AAN-EFNS guidelines on trigeminal neuralgia management (original) (raw)
Related papers
Neurology, 2008
Background: Trigeminal neuralgia (TN) is a common cause of facial pain. Purpose: To answer the following questions: 1) In patients with TN, how often does routine neuroimaging (CT, MRI) identify a cause? 2) Which features identify patients at increased risk for symptomatic TN (STN; i.e., a structural cause such as a tumor)? 3) Does high-resolution MRI accurately identify patients with neurovascular compression? 4) Which drugs effectively treat classic and symptomatic trigeminal neuralgia? 5) When should surgery be offered? 6) Which surgical technique gives the longest pain-free period with the fewest complications and good quality of life? Methods: Systematic review of the literature by a panel of experts. Conclusions: In patients with trigeminal neuralgia (TN), routine head imaging identifies structural causes in up to 15% of patients and may be considered useful (Level C). Trigeminal sensory deficits, bilateral involvement of the trigeminal nerve, and abnormal trigeminal reflexes are associated with an increased risk of symptomatic TN (STN) and should be considered useful in distinguishing STN from classic trigeminal neuralgia (Level B). There is insufficient evidence to support or refute the usefulness of MRI to identify neurovascular compression of the trigeminal nerve (Level U). Carbamazepine (Level A) or oxcarbazepine (Level B) should be offered for pain control while baclofen and lamotrigine (Level C) may be considered useful. For patients with TN refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma knife, and microvascular decompression may be considered (Level C). The role of surgery vs pharmacotherapy in the management of TN in patients with MS remains uncertain.
Trigeminal neuralgia--pathophysiology, diagnosis and current treatment
British Journal of Anaesthesia, 2001
Both the International Association for the Study of Pain (IASP) and International Headache Society (IHS) have suggested their own diagnostic criteria for TGN. 91 143 These are remarkably similar and highlight the sudden, explosive nature of the pain (Table 1). In further descriptions of the condition, both classi®cations allude to vascular compression, MS and tumours as known aetiological causes. The IASP classi®cation makes a distinction between TGN (including MS) and secondary neuralgias (caused by structural lesions and injuries, but not including MS), while IHS separates idiopathic TGN from the`symptomatic form' depending on the presence of a structural lesion; it is not quite clear if vascular compression quali®es as such. Neither approach includes reference to variant forms of TGN, which satisfy the diagnostic criteria but display additional features as well.
European Academy of Neurology guideline on trigeminal neuralgia
European Journal of Neurology, 2019
Background and purposeTrigeminal neuralgia (TN) is an extremely painful condition which can be difficult to diagnose and treat. In Europe, TN patients are managed by many different specialities. Therefore, there is a great need for comprehensive European guidelines for the management of TN. The European Academy of Neurology asked an expert panel to develop recommendations for a series of questions that are essential for daily clinical management of patients with TN.MethodsA systematic review of the literature was performed and recommendations was developed based on GRADE, where feasible; if not, a good practice statement was given.ResultsThe use of the most recent classification system is recommended, which diagnoses TN as primary TN, either classical or idiopathic depending on the degree of neurovascular contact, or as secondary TN caused by pathology other than neurovascular contact. Magnetic resonance imaging (MRI), using a combination of three high‐resolution sequences, should b...
Trigeminal Neuralgia Prevalence and Management
2020
Background: Trigeminal neuralgia is a sudden, unilateral, brief, stabbing, recurrent pain in one or more branches of the fifth cranial nerve distribution that affects quality of life of the affected patient. Diagnosis is made using the history alone, based on the pain characteristics. Pain occurs in paroxysms, which can last between a few seconds and a few minutes. The frequency of the paroxysms varies from a few to hundred times per day. Aim: The objective of this article is to provide an up-to-date review regarding the prevalence, etiology, diagnosis, and the management of trigeminal neuralgia. Conclusion: TN is a rare disease but often associated with debilitating pain and disability. TN management is a concern for neurologists and neurosurgeons alike. Progress has been achieved in recent years, leading to the introduction of neuro-radiological approaches for both pathogenesis and surgical treatment. Medical treatment should be done in TN. With an growing variety of medications available, it is possible the surgical alternative may not be available for several years.
Advances in diagnosis and treatment of trigeminal neuralgia
Therapeutics and Clinical Risk Management, 2015
Various drugs and surgical procedures have been utilized for the treatment of trigeminal neuralgia (TN). Despite numerous available approaches, the results are not completely satisfying. The need for more contemporaneous drugs to control the pain attacks is a common experience. Moreover, a number of patients become drug resistant, needing a surgical procedure to treat the neuralgia. Nonetheless, pain recurrence after one or more surgical operations is also frequently seen. These facts reflect the lack of the precise understanding of the TN pathogenesis. Classically, it has been related to a neurovascular compression at the trigeminal nerve root entry-zone in the prepontine cistern. However, it has been evidenced that in the pain onset and recurrence, various neurophysiological mechanisms other than the neurovascular conflict are involved. Recently, the introduction of new magnetic resonance techniques, such as voxel-based morphometry, diffusion tensor imaging, three-dimensional time-of-flight magnetic resonance angiography, and fluid attenuated inversion recovery sequences, has provided new insight about the TN pathogenesis. Some of these new sequences have also been used to better preoperatively evidence the neurovascular conflict in the surgical planning of microvascular decompression. Moreover, the endoscopy (during microvascular decompression) and the intraoperative computed tomography with integrated neuronavigation (during percutaneous procedures) have been recently introduced in the challenging cases. In the last few years, efforts have been made in order to better define the optimal target when performing the gamma knife radiosurgery. Moreover, some authors have also evidenced that neurostimulation might represent an opportunity in TN refractory to other surgical treatments. The aim of this work was to review the recent literature about the pathogenesis, diagnosis, and medical and surgical treatments, and discuss the significant advances in all these fields.
Recent update on trigeminal neuralgia
Journal of the Korean Society of Stereotactic and Functional Neurosurgery
Trigeminal neuralgia (TN), a long-term disorder affecting the trigeminal nerve, is a form of debilitating neuropathic pain. Although the underlying pathogenesis of TN is debatable, loss of myelin along the trigeminal nerve due to direct compression from a blood vessel or secondary to other conditions such as multiple sclerosis or stroke is thought to be the principal cause. Paroxysmal sporadic pain, with unilateral onset, is the main phenomenon of TN. TN is typically diagnosed clinically. Medications, surgery, and complementary techniques are among the current therapy options for altering the neural circuits associated with TN. Nevertheless, anti-epileptic and tricyclic antidepressant medications are recognized as first-line treatments, and surgical treatment may be required for patients who have not obtained a therapeutic effect with at least three medications, have experienced intolerable side effects, or have symptoms that are not resolving. Stimulation of brain regions is an eme...
BMJ, 2014
Trigeminal neuralgia is a severe, unilateral, episodic pain of the face that is provoked by light touch; it should be differentiated from dental causes of pain Magnetic resonance imaging (MRI) can distinguish between patients having secondary trigeminal neuralgia related to tumours and that related to multiple sclerosis The first line drug for treatment is either carbamazepine or oxcarbazepine, and doses should be slowly escalated. Neurosurgical options should be discussed at an early stage, but surgery may not be required until quality of life is compromised Microvascular decompression is a major neurosurgical procedure that provides the longest period of pain relief and aims to preserve function of the nerve Percutaneous, palliative destructive procedures and stereotactic radiosurgery can provide temporary relief, but at the risk of facial numbness, which increases with repetition of the procedure Sources and selection criteria We used Medline and Embase and the search terms "trigeminal neuralgia" and "tic doloureux." One author (JZ) has done Cochrane reviews on both medical and surgical outcomes for trigeminal neuralgia, and the search strategy is shown in those publications. We searched the Cochrane Neuromuscular Disease Group specialised register, Cochrane Library, Medline, and Embase using the search terms "trigeminal neuralgia/facial neuralgia/tic douloureux," "tic doloureux," "tic doloreux," or "tic douloreux" with no language exclusion. Clinical knowledge summaries and international guidelines for trigeminal neuralgia were published in 2008, and the search strategy can be found on www.aan. com. We also used our own extensive archives of references.
Trigeminal neuralgia: diagnosis and treatment
2005
Introduction: Trigeminal neuralgia (TN) is characterized by touch-evoked unilateral brief shock-like paroxysmal pain in one or more divisions of the trigeminal nerve. In addition to the paroxysmal pain, some patients also have continuous pain. TN is divided into classical TN (CTN) and secondary TN (STN). Etiology and pathophysiology: Demyelination of primary sensory trigeminal afferents in the root entry zone is the predominant pathophysiological mechanism. Most likely, demyelination paves the way for generation of ectopic impulses and ephaptic crosstalk. In a significant proportion of the patients, the demyelination is caused by a neurovascular conflict with morphological changes such as compression of the trigeminal root. However, there are also other unknown etiological factors, as only half of the CTN patients have morphological changes. STN is caused by multiple sclerosis or a space-occupying lesion affecting the trigeminal nerve. Differential diagnosis and treatment: Important differential diagnoses include trigeminal autonomic cephalalgias, posttraumatic or postherpetic pain and other facial pains. First line treatment is prophylactic medication with sodium channel blockers, and second line treatment is neurosurgical intervention. Future perspectives: Future studies should focus on genetics, unexplored etiological factors, sensory function, the neurosurgical outcome and complications, combination and neuromodulation treatment as well as development of new drugs with better tolerability.
Trigeminal Neuralgia: A Clinical Review for the General Physician
Cureus, 2018
General practitioners (GPs) are often the first clinicians to encounter patients with trigeminal neuralgia (TN). Given the gravity of the debilitating pain associated with TN, it is important for these clinicians to learn how to accurately diagnose and manage this illness. The objective of this article is to provide an up-to-date literature review regarding the presentation, classification, diagnosis, and the treatment of TN. This article also focuses on the long-term management of these patients under the care of GPs. GPs play an important role in the management of patients with TN by following the evidence-based management guidelines. The most important aspects of the management of TN are discussed in this review article.
Clinical aspects of Trigeminal Neuralgia: A systematic Review
International Journal for Research Trends and Innovation, 2021
The fifth cranial nerve, the Trigeminal nerve, is amongst the most widely distributed nerves in the human body. Trigeminal neuralgia (TN) is characterized by recurring occurrences of unilateral, intense, lancinating, stabbing discomfort in the distribution of one or more branches of the trigeminal nerve. When compared to men, women are more likely to develop Trigeminal Neuralgia. The trigeminal nerve is compressed and demyelinated, which causes Trigeminal Neuralgia. Diagnostic tests for Trigeminal Neuralgia include physical examinations, neuroimaging techniques, and neurophysiological studies. Initially, the patient was given a low daily intake of anti-epileptic drugs, with carbamazepine being the first-line treatment for Trigeminal Neuralgia. Surgery is a realistic and successful alternative if medical therapy has failed. Microvascular decompression, gamma knife radio surgery, percutaneous treatments at the Gasserian ganglion level and peripheral approaches are some of the surgical procedures used. The clinical symptoms, aetiology, diagnostic testing, and treatment for TN are all detailed in this review.