Trigeminal Neuralgia: Basic and Clinical Aspects

Abstract

The trigeminal nerve is the largest of all cranial nerves. It has three branches that provide the main sensory innervation of the anterior two-thirds of the head and face. Trigeminal neuralgia (TN) is characterized by sudden, severe, brief, and stabbing recurrent episodes of facial pain in one or more branches of the trigeminal nerve. Pain attacks can occur spontaneously or can be triggered by non-noxious stimuli, such as talking, eating, washing the face, brushing teeth, shaving, a light touch or even a cool breeze. In addition to pain attacks, a proportion of the patients also experience persistent background pain, which along with autonomic signs and prolonged disease duration, represent predictors of worse treatment outcomes. It is now widely accepted that the presence of a neurovascular compression at the trigeminal root entry zone is an anatomic abnormality with a high correlation with classical TN. However, TN may be related to other etiologies, thus presenting different and/or additional features. Since the 1960s, the anticonvulsant carbamazepine is the drug of choice for TN treatment. Although anti-epileptic drugs are commonly used to treat neuropathic pain in general, the efficacy of carbamazepine has been largely limited to TN. Carbamazepine, however, is associated with dose-limiting side-effects, particularly with prolonged usage. Thus, a better understanding and new treatment options are urgently warranted for this rare, but excruciating disease.

An Effective Phytoconstituent Aconitine: A Realistic Approach for the Treatment of Trigeminal Neuralgia

“…The pain experienced with TN has a significant impairment on the quality of life with suboptimal outcomes due to the lack of efficacy and poor tolerability of current medical therapies [ 33 , 34 ]. Recent clinical studies have reported that patients present different levels of depression and anxiety [ 35 , 36 ].…”

Comparison of efficacy and safety of complementary and alternative therapies for primary trigeminal neuralgia

“…At present, carbamazepine and oxcarbazepine are the first-line drugs. [ 22 ] After long-term medication, the curative effect will decline, and adverse reactions such as dizziness and headache will occur. When the effect of drug treatment is unsatisfactory, surgical treatment can be selected, such as microvascular decompression, radiofrequency thermocoagulation, and radiation therapy.…”

Treatment of trigeminal and glossopharyngeal neuralgia in an adolescent: a case report

“…However, recurrence rates were higher than in MVD [ 4 – 6 ]. Other surgical treatments include destruction in the ganglion or peripheral nerves, which can be performed chemically by glycerol blockade, mechanically by balloon compression, or thermically by RFT, with almost no major complications [ 4 , 5 ]. RFT of the right mandibular nerve was performed for TN in our patient.…”

“…Overall, the pain evoked by HDS is remarkably severe such that it impairs the quality of life. TN is characterized by recurrent unilateral brief electric shock-like pain triggered by innocuous sensory stimuli [ 4 , 5 ], while GPN is characterized by pain that radiates to the posterior tongue, pharynx and/or unilateral ear precipitated by deglutition, coughing, talking, or yawning [ 6 , 7 ]. This pathology is caused by cranial nerve compression by a vessel at the root entry or exit zone (REZ) near the brainstem, which excludes other possible etiologies, such as multiple sclerosis and brain tumors.…”