Management Of Trigeminal Neuralgia Research Articles

Clinical Efficacy of Oxcarbazepine compared with Carbamazepine in terms of Pain Relief in the Management of Trigeminal Neuralgia

Background: Despite various pharmacological drugs used for the treatment of Trigeminal Neuralgia (TN), the clinical efficacy of carbamazepine with oxcarbazepine in terms of pain relief particularly in Pakistani population is poorly studied. This study aimed to compare the efficacy of carbamazepine with oxcarbazepine for treating Trigeminal Neuralgia. Objective: To compare oxcarbazepine with carbamazepine in the management of trigeminal neuralgia in terms of mean pain. Study Design: Quasi-Experimental study. Settings: Fauji Foundation Hospital, Rawalpindi Pakistan. Duration: 06 months i.e. 30th Apr 2018 to 30th Oct 2018. Methods: This single-centre, prospective clinical study was conducted on 70 patients diagnosed with TN. Patients were divided into two groups; Group A: Control group (n = 35), in which patients were given Carbamazepine 200mg twice a day upto1800mg and Group B: an Experimental group (n = 35), in which the patients receive Oxcarbazepine (300mg BD daily up-to 1800mg). The clinical parameters were evaluated by a self-reported questionnaire. Pain level was assessed at 1st and 2nd month follow-up using a Visual Analog Scale. Results: The mean postoperative pain was measured for both groups. Although the mean pain score at 1st follow-up month was similar for Group A (5.2±1.0) and B (4.9±1.1), p=0.328, higher clinical efficacy was observed in 2nd follow-up month for Group B– Oxcarbazepine (3.1±0.8) when compared with Group A– Carbamazepine (5.14±0.8) in terms of mean pain score that was statistically significant p<0.001. Conclusion: This study concludes that in term of pain relief, Oxcarbazepine appears to be a more effective as compared to Carbamazepine in the treatment of TN.

[Microvascular Decompression:The Superiority of Transposition].

In this feature article, we underscore the advantages of Transposition over Interposition in the management of trigeminal neuralgia and hemifacial spasm. Interposition, while effective, has raised concerns owing to long-term complications associated with the use of artificial materials, such as Teflon and silicone sponges. Transposition, on the other hand, mitigates these issues, showcasing adaptability to a range of anatomical and pathological conditions and affirming its standing as a safer and more effective treatment alternative. Each technique has distinct applications that are governed by the patient's specific anatomical and pathological needs. While Transposition is emerging as a favored option, Interposition remains relevant in specific cases, underscoring the necessity for a personalized approach to neurovascular decompression. In offering a comprehensive overview, this article is not just an academic exercise, but also a practical resource. A nuanced exploration of these surgical interventions is meant to provide readers with actionable insights, blending the current findings with real-world applicability. The goal is to foster a deeper understanding and aid practitioners in making informed decisions that are finely attuned to each patient's unique needs and conditions, ensuring optimal outcomes, while prioritizing safety and effectiveness.

Trigeminal Neuralgia Management with <i>Varmam</i> Therapy and <i>Siddha</i> Medicine – A Case Report

A 48 year old female staff nurse from Chennai consulted in the Varma Maruthuvam Outpatient Department of APH-NIS, Chennai presented with complaints of sudden and severe stabbing pain with burning sensation at the left half of the maxillary and mandibular region for one year. After her MRI scan was done, she was diagnosed with trigeminal neuralgia due to vascular compression. The patient had consulted an allopathic hospital and used carbamazepine for the long term. She experienced some temporary relief, but the episodes occurred for a short while, and she felt drowsy. For further improvement, she came for Varmam treatment. The present study is a case report of typical Trigeminal Neuralgia (TN) that was treated with Siddha Varmam therapy along with Amukkarachooranam, Arumugachenduram and Arakku thailam for two months. This case report showed a promising reduction in pain episodes and recurrence following treatment, as measured by the Visual Analogue Scale (VAS) score. This study sheds light on the fact that Varmam therapy with concomitant medicines has a promising effect in the management of trigeminal neuralgia.

Sphenopalatine Ganglion Block Using Intranasal Lignocaine Spray for Trigeminal Neuralgia: A Case Series

Abstract Various interventions have been tried for the management of trigeminal neuralgia which is a sharp, shooting recurrent neuropathic pain. The use of the sphenopalatine ganglion (SPG) block has been established as a fast, safe, and effective means of pain relief for these patients. Recently, 10% lignocaine spray has been described as a less invasive alternative for this block. We report seven patients of idiopathic trigeminal neuralgia with acute unilateral severe pain managed by SPG blocks using 10% intranasal lignocaine spray. Seven patients with unilateral trigeminal neuralgia were included in the study. Two puffs of 10% lignocaine were sprayed into the nostril of the affected side in a slightly medial and inferior direction. Before the procedure and 30 min later, Visual Analog Scale (VAS) scoring was done. The procedure was repeated in case of no pain relief after 1 h of nasal spray (VAS 4 or 5). All patients were observed for 2 h and oral medication was prescribed if required after assessment at 24 h. Four patients reported complete relief (VAS 0 or 1) and two of them reported pain (VAS 4 and 5) after 24 h. The procedure had to be repeated in two patients with no pain relief (VAS 4 and 5) after 1 h. There was no relief in one patient even after repeated administration (VAS 5). The findings suggest a role for intranasal lignocaine spray for SPG block in trigeminal neuralgia for alleviating acute exacerbations of pain and obtaining quick relief.

Safety and efficacy of carbamazepine in the treatment of trigeminal neuralgia: A metanalysis in biomedicine

<abstract> <p>Trigeminal neuralgia is a debilitating condition characterized by severe facial pain. Carbamazepine has been widely used as a first-line treatment option for trigeminal neuralgia, but there is a need to evaluate its safety and efficacy based on existing evidence. This meta-analysis aims to systematically assess the available literature and provide a comprehensive evaluation of the safety and efficacy of carbamazepine in the treatment of trigeminal neuralgia. A thorough search of electronic databases yielded a total of 15 relevant studies that met the inclusion criteria. The pooled analysis of these studies revealed that carbamazepine demonstrated significant efficacy in reducing pain intensity and frequency in patients with trigeminal neuralgia. Moreover, the drug was generally well-tolerated, with the most common adverse events being mild and transient. Subgroup analyses based on different dosages and treatment durations further supported the overall findings. However, caution should be exercised in patients with certain comorbidities or specific populations, as some rare but severe adverse events were reported. In conclusion, this meta-analysis provides strong evidence supporting the safety and efficacy of carbamazepine as a valuable therapeutic option for the management of trigeminal neuralgia. These results can guide clinicians in making informed decisions regarding the use of carbamazepine and contribute to optimizing treatment strategies for patients with trigeminal neuralgia. Further research is warranted to explore long-term safety and efficacy outcomes, as well as to compare carbamazepine with alternative treatment modalities.</p> </abstract>

Trigeminal Neuralgia: Anticonvulsants and Antidepressants

Orofacial neuropathic pain happens due to somatosensory nervous system injury or disease in the orofacial region. Multiple types of orofacial neuropathic pain have been identified, including nonodontogenic neuropathic orofacial pain, postherpetic neuralgia, atypical odontalgia, glossopharyngeal neuralgia and trigeminal neuralgia. Currently, pharmacological intervention is well known as the foundation for managing neuropathic pain. Drugs from different classifications, including anticonvulsants, antidepressants, opioids, and nonsteroidal anti-inflammatory drugs, are generally used to treat these events. However, these drugs are not yet broadly accepted for these treatments. This review will explore recent clinical findings and fragments of evidence regarding anticonvulsants and antidepressants in the management of trigeminal neuralgia.

Effectiveness of gamma knife radiosurgery in the management of trigeminal neuralgia associated with multiple sclerosis: a systematic review and meta-analysis

Effectiveness of gamma knife radiosurgery in the management of trigeminal neuralgia associated with multiple sclerosis: a systematic review and meta-analysis

The role of artificial intelligence in the management of trigeminal neuralgia.

Trigeminal neuralgia (TN) is the most frequent facial pain. It is difficult to treat pharmacologically and a significant amount of patients can become drug-resistant requiring surgical intervention. From an etiologically point of view TN can be distinguished in a classic form, usually due to a neurovascular conflict, a secondary form (for example related to multiple sclerosis or a cerebello-pontine angle tumor) and an idiopathic form in which no anatomical cause is identifiable. Despite numerous efforts to treat TN, many patients experience recurrence after multiple operations. This fact reflects our incomplete understanding of TN pathogenesis. Artificial intelligence (AI) uses computer technology to develop systems for extension of human intelligence. In the last few years, it has been a widespread of AI in different areas of medicine to implement diagnostic accuracy, treatment selection and even drug production. The aim of this mini-review is to provide an up to date of the state-of-art of AI applications in TN diagnosis and management.

Purgation therapy (bhedhi) in the treatment of Trigeminal neuralgia and evaluation using Siddha diagnostic tool neerkuri and neikuri – A Case study

Siddha science is an immortal science, which has its origin from ‘Siddhars’. The Siddha system is mainly based on the humoral theory. The three humors namely Vatham, Pitham and Kapham. Any increase or decrease in the ratio of the three humors causes disease in the human body. In the Siddha system of medicine, diseases are classified into 4448 in number. Out of these Yugi Munivar classified Vatham as 80 types. The symptoms of Trigeminal Neuralgia come under this Vatha classification. The elevated Vatham is decreased by giving purgation therapy based on the quote ‘Bhedhiyaal Vatham Thaalum’. Agasthiyar Kuzhambu is one of the best commonly used purgative medicine in the Siddha System.Trigeminal neuralgia is one of the painful disorders involving the fifth cranial nerve and causes severe unilateral pain in the face over regions supplied by the branches of the trigeminal nerve[5]. The present study is conducted to know the efficacy of Siddha Purgation Therapy for the management of trigeminal neuralgia on the basis of the quote “Bhedhiyaal Vatham Thaalum”. A female patient of 56 years, diagnosed with trigeminal neuralgia approached our hospital and got purgation therapy using Agasthiyar Kuzhambu for 3 days. Patient complaints were assessed before and after treatment with 1) Siddha diagnostic tool neerkuri and neikuri,  2) Questionnaire about increased  Vatha symptoms and 3)Visual Analog Scale (VAS) pain scale. After giving Agasthiyar Kuzhambu follow up the patient she got relieved from their symptoms and got satisfactory results with the Siddha line of management. The possible understanding of the case and therapeutic protocol in Siddha has been discussed.

New insight into the mandibular nerve at the foramen ovale level for percutaneous radiofrequency thermocoagulation.

Percutaneous radiofrequency thermocoagulation (RFTC) has been widely utilized in the management of trigeminal neuralgia. Despite using image guidance, accurate needle positioning into the target area still remains a critical element for achieving a successful outcome. This study was performed to precisely clarify the anatomical information required to ensure that the electrode tip is placed on the sensory component of the mandibular nerve (MN) at the foramen ovale (FO) level. The study used 50 hemi-half heads from 26 South Korean adult cadavers. The cross-sectioned anterior and posterior divisions of the MN at the FO level could be distinguished based on an irregular boundary and color difference. The anterior division was clearly brighter than the posterior one. The anterior division of the MN at the FO level was located at the whole anterior (38.0%), anteromedial (6.0%), anterior center (8.0%), and anterolateral (22.0%) parts. The posterior division was often located at the whole posterior or posterolateral parts of the MN at the FO level. The anterior divisions covered the whole MN except for the medial half of the posterolateral part in the overwrapped images of the cross-sectional areas of the MN at the FO level. The cross-sectional areas of the anterior divisions were similar in males and females, whereas those of the posterior divisions were significantly larger in males (P = 0.004). The obtained anatomical information is expected to help physicians reduce unwanted side effects after percutaneous RFTC within the FO for the MN.

Management of trigeminal neuralgia: A multi-centre case study in general practice

Background and aims Patients often first present with symptoms of trigeminal neuralgia (TN) to primary care. However, there has been little research to determine whether the diagnosis and management of this condition is carried out according to current guidelines. Furthermore, there is little up-to-date information regarding the prevalence of TN in the UK. The aim is to estimate the prevalence of TN and to audit the diagnosis and management process of TN in primary care. Methods Between 2019 and 2020 a search was made at five UK GP practices with a total patient population of 55,842 using EMIS and SystmOne patient record systems to review patient consultations to identify patients coded with TN or facial pain (FP). These records were reviewed to ascertain the basis for diagnosis, management in primary care and referral to secondary care. Results 157 patients were identified; 54 coded with FP and 103 with TN. These results indicate a prevalence of 22.3 in 10,000. There was no difference in documented symptoms between the two groups. Seven patients had all ICDH3 criteria recorded, with two meeting the requirements for TN diagnosis. 58.8% of patients with TN were started on carbamazepine, the current gold standard treatment, compared with 16.7% in the FP group. 38.2% of TN patients were referred to a range of different specialities. Conclusion The prevalence of TN may be higher than previously thought. Key diagnostic criteria are often omitted, leading to potential misdiagnosis or delays in diagnosis. Relatively few referrals are made, though all patients should be considered for imaging.

An insight towards the Ayurvedic management of Trigeminal Neuralgia - A Single Case Report

One of the unpleasant conditions affecting the fifth cranial nerve, trigeminal neuralgia causes extreme unilateral pain in the areas served by its branches, along with stiffness in the temporal mandibular joint. Anticonvulsants, tricyclic antidepressants, and other surgical procedures are used to treat trigeminal neuralgia in contemporary medicines Initial adverse effects that are frequently experienced are ataxia, diplopia, nausea, and drowsiness. According to ancient Ayurvedic texts, this condition is closely related to the Sannipatika disease Ananthavata. Even the name suggests that the Vatadosha is highly vitiated. Anantavata is one of the 11 varieties of Shirorogas described by Acharya Sushruta. The treatment is based on Tridosha. The goal of the current study is to determine how effective Ayurveda medicine in Trigeminal neuralgia.

Ayurvedic management of Trigeminal neuralgia by Jalauka Avacharana - An Experience

Trigeminal neuralgia is neuropathic pain causes intense, stabbing pain throughout the face. Attacks can be sudden, come without warning, and make it difficult or impossible to perform normal activities. It was once considered a suicidal disease. The condition is managed through various medications and surgical procedures. Carbamazepine is the drug of choice. If medicines are not effective or side effects are intolerable then surgery is the choice. But it is associated with complications in most cases after surgery and also pain episodes may recur after some years. Recently LASERs are used as adjunctive in the treatment of trigeminal neuralgia for reduction of pain intensity. In Ayurveda it can be correlated with Ananta Vata and plays important role in management and for better quality of life. In Ayurveda Jalauka is the best treatment modality for pain management and stopping recurrence of disease and being healthy ever. A male patient of age 60 years, diagnosed with Trigeminal Neuralgia was treated with allopathy medications. But did not get satisfactory results. Hence patient approached our centre and got the improvement provided by the therapy was assessed on the basis of signs and symptoms before and after the treatment. The therapy was found safe and effective in controlling signs and symptoms and improving the overall condition of trigeminal neuralgia.

The Efficacy of Gamma Knife® Radiosurgery Using Retrogasserian Approach in the Management of Trigeminal Neuralgia: A Prospective Study

The Efficacy of Gamma Knife® Radiosurgery Using Retrogasserian Approach in the Management of Trigeminal Neuralgia: A Prospective Study

Atlas orthogonal chiropractic management of trigeminal neuralgia: A series of case reports

ContextTrigeminal neuralgia is a debilitating facial pain condition. Upper cervical chiropractic care has been mentioned as a possible solution ObjectiveTo determine the effects of Atlas Orthogonal upper cervical chiropractic technique adjustments on trigeminal neuralgia sufferers DesignCase series SettingA private chiropractic practice ParticipantsFive persons with chronic, severe, daily trigeminal neuralgia pain, radiological findings of significant head tilt, pain upon upper cervical palpation, and supine leg length inequality InterventionsUp to two consultations and/or Atlas Orthogonal adjustments a week for eight weeks Outcome measuresSelf-reported reduction in trigeminal neuralgia pain and changes in radiological findings, sensitivity to upper cervical palpation, and leg length inequality ResultsFour participants reported reduced trigeminal neuralgia pain, including two with complete cessation of pain. Three participants reduced medication dosages. One reported no change

Retrospective comparison of percutaneous balloon compression and radiofrequency-thermocoagulation in the management of trigeminal neuralgia

PurposeTo compare percutaneous balloon compression (PBC) and radiofrequency thermocoagulation (RFTC) for the treatment of trigeminal neuralgia.MethodsThis was a retrospective single-center analysis of data from 230 patients with trigeminal neuralgia who underwent 202 PBC (46%) and 234 RFTC (54%) from 2002 to 2019. Comparison of demographic data and trigeminal neuralgia characteristics between procedures as well as assessment of 1) initial pain relief by an improved Barrow Neurological Institute (BNI) pain intensity scale of I–III; 2) recurrence-free survival of patients with a follow-up of at least 6 months by Kaplan-Meier analysis; 3) risk factors for failed initial pain relief and recurrence-free survival by regression analysis; and 4) complications and adverse events.ResultsInitial pain relief was achieved in 353 (84.2%) procedures and showed no significant difference between PBC (83.7%) and RFTC (84.9%). Patients who suffered from multiple sclerosis (odds ratio 5.34) or had a higher preoperative BNI (odds ratio 2.01) showed a higher risk of not becoming pain free. Recurrence-free survival in 283 procedures was longer for PBC (44%) with 481 days compared to RFTC (56%) with 421 days (p=0.036) but without statistical significance. The only factors that showed a significant influence on longer recurrence-free survival rates were a postoperative BNI ≤ II (P=<0.0001) and a BNI facial numbness score ≥ 3 (p = 0.009). The complication rate of 22.2% as well as zero mortality showed no difference between the two procedures (p=0.162).ConclusionBoth percutaneous interventions led to a comparable initial pain relief and recurrence-free survival with a low and comparable probability of complications. An individualized approach, considering the advantages and disadvantages of each intervention, should guide the decision-making process. Prospective comparative trials are urgently needed.

Guidelines for the management of trigeminal neuralgia

Guidelines for the diagnosis and treatment of patients with trigeminal neuralgia (TN) advocate for a multidisciplinary team approach to improve the care of patients with acute and chronic TN. Evidence-based discussions and decisions are encouraged to establish care pathways for prompt diagnosis and treatment, and long-term outcomes data collection to improve care. The guidelines include summary materials for patients to inform them about their condition and available treatments.

Surgical Management for Trigeminal Neuralgia Caused by Trigeminocerebellar Artery Compression

Surgical Management for Trigeminal Neuralgia Caused by Trigeminocerebellar Artery Compression

Bibliometric Analysis of the Top 100 Cited Articles on Stereotactic Radiosurgery for Trigeminal Neuralgia.

Background  Stereotactic radiosurgical rhizolysis of the trigeminal nerve is an established modality increasingly employed to alleviate the symptoms of refractory trigeminal neuralgia. This study analyzes the academic impact of the top 100 cited articles on the radiosurgical management of trigeminal neuralgia. Methods  The Scopus database was searched for articles containing "radiosurgery" and one or more of "trigeminal neuralgia," "trigeminus neuralgia," and "tic douloureux." The top 100 articles written in English were arranged in descending order by citation count. Documents were evaluated for authors, publication year, journal and impact factor, total citations, nationality, study type, radiosurgical modality, and the affiliated institution. Quantitative and qualitative analyses were performed on the data. Results  The most cited articles were published between 1971 and 2019. The average citation per year was 4.3. The most targeted anatomic area was the "root entry zone" or proximal portion of the cisternal segment of the trigeminal nerve. The most utilized modality was Gamma Knife radiosurgery. The country with the highest number of publications was the United States. Thirty-six percent of the articles were published in the Journal of Neurosurgery . Lunsford, Kondziolka, Flickinger, and Régis, respectively, were the most frequently listed co-authors. The most prolific institute was the University of Pittsburgh Medical Center. Conclusion  Stereotactic radiosurgery is an important modality in the management of medically or surgically refractory trigeminal neuralgia. This analysis assesses its contributions over the past five decades to identify trends in treatment practices for neurosurgeons and to highlight areas where further study is needed.

Efficacy of transcutaneous electrical nerve stimulation (TENS) in the management of trigeminal neuralgia: A systematic review and meta-analysis.

Trigeminal Neuralgia is one of the most painful disorders known to man. So making patient pain free and to achieve a better quality of life in TN patients is one of the biggest challenge. Non-invasive procedures like Transcutaneous electrical nerve stimulation (TENS) have been tried clinically for Trigeminal neuralgia. Aim: The systematic review and meta-analysis aimed to compare and evaluate the efficacy of transcutaneous electric nerve stimulation in the management of trigeminal neuralgia. The present review has been registered with PROSPERO - An international prospective register of systematic review CRD42021254136. An electronic search was done in PubMed, Cochrane Library, Science Direct, Google Scholar, EBSCOHOST. The assessments of articles were done using selection criteria and PRISMA guidelines Only prospective clinical trials like Randomized clinical trials (RCTs) and clinical trials were included in this review. A total of three studies were included in the meta -analysis. The proportion of total number of patients after TENS therapy across studies with p-value < 0.0001 for each which showed statistically significance. The overall difference in two groups was significant with standardize mean difference of 3.03 [95% CI: 2.50, 3.56]. TENS can be an effective treatment modality for trigeminal neuralgia in reducing the pain intensity with no reported side effects for patients with trigeminal neuralgia alone or even in combination with other first line drugs. Key words:TENS, TN, TENS, TN, Transcutaneous electrical nerve stimulation.