Recent advances in understanding/managing trigeminal neuralgia

Abstract

Despite recent advances in understanding and treating trigeminal neuralgia, its management remains a considerable challenge. Better classification of different types of facial pain and the identification of prognostic factors for different treatment options lead the way toward better quality of life for the individual patient. Although the principles of treating trigeminal neuralgia remain basically the same, antiepileptic drugs, muscle relaxants, and neuroleptic agents are widely used medical treatment options. They were not originally developed for treating trigeminal neuralgia. Carbamazepine was studied in adequate placebo-controlled clinical trials in the 1960s and is still considered the most effective drug. Among emerging treatment options currently under clinical investigation are local botulinum neurotoxin type A injections and a novel sodium channel blocker (CNV1014802) that selectively blocks the Nav1.7 sodium channel. Non-pharmacological treatment options are non-invasive electrical stimulation with either transcranial direct-current stimulation or repetitive transcranial magnetic stimulation which both require further evaluation in regard to applicability. Surgical options remain a valid choice for patients not responding to medical treatment and include Gasserian ganglion percutaneous techniques, gamma knife surgery, and microvascular decompression. There is continual effort to improve these techniques and predict the outcome for better patient selection.

Clinical Characteristics and Associated factors of Trigeminal Neuralgia in Addis Ababa, Ethiopia: Experience from Addis Ababa, Ethiopia

“…Patients on carbamazepine reported prominent treatment satisfaction (Jainkittivong et al 2012). The mean carbamazepine dose of the study participants was 691.8 mg, which is consistent with similar reports (Obermann 2019, Omoregie & Okoh, 2015, Bendtsen et al, 2019. We found that those patients who had history tooth extraction required a higher dose of carbamazepine compared to those without a history of tooth extraction.…”

Chronic Facial Pain: Trigeminal Neuralgia, Persistent Idiopathic Facial Pain, and Myofascial Pain Syndrome—An Evidence-Based Narrative Review and Etiological Hypothesis

“…Trigeminal neuralgia, or tic douloureux, is chronic, episodic, and recurrent. It is a neuralgic pain that at best is distracting and at worst totally debilitating and disabling [ 22 , 23 ]. Pain originates in the trigeminal nerve complex or its territory.…”

“…Pain originates in the trigeminal nerve complex or its territory. It is caused by compression of the nerve root by vessels in the posterior fossa in 80–90% of cases [ 22 , 23 , 24 ], but it can be secondary to a number of other conditions to be mentioned shortly. The vessel most commonly compressing the trigeminal nerve root is the superior cerebellar artery (SCA), as identified by high-resolution 3 T magnetic resonance imaging (MRI).…”

Trigeminal Neuralgia: Basic and Clinical Aspects

“…TN surgical management is either non-ablative, which consists of the decompression of the nerve, preserving its normal function or ablation, which results in the destruction of sensory function of the trigeminal nerve. Some features are briefly discussed here including the main surgical options, but detailed indications and more information on the surgical procedures may be found in guidelines and have been reviewed by others [ 111 , 134 , 135 ].…”

“…up to several weeks) and a high rate of pain recurrence compared to MVD. The most frequent complications reported are paraesthesias and facial numbness [ 135 , 140 , 141 ].…”