Medical Management of Trigeminal Neuralgia

Abstract

Background: Trigeminal neuralgia (TN) is a painful condition, often leading to poor quality of life. Objective: The aim of this review was to discuss the various treatment modalities for the medical management of TN. Materials and Methods: 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. Results: 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. Conclusion: 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.

Functional MRI–Guided Motor Cortex and Deep Brain Stimulation for Intractable Facial Pain: A Novel, Personalized Approach in 1 Patient

“…19,20 Drugs such as baclofen, gabapentin, pregabalin, lamotrigine, and misoprostol have shown benefit in refractory cases and can be considered second-line agents. [21][22][23] Conventional surgical options include microvascular decompression, radiosurgery, and rhizotomy. 19,24 Long-term success rates vary by procedure type, and recurrence after surgery can be common, with microvascular decompression reporting the highest long-term success rate of 86% at 3 years.…”

Botulinum Toxin as an Effective Treatment for Trigeminal Neuralgia in Surgical Practices

“…While the voracity of painful episodes can make TN a debilitating disease, effective treatments do exist, albeit most with cons that significantly limit their respective uses. Carbamazepine is the sole FDA-approved medication, and while many studies boast an impressive 70-80% of TN patients experiencing significant relief, it is far from a benign choice, with serious adverse effects and induction of the CYP3A enzymes [6][7][8][23][24][25]. MVD has been shown to have immediate relief in up to 90.6% of patients with TN and long-term relief in 70-73.4% of patients [26][27][28][29].…”

“…Trigeminal neuralgia (TN) is one of the most common causes of craniofacial pain in the world with an incidence ranging from 4.7 to 27 per 100,000 people worldwide [1][2][3]. Carbamazepine is the only FDA-approved medication for this indication, and its myriad problems range from serious adverse events like myelosuppression to less serious but still misery-inducing occurrences like vertigo, all of which limit its utility long-term [4][5][6][7]. Other neuropathic compounds like baclofen, lamotrigine, and gabapentin provide symptomatic relief for some; however, monotherapy does not keep the pain at bay [7][8][9][10].…”

Evaluating Changes in Pulsatile Flow With Endovascular Stents in an In Vitro Blood Vessel Model: Potential Implications for the Future Management of Neurovascular Compression Syndromes

“…However, its effectiveness can decrease over time for some patients, and it may cause undesirable side effects, including drowsiness, dizziness, double vision, and nausea [ 12 ]. Alternative treatments can include anticonvulsants like lamotrigine, phenytoin, gabapentin, and botulinum toxin injections [ 13 , 14 ]. If these medical treatments prove ineffective, procedural interventions are then considered for the patient.…”