Supplementary Material for: Botulinum toxin-A for the treatment of neuropathic pain after decompressive craniotomy in stroke – two cases

Botulinum toxin-A (BoNT-A) is recommended as third-line off-label treatment for the management of neuropathic pain. BoNT-A has been reported as treatment for different neuropathic pain conditions; however not for neuropathic pain after decompressive craniotomy for stroke. The aim of this retrospective case series is to provide information on safety, the effect and the application method of BoNT-A in clinical practice for the treatment of neuropathic pain after trepanation. This case series describes two patients treated in 2021 at a BoNT outpatient clinic for chronic neuropathic pain at the incisional site after decompressive craniotomy for stroke which was resistant to pain medication. Cases were a 48-year old woman and a 63-year old man suffering from chronic neuropathic pain since 3 and 6 years, respectively. They were treated regularly with BoNT-A with a total dose of 100 mouse units of incobutulinumtoxin-A dose injected into peri-incisional sites of the scalp. Both patients reported subjective decrease in pain frequency (40% and 60%), in pain intensity (60% and 90%) and an increase of quality of life (80%). BoNT-A should be further investigated as treatment for neuropathic pain – especially in underreported conditions such as neuropathic pain after craniotomy in stroke.