Pharmaceutical Management of Trigeminal Neuralgia in the Elderly

Abstract

Classical trigeminal neuralgia (CTN) is a severe neuropathic pain in the distribution of one or more branches of the trigeminal nerve, which occurs in recurrent episodes, causing deterioration in quality of life, affecting everyday habits and inducing severe disability. The aim of this review is to give an overview of the current literature on pharmaceutical treatment options for CTN in the elderly. The first-line treatment for the management of CTN in adults is an antiepileptic—carbamazepine or oxcarbazepine. There is a lack of research on the use of antiepileptics in the elderly. This is a deficiency, as the use of antiepileptics raises a number of problems due to the polypharmacotherapy common in older patients. This can induce drug interactions due to co-morbidities and changes in pharmacokinetics and pharmacodynamics. Furthermore, the side effects of carbamazepine include central nervous system disturbances, such as a lack of balance, dizziness, somnolence, renal dysfunction and cardiac arrhythmias, which are poorly tolerated by the elderly. Unfortunately, the efficacy and safety of alternative treatment options have not been systematically evaluated. On the basis of the current literature, it is not possible to give an evidence-based recommendation for first-line pharmaceutical management of CTN specifically for the elderly.

Evaluation of Some Modalities of Therapy in Idiopathic Trigeminal Neuralgia

“…The results of the present study were in line with those of Cruccu et al 2008 [9], Oomens and Forouzanfar. 2015 [27]. On the other hand, the results of the present study were not in line with those yielded by Sato et al2004 [28] who studied the effect of CBZ in 50 patients with ITN and they concluded that 45 patients (90%) of them became pain free.…”

Carbamazepine Induced Ebstein-Barr Virus Reactivation: A Rare Manifestation of Anticonvulsant Hypersensitivity Syndrome

“…TN is a severe neuropathic pain in the distribution of one or more branches of the trigeminal nerve, which is characterized by short-lasting, recurrent episodes of electrical and/or shock-like pain with abrupt onset and ter- mination [12]. Since it is a disabling neuralgiform pain disorder, the underlying pathophysiology is considered to be the sensitization of trigeminal nociceptive systems in the brain [13].…”

“…Routine blood tests including complete blood count, erythrocyte sedimentation rate, serum kidney and liver function tests, electrolytes, fasting blood glucose, and thyroid functions were normal. Since the type of headache was consistent with trigeminal neuralgia according to the criteria of international headache society (IHS) classification 3rd edition beta-3 version, CBZ was administered to the patient and gradually increased to 200 milligram of twice daily [12]. One week after CBZ regimen, the patient was pain-free.…”

Postherpetic Neuralgia and Trigeminal Neuralgia

“…Trigeminal neuralgia can also be symptomatic if it is associated with some other cause such as multiple sclerosis or nonvascular space-occupying lesions in the brain [ 30 , 31 ] ( Figure 1 ). Symptomatic trigeminal neuralgia is associated with an increased risk of bilateral neuralgic pain and is characterized by dull continuous pain between paroxysms, neurological abnormalities in the trigeminal nerve distribution, and younger age, usually under 40 [ 18 , 19 , 22 , 24 , 32 ]. In persons with multiple sclerosis, the onset of trigeminal neuralgia occurs at an earlier age, with an increased prevalence ranging from 3.8% to 9.7% and with increased incidence of bilateral manifestation [ 33 , 34 ].…”

“…In the treatment of classical trigeminal neuralgia, the anticonvulsants carbamazepine and oxcarbazepine are equally effective and are the drugs of choice [ 27 , 31 , 32 ]. These drugs inhibit the function of voltage-sensitive sodium channels of hyperexcited neuronal membranes, thus raising the threshold of excitability [ 31 , 32 ], inhibiting the high-frequency repetitive neuronal firing characteristic of trigeminal neuralgia. Baclofen, lamotrigine, gabapentin, phenytoin, and clonazepam are other agents with neural membrane-stabilising properties that may likewise relieve the pain [ 27 ].…”