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This combination therapy consists of botulinum toxin type A (BoNT/A) and cobra neurotoxin (CNT), specifically being investigated for the treatment of refractory trigeminal neuralgia. Botulinum toxin type A is a potent neurotoxin produced by *Clostridium botulinum* that acts by cleaving the synaptosomal-associated protein 25 (SNAP-25), a key component of the SNARE complex. This cleavage prevents the fusion of neurotransmitter-containing vesicles with the presynaptic membrane, thereby inhibiting the release of acetylcholine and pro-nociceptive neurotransmitters like glutamate and substance P, which reduces peripheral and central sensitization. Cobra neurotoxin, typically an alpha-neurotoxin derived from *Naja* species, acts as a potent antagonist of nicotinic acetylcholine receptors (nAChRs). Research conducted by the Second Affiliated Hospital of Soochow University suggests that the combination of these two toxins may provide synergistic analgesic effects, potentially allowing for lower dosages of each component while improving the duration and efficacy of pain relief in patients who are unresponsive to conventional carbamazepine therapy.
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