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not NMDA or AMPA mediated currents in cortical neu-
rons cell culture. SPD had no effect on voltage dependent
sodium channel currents.
Conclusions: SPD, a novel amide analogue of valproic
acid, robustly suppresses CSD frequency and elevates
the threshold of both NTG induced mechanical allodynia
and heat hyperalgesia. SPD may exert its anti-migraine
effects through enhancing cortical inhibition. As a promis-
ing novel anti-migraine compound further evaluation of
SPD’s specific mechanism of action is warranted.
P152
A Case Series: IncobotuIinumtoxin A - A Novel
Therapy for Refractory Trigeminal Neuralgia
R. Krel1, T. Mednick1, W. Spinner1
1 show that botulinum toxin A has the potential to become
Neurology, Stony Brook University Hospital, Stony Brook,
NY, USA.
Objectives: To discuss the potential benefits of using
incobotuIinumtoxin A in treating cases of refractory tri-
geminal neuralgia.
Background: The first patient is an 81 year old male with
over 10 years of V1 distribution trigeminal neuralgia of the
right hemifacial region. Patient reported pain that would
‘‘drop him to his knees’’ and was intractable to multiple
oral medications. His pain was refractory to surgical inter-
ventions such as gamma knife surgery, microvascular
decompression and nerve ablation. Patient was started
on onobotuIinumtoxin A (Botox) and after several
rounds of injections, patient began to develop resistance
to therapy and was subsequently transitioned to
incobotuIinumtoxin A at the same unit dose with >90%
relief in the frequency and severity of his symptoms.
The second patient is a 36 year old male with a 4 year
history of right V3 distribution trigeminal neuralgia. He had
also failed multiple oral medications and gamma knife sur-
gery on two occasions. Patient was started on incobotuli-
numtoxin A with an 80% reduction in pain intensity and a
90% reduction in frequency of his pain symptoms. This
benefit was maintained for the duration of three months.
Methods: The first patient was seen every 12 weeks for
onobotuIinumtoxin A injections in a grid like pattern along
the V1 territory. After several sessions of onobotuIinumtoxin
A patient was transitioned to incobotuIinumtoxin A. Pain was
assessed via patient pain scale that was administered at every
appointment visit.
The second patient was started on incobotulinumtoxin A
injected in a grid like pattern along the V3 territory. The
Cephalalgia 33(8 Supplement)
patient’s pain scale was assessed at 6 and 12week follow-
up sessions.
Results: Despite multiple trials of medical and surgical
management patient developed substantial relief with the
use of onobotuIinumtoxin A. Due to development of
onobotuIinumtoxin A resistance in the form of shortened
duration of therapeutic activity, patient was transitioned to
incobotuIinumtoxin A with a beneficial result for a 12
week period of time. In the second patient an improve-
ment in patient symptoms were seen with injections of
incobotulinumtoxin A.
Conclusions: Botulinum toxin A has been used as a mini-
mally invasive therapy for several neurological conditions
such as cervical dystonia and blepharospasm, and has since
transcended into being a mainstay therapy for migraines,
tension, and occipital headaches. The cases we describe
part of the treatment regimen for trigeminal neuralgia
cases that are refractory to both medical and surgical
intervention.
We can furthermore discuss that those patients whom
develop resistance to onobotuIinumtoxin A may be suc-
cessfully transitioned to incobotuIinumtoxin A.
Incobotulinumtoxin A may also be used an additional med-
ication in the management of trigeminal neuralgia.
These cases, like other similar case reports and studies,
show that botulinum toxin A, and in particular
incobotuIinumtoxin A, can become an integral part of tri-
geminal neuralgia therapy.
P153
Dedicated Headache Clinic Impact on Care and
Cost in a Multispeciality Clinic
D.M. Ready
Neurology, Scott & White Healthcare, Temple, TX, USA.
Objectives: To measure the impact a dedicated Headache
Clinic may have upon delivery of care in a multispeciality
clinic.
Background: With the coming health care changes there
many patients will now have access to services previously
unavailable. How this care is delivered will come under
greater scrutiny for its evidence base and cost effective-
ness. Migraine is the second leading cause of disability in
the USA so an individual with Migraine can be assured that
there will be attacks that will on occasion require rescue.
All too often today Migraine patients seek that care in an
expensive Emergency Department setting. It is because of
these episodes of disabling attacks that migraine patients