subjects treated with BTX and those who received placebo ( VAS 4.9 vs 6.63 , t test , P = 0.07 ) . Three months after the injection , significant differences were observed in the average VAS score for subjects treated with BTX and those treated with placebo ( VAS 4.75 vs 6.94 , respectively ; t test , P = 0.01 ) . Onabotulinum toxin A was well tolerated and seems to be a safe and useful therapy for patients with essential trigeminal neuralgia OBJECTIVE To determine the efficacy of occipital nerve blocks using reconstituted botulinum toxin type-A ( BTX-A ) in providing significant and prolonged pain relief in chronic occipital neuralgia . BACKGROUND Occipital neuralgia is a unilateral or bilateral radiating pain with paresthesias commonly manifesting as paroxysmal episodes and involving the occipital and parietal regions . Common causes of occipital neuralgia include irritation or injury to the divisions of the occipital nerve , myofascial spasm , and focal entrapment of the occipital nerve . Treatment options include medication therapy , occipital nerve blocks , and surgical techniques . BTX-A , which has shown promise in relief of other headache types , may prove a viable therapeutic option for occipital neuralgia pain . METHODS Botulinum toxin type-A ( reconstituted in 3 cc of saline ) was injected into regions traversed by the greater and lesser occipital nerve in 6 subjects diagnosed with occipital neuralgia . Subjects were instructed to report their daily pain level ( on a visual analog pain scale ) , their ability to perform daily activities ( on several quality of life instruments ) and their daily pain medication usage ( based on a self-reported log ) , 2 weeks prior to the injection therapy and 12 weeks following injection therapy . Data were analyzed for significant variation from baseline values . RESULTS The dull/aching and pin/needles types of pain reported by the subjects did not show a statistically significant improvement during the trial period . The sharp/shooting type of pain , however , showed improvement during most of the trial period except weeks 3 - 4 and 5 - 6 . The quality of life measures exhibited some improvement . The headache-specific quality of life measure showed significant improvement by 6 weeks which continued through week 12 . The general health- and depression-related measures showed no statistical improvement . No significant reduction in pain medication usage was demonstrated . CONCLUSIONS Our results indicate that BTX-A improved the sharp/shooting type of pain most commonly known to be associated with occipital neuralgia . Additionally , the quality of life measures assessing burden and long-term impact of the headaches , further corroborated improvement seen in daily head pain Current migraine preventive therapies are often unsatisfactory because of their limited efficacy , adverse effects , and drug interactions . An open-label , noncontrolled study of botulinum toxin type A ( BTX-A ) suggested some benefits for patients with migraine . To assess the efficacy and safety of BTX-A , a r and omized , double-blind , vehicle-controlled , parallel group study was conducted in 32 patients with a history of 2 to 8 migraine attacks per month , with or without aura . The patients were r and omized to receive single administrations of 50-U BTX-A or vehicle injected into multiple sites of pericranial muscles at the same visit . Patients kept daily diaries in which they recorded outcome measures like migraine frequency , migraine severity , and the occurrence of migraine-associated symptoms . Patients grade d symptoms on a 4-point scale ranging from grade s 0 to 3 before and up to 3-months after treatment . The assessment s were made at 0 , 1 , and 3 months . The primary efficacy parameters included number of headaches resolved ( grade 3/2 to grade 0 ) and alleviation of other accompanying symptoms of migraine . The supplementary end point included improvement in quality of life ( QOL ) . About 75 % of patients reported complete relief to mild headache ( grade 0–1 ) by BTX-A and none by placebo group . Patient ' QOL parameters like energy/vitality and feelings and concerns about the treatment had shown considerable improvement . However , normal day-to-day work functioning and social interactions deteriorated . No adverse effects were reported in any of the patients in either of the groups during the study . It is evident from the study that pericranial injection of 50-U BTX-A showed good efficacy and tolerability as a prophylactic agent . However , this therapy will be expensive to the patients , but it is far superior in providing relief to the patients compared with existing therapies 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 r and omized , 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 r and omized 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 grade d 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 PURPOSE We determined the safety and efficacy of each of 2 doses of botulinum toxin type A ( BTX-A ) ( 200 or 300 U BOTOX ) injected into the detrusor for urinary incontinence caused by neurogenic detrusor overactivity of predominantly spinal cord origin . MATERIAL S AND METHODS A total of 59 patients with urinary incontinence caused by neurogenic detrusor overactivity ( due to spinal cord injury in 53 and multiple sclerosis in 6 ) requiring clean intermittent self-catheterization were r and omized to receive a single dose into the detrusor of BTX-A ( 200 U or 300 U ) or placebo . Changes in daily frequency of urinary incontinence episodes were monitored via a patient bladder diary during 24 weeks . Key urodynamic assessment s ( maximum cystometric capacity , reflex detrusor volume and maximum detrusor pressure during bladder contraction ) were used to provide objective measures of the treatment effect on bladder function . The impact of treatment on quality of life was assessed using the Incontinence Quality of Life question naire . RESULTS There were significant posttreatment decreases in incontinence episodes from baseline in the 2 BTX-A groups ( p < /=0.05 ) but not in the placebo group . In addition , more patients who received BTX-A reported no incontinence episodes during at least 1 posttreatment evaluation period . Positive treatment effects were also reflected by significant improvements in bladder function in the BTX-A groups , as assessed by urodynamics and in patient quality of life . Benefits were observed from the first evaluation at week 2 to the end of the 24-week study . No safety concerns were raised . CONCLUSIONS Intramuscular injections of BTX-A into the detrusor can provide rapid , well tolerated , clinical ly significant decreases in the signs and symptoms of urinary incontinence caused by neurogenic detrusor overactivity during a 24-week study period In this multicenter study of 100 patients with cervical dystonia , we examined the immunogenicity of botulinum toxin type B ( BTX-B ) and correlated the clinical response with the presence of blocking antibodies ( Abs ) using a novel mouse protection assay . One-third of the patients who were negative for BTX-B Abs at baseline became positive for BTX-B Abs at last visit . Thus , the high antigenicity of BTX-B limits its long-term efficacy OBJECTIVE To assess the benefits of subcutaneous injection of botulinum toxin A ( BTX-A ) for the treatment of postherpetic neuralgia ( PHN ) . DESIGN We investigated the therapeutic benefits of BTX-A in subjects with PHN in a r and omized , double-blind , placebo-controlled study . Sixty subjects with PHN were r and omly and evenly distributed into BTX-A , lidocaine , and placebo groups . MEASURES After r and omization , one of the following solutions was injected subcutaneously in the affected dermatome : 5u/mL BTX-A , 0.5 % lidocaine , or 0.9 % saline ( placebo ) .  Visual analog scale ( VAS ) pain and sleeping time ( hours ) were evaluated at the time of pretreatment , day 1 , day 7 , and 3 months posttreatment . Opioid usage was calculated at day 7 and 3 months posttreatment . RESULTS Compared with pretreatment , VAS pain scores decreased at day 7 and 3 months posttreatment in all three groups ( P<0.01 ) . However , the VAS pain scores of the BTX-A group decreased more significantly compared with lidocaine and placebo groups at day 7 and 3 months posttreatment ( P<0.01 ) . Sleep time ( hours ) had improved at day 7 and at 3 months compared with pretreatment in all three groups , but the BTX-A group improved more significantly compared with lidocaine and placebo groups ( P<0.01 ) . The percent of subjects using opioids posttreatment in the BTX-A group was the lowest ( 21.1 % ) compared with the lidocaine ( 52.6 % ) and placebo ( 66.7 % ) groups ( P<0.01 ) . CONCLUSIONS Subcutaneous administration of BTX-A significantly decreased pain in PHN and reduced opioid use compared with lidocaine and placebo at day 7 and 3 months post-treatment . It also increased subjects ' sleep times INTRODUCTION Migraine is a frequent medical complaint . In military population s , migraine can be detrimental to productivity and troop readiness , and can be disqualifying for service in some military duty specialties . This study assessed the effectiveness of botulinum neurotoxin type-A ( BTX-A ) in reducing the frequency of migraines  in known migraineurs . METHODS There were 32 subjects ( control = 17 , test n = 15 ) who completed the assessment battery at baseline and monthly for 3 mo . Adult subjects with migraine headaches occurring more than 5 times/month were recruited and r and omized to receive placebo saline injection vs. BTX-A. The primary efficacy parameter was the average frequency of headache days for 3 mo . Secondary outcome measures were severity of attacks and quality of life . RESULTS Quadratic trends were noted for headache severity ( F ( 2,29 ) = 14.1 , p = 0.001 ) and headache indexes ( F ( 2,29 ) = 4.5 , p = 0.042 ) for both groups , suggesting changes in severity of head pain and overall intensity of headaches experienced over time ; however , results were not significant for headache frequency and severity between groups . Paired t-tests of the headache index scores for the control group revealed a significant increase from the first to the third follow-up periods ( t = -2.58 , p = 0.020 ) . Such a trend was not observed for the BTX-A group . Both groups , however , reported similarly low to moderate quality of life as a result of their migraines . CONCLUSIONS This controlled trial failed to demonstrate efficacy of BTX-A in reducing the frequency of migraine headaches . The pattern headache index in the botox group , however , suggested a protective effect for botox against the headache severity To assess , in a prospect i ve study , whether botulinum toxin A ( BTXA ) injected into the detrusor muscle is safe and well tolerated , produces significant changes in urodynamic variables , if the effect is durable , as measured by the Bristol Female Lower Urinary Tract Symptom Question naire ( BFLUTS ) , and to assess changes in quality of life , as measured by the Kings Health Question naire ( KHQ ) , when it is used to manage idiopathic detrusor overactivity Abstract Objective . Male chronic pelvic pain syndrome ( CPPS ) has been the subject of numerous clinical trials , but so far , no uniformly effective treatment has been identified . A commonly reported tender spot in men with CPPS is the bulbospongiosus muscle . A r and omized placebo controlled pilot trial of botulinum toxin A ( BTX-A ) injection into the perineal skeletal musculature for the treatment CPPS was conducted . Material and methods . Twenty-nine men with CPPS were identified from a urology clinic . Symptom evaluation was performed using a Global Response Assessment ( GRA ) and the Chronic Prostatitis Symptom Index ( CPSI ) .  All subjects were r and omized to receive either BTX-A 100 U or normal saline injected into the perineal body and bulbospongiosus muscle . Results . BTX-A  injection was administered in 13 men . At the 1 month follow-up there was a 30 % response rate for BTX-A treatment compared with 13 % for placebo ( p = 0.0002 ) , based on GRA results . Total CPSI score did not reach significance in the BTX-A-treated group , compared with controls . The CPSI pain subdomain score reached statistical significance in the BTX-A patients compared with controls ( p = 0.05 ) . The injections were well tolerated . There were no complications from the injections and no patients reported side-effects . Conclusions . BTX-A injection into the perineal body and bulbospongiosus muscle results in a modest response rate on the GRA compared with placebo for overall symptoms associated with CPPS . The treatment is well tolerated and safe . BTX-A use may enhance polytherapeutic pain management We used single fiber electromyography ( SFEMG ) to study 42 patients who had enrolled in a double-blind , placebo-controlled trial undertaken to assess the efficacy of botulinum toxin ( BTX ) injection of neck muscles to treat torticollis . SFEMG in a limb muscle was performed before treatment , 2 , and 12 weeks after injection of placebo or BTX . Before treatment , the mean jitter was 26.8 microsec in patients who were to receive BTX , and 25.7 microsec in the placebo group . Two weeks after injection , mean jitter in the group receiving BTX was 43.6 microsec . In the placebo group , it was 26.5 microsec ( P = less than .05 ) . Twelve weeks after injection , mean jitter in the BTX group was 35.5 ; for the placebo group it was 24.5 . Fiber density did not change in any patient during the study . There were no remote clinical effects of BTX . Injection of BTX into muscles affected with focal dystonia is a promising and safe treatment , but there are sub clinical effects on uninjected muscles
Conclusion Based on the current evidence , BTX-A may be an effective and safe option for the treatment of neuralgia .
Aim This meta- analysis was performed to evaluate the efficacy and safety of botulinum toxin-A ( BTX-A ) for the treatment of neuralgia .