Medical Management Of Trigeminal Neuralgia Research Articles

Medical Management of Trigeminal Neuralgia.

Trigeminal neuralgia (TN) is a painful condition, often leading to poor quality of life. The aim of this review was to discuss the various treatment modalities for the medical management of TN. We reviewed the available literature on TN in clinical databases including PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews, with a specific focus on the pharmacological treatment and newer drugs under development for the treatment of TN. Carbamazepine (CBZ) is the gold standard of treatment for TN. The first-line drugs for the treatment of TN are CBZ and oxcarbazepine (OXC). A proportion of cases (30%) are initially resistant to the first-line drugs. Alternative drugs need to be considered if the first-line drugs are not well tolerated or become ineffective with prolonged therapy. The second-line drugs comprise lamotrigine, baclofen, gabapentin, and pregabalin used as monotherapy or in combination with CBZ/OXC. Botulinum toxin A may be a promising presurgical option. Newer drug like vixotrigine has shown good results in phase two randomized control trials. About 50% of cases develop treatment resistance to oral drugs over the subsequent years of therapy and require surgical options. The first-line drugs for the treatment of TN (irrespective of the age group or type) are CBZ and OXC. Combination therapy with second-line or other drugs may become necessary with poor response to CBZ/OXC, or if adverse events occur. Patients should be offered surgical options if there is poor response or tolerance to the medical therapy.

Favourable prognosis of trigeminal neuralgia when enrolled in a multidisciplinary management program - a two-year prospective real-life study

BackgroundPrognosis of medically treated trigeminal neuralgia patients is assumed to be poor, but the evidence is lacking. Thus, prospective real-life studies of medical management of trigeminal neuralgia are warranted.MethodsThis was an observational study. Patients were consecutively enrolled in a structured management program at a specialist centre for facial pain. Optimisation of medical treatment, physiotherapy, psychotherapy, and advice from trained nurses, were parts of the program. Medically intractable patients were referred for neurosurgery. Data-collection was prospective using standardised schemes and patient surveys. The aim was to describe the two-year outcome of medical treatment at the specialist centre. The primary outcome was a 50% reduction in the overall burden of pain according to a Numerical Rating Scale (NRS) after two years.ResultsA total of 186 primary TN patients were enrolled in the program of which 103 patients remained medically managed and completed the two-year follow-up. Fifty patients were treated surgically within the first two years of follow-up. Half of the medically managed patients (53 (51%)), had more than a 50% reduction in the overall burden of pain over the two-year period. The overall burden of pain on NRS decreased from mean 5.34 to 3.00, p < 0.01. There was no significant association between primary outcome and sex, depression and/or anxiety, concomitant persistent pain, or neurovascular contact with morphological changes of the trigeminal nerve.ConclusionsPatients with trigeminal neuralgia improve over a two-year period when enrolled in a structured medical management program. Optimisation of drug treatment, continuous advice and education and support by the multidisciplinary team, referral of the medically intractable patients for surgery or the natural history of the disease, can be some of the reasons for the improvement. The favourable prognosis provides hope and optimism for medically managed TN patients.Trial registrationCurrent study was observational, and patients were offered standard clinical care and laboratory workups according to current American Academy of Neurology and European Federation of Neurological Societies treatment guidelines. The study has been registered at ClincalTrials.gov. ID: NCT03838393.

Medical Management of Trigeminal Neuralgia with Carbamazepine, Gabapentin and Pregabalin: A Randomized Placebo Controlled Trial

Trigeminal neuralgia (TN) or Tic douloureux is a disorder characterized by stabbing or electric-shock-like pain in parts of the face. The presented research evaluates the use of gabapentin and pregabalin with carbamazepine to relieve neuropathic pain in this condition.

Medical Management of Trigeminal Neuralgia

Medical Management of Trigeminal Neuralgia

1. Trigeminal Neuralgia

Trigeminal neuralgia is a common cause of facial pain. It has a significant impact on the quality of life and the socioeconomic functioning of the patient. The aim of this review is to provide recommendations for medical management of trigeminal neuralgia based on current evidence. Based upon the analyses of the literature combined with experience in pain management, symptoms, assessment, differential diagnosis, and treatment possibilities of trigeminal neuralgia are described and discussed. Recommendations for pain management are given and are displayed in a clinical practice algorithm. Treatment should be multidisciplinary. Various treatment options and their risks should be discussed with the patient. The first treatment of choice is carbamazepine or oxcarbazepine. In younger patients, the first choice of invasive treatment is probably microvascular decompression. For elderly patients, radiofrequency treatment of Gasserian ganglion is recommended and the technique is described in detail.

Trigeminal neuralgia: assessment and management by oral and maxillofacial surgeons in the United Kingdom

We aimed to find out how oral and maxillofacial surgeons in the United Kingdom currently assess and manage patients with suspected trigeminal neuralgia, and compared this with best practice. We undertook a postal survey of 297 consultant oral and maxillofacial surgeons in the UK (of whom 178 (60%) replied) asking questions about examinations and routine investigations of new patients with symptoms of trigeminal neuralgia, and their subsequent management. Clinical examination including cranial nerve function was made by almost all respondents (92%). Magnetic resonance imaging gives the most helpful diagnostic information and was requested by most surgeons (55%). Current publications have suggested that medical management of trigeminal neuralgia is appropriate for most patients, and this was reflected in current practice. Most surgeons (93%) used carbamazepine as their first choice of drug.

The Medical Management of Trigeminal Neuralgia

Trigeminal neuralgia results from disturbances in the trigeminal root entry zone which generate repetitive action potentials. Drugs which relieve the pain of trigeminal neuralgia depressed these potentials. Anticonvulsants which exert this or related effects, and which have been demonstrated to be efficacious in trigeminal neuralgia, include carbamazepine, phenytoin, clonazepam, and valproic acid. Baclofen may act by facilitating segmental inhibition of the trigeminal complex. The mechanism of action of pimozide for treating trigeminal neuralgia is not known. Carbamazepine is suggested as the drug of first choice; baclofen or clonazepam could be added if carbamazepine monotherapy is ineffective. When these fail, monotherapy with phenytoin, pimozide, or valproic acid would be a reasonable next step.

Medical management of trigeminal neuralgia'

Medical management of trigeminal neuralgia'

Medical management of trigeminal neuralgia'

Medical management of trigeminal neuralgia'

Medical management of trigeminal neuralgia

Trigeminal neuralgia is a sudden, severe, brief, recurrent stabbing pain in the distribution of the trigeminal nerve whose aetiology remains unknown. Medical management is the first line of treatment and when this fails, surgical treatment needs to be undertaken. Carbamazepine is the best anti-neuralgic drug available at present, but may cause unacceptable side-effects. Phenytoin, baclofen and clonazepam are other drugs used, either as monotherapy or together with carbamazepine, but they are not as effective. Oxcarbazepine, a new drug, similar to carbamazepine but with fewer side-effects, may prove to be the drug of the future. Once diagnosed, these patients should be managed by specialists who can offer a range of treatments.