Real‐world effectiveness and tolerability of carbamazepine and oxcarbazepine in 354 patients with trigeminal neuralgia

Abstract

Background: We aimed at evaluating the differential involvement of large myelinated Aβ-, small myelinated Aδ-, and unmyelinated C-fibers in patients with diabetic polyneuropathy and how they contribute to neuropathic pain. Methods: We collected clinical and diagnostic test variables in 133 consecutive patients with diabetic polyneuropathy. All patients underwent Aβ-fiber mediated nerve conduction study, Aδ-fiber mediated laser-evoked potentials and skin biopsy mainly assessing unmyelinated C-fibers. Results: Pure large-fiber and small-fiber polyneuropathy were relatively uncommon; conversely mixed-fiber polyneuropathy was the most common type of diabetic polyneuropathy (74%). The frequency of neuropathic pain was similar in the three different polyneuropathies. Ongoing burning pain and dynamic mechanical allodynia were similarly associated with specific small-fiber related variables. Conclusions: Diabetic polyneuropathy mainly manifests as a mixed-fiber polyneuropathy, simultaneously involving Aβ-, Aδ-, and C-fibers. In most patients, neuropathic pain is distinctly associated with small-fiber damage. The evidence that the frequency of neuropathic pain does not differ across pure large-, pure small-, and mixed-fiber polyneuropathy, raises the possibility that in patients with pure largefiber polyneuropathy nociceptive nerve terminal involvement might be undetected by standard diagnostic techniques.

The Molecular Basis and Pathophysiology of Trigeminal Neuralgia

“…Despite their effectiveness, the use of both medications is often limited by their side effects, which include drowsiness, dizziness, rash, ataxia, elevated liver enzymes, hematologic dyscrasias, and hyponatremia. A recent study demonstrated that oxcarbazepine might be better tolerated than carbamazepine, although any side effects may be seen with either medication [ 105 ].…”

Novel ways of approaching the pharmacologic treatment of trigeminal neuralgia

“…9 A recent study showed a higher frequency of treatment refractoriness in patients with idiopathic and secondary TN than in patients with classical TN. 10 Other drugs, such as lamotrigine, gabapentin, and phenytoin, can be considered in patients with a suboptimal response or toxicity to first-line pharmacologic treatment. Oftentimes, these medications are given as an add-on to first-line treatment despite there not being comparative studies between first-line monotherapy and combination therapy.…”

“…Oxcarbazepine is often used initially given its relatively better drug tolerability and a decreased potential for drug interaction compared to carbamazepine 9 . A recent study showed a higher frequency of treatment refractoriness in patients with idiopathic and secondary TN than in patients with classical TN 10 . Other drugs, such as lamotrigine, gabapentin, and phenytoin, can be considered in patients with a suboptimal response or toxicity to first‐line pharmacologic treatment.…”

Clinical Analysis of the Treatment of Primary Trigeminal Neuralgia by Percutaneous Balloon Compression

“…Carbamazepine, as the first-line drug at present, can effectively relieve the pain. However, after taking it for a long time, the curative effect will decrease, and the patient finally stops taking the medicine because of the pain that cannot be tolerated and seek surgical treatment ( 5 , 6 ).…”