Treatment options in trigeminal neuralgia

Abstract

The incidence of trigeminal neuralgia (TN) is 4.3 per 100,000 persons per year, with a slightly higher incidence for women (5.9/100,000) compared with men (3.4/100,000). There is a lack of certainty regarding the aetiology and pathophysiology of TN. The treatment of TN can be very challenging despite the numerous options patients and physicians can choose from. This multitude of treatment options poses the question as to which treatment fits which patient best. The preferred medical treatment for TN consists of anticonvulsant drugs, muscle relaxants and neuroleptic agents. Large-scale placebo-controlled clinical trials are scarce. For patients refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma knife surgery and microvascular decompression are the most promising invasive treatment options.

Two Needle Electrode System for Trigeminal Neuralgia Radiofrequency of Gasserian Ganglion

“…Previous studies report pain free rates during first year after RF between 68-85% [13,14]. Kanpolat et al [15], finds a recurrence rate of 7.7% in the first 6 months after RF and 17.4% later on.…”

Treatment Options in Trigeminal Neuralgia an Update

“…Oxcarbazepine a prodrug of carbamazepine has been shown to have equal efficacy but with less side effects and better tolerance (18,23,30,39). In a review of 3 RCTs it was found that reduction in attacks were similar with CBZ and oxcarbazepine (40).…”

“…Carbamazepine is the is the first line drug in the management of TN. Several studies and systematic reviews have shown that this is the most effective drug in trigeminal neuralgia.It is considered the gold standard drug in treatment of symptoms of Trigeminal neuralgia (8,16,18,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The advised dosage is 200-1200 mg/day according to the current evidence based guidelines (18,21).…”

A successful case of multiple stereotactic radiosurgeries for ipsilateral recurrent trigeminal neuralgia

“…Common side effects of the aforementioned surgical options include sensory loss (50%), dysesthesias (6%), anesthesia dolorosa (4%), and corneal numbness (4%). 11,22,30 Another, often more favorable, nondestructive surgical option is microvascular decompression (MVD). This procedure often leads to very good, sustained pain relief and is highly recommended for younger patients or those with few to no comorbidities.…”

“…Destructive procedures include rhizotomy, balloon compression, and radiofrequency thermocoagulation. 22 Rhizotomy involves injecting an agent directly into the affected nerve branch. In balloon compression a small balloon can be inserted into the nerve branches to compress the nerve within a bony foramen.…”