AAN‐EFNS guidelines on trigeminal neuralgia management

Cruccu, G.; Gronseth, G. S.; Alksne, John F.; Argoff, Charles E.; Brainin, Michael; Burchiel, Kim J.; Nurmikko, Turo; Zakrzewska, Joanna M

doi:10.1111/j.1468-1331.2008.02185.x

Cited by 610 publications

(548 citation statements)

References 86 publications

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“…Patients' age, medical status and response to medical therapy factor into making the decision to treat surgically [45,46]. However, there is insufficient evidence to determine what is the most effective surgical intervention due to lack of RCTs, cohort studies, uniform criteria and outcome measures [47,48].…”

Section: Review Napeñas and Zakrzewskamentioning

confidence: 99%

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Diagnosis and Management of Trigeminal Neuropathic Pains

Napeñas

Zakrzewska

2011

Pain Manage.

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Background -There is a lack of consistent classification systems and incomplete understanding of mechanisms of trigeminal neuropathic pains, with very few randomized controlled trials.Trigeminal neuralgia -Comprehensive history, examination, imaging studies (i.e., MRI), and measures of pain and quality of life are essential.Carbamazepine is a first-line drug, however, its side effects and drug interactions make it difficult to use in practice, while oxcarbazepine shows promise but requires more high-quality trials to show its efficacy.Ablative surgery results in trigeminal nerve injury and gives pain relief for 3-5 years, but is accompanied by sensory loss and dysesthesias.Microvascular decompression offers the longest pain-free period and is indicated for patients with proven neurovascular compression.Trigeminal neuropathic pain -Trigeminal neuropathic pain is probably due to trauma of the trigeminal nerve.Management recommendations are based on case series and guidelines for other neuropathic pain conditions, with tricyclic antidepressants and anticonvulsants (e.g., gabapentin and pregabalin) as first-line therapies.Burning mouth syndrome -Neuropathic, hormonal and psychological factors are suspected as contributing to its pathophysiology.Secondary causes (local and systemic) of burning mouth must be ruled out to obtain a definitive diagnosis.Clonazapam and selective serotonin reuptake inhibitors have been shown to be effective in limited randomized controlled trials, with anticonvulsants considered to be another option.Future perspective -Consistent classification systems, taxonomy and phenotyping of conditions are required.Increased knowledge on pathophysiology and mechanisms will determine the choice of targeted therapies for these conditions. Summary Points

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Section: Review Napeñas and Zakrzewskamentioning

confidence: 99%

“…Those patients with multiple sclerosis-related TN are difficult to manage, as their tolerability of drugs is low and recurrence rates are much higher after surgical procedures [45].…”

Section: Review Napeñas and Zakrzewskamentioning

confidence: 99%

Diagnosis and Management of Trigeminal Neuropathic Pains

Napeñas

Zakrzewska

2011

Pain Manage.

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“…Despite the entry of several new drugs for this condition over the last few decades carbamazepine (CBZ) has still retained its position as the drug of choice for TN. 3 However, a number of patients tolerate this drug poorly mainly due to serious side effects such as vertigo, ataxia, diplopia, stupor blurred vision, respiratory depression, aplastic anemia, hypersensitivity reaction, and retention of water. 4 If pain relief is incomplete with CBZ or contraindicated, other drugs such as phenytoin, gabapentin, sodium valproate, topiramate, clonazepam or lamotrigine (LTG) are suggested.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of lamotrigine in patients with trigeminal neuralgia: a comparison with carbamazepine

Goel

Tanwar

Singh³

et al. 2015

Int J Basic Clin Pharmacol

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“…neurological deficit and not attributable to another headache cause (3,12). Episodes of pain start unexpectedly and should last seconds to minutes.…”

Section: Introductionmentioning

confidence: 99%

Trigeminal neuralgia as an unusual isolated symptom of pituitary adenoma: case report and review of the literature

Gurcan¹,

Gürçay²,

Kazanci³

et al. 2014

Turkish Neurosurgery

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ABSTRACTneurological deficit and not attributable to another headache cause (3,12). Episodes of pain start unexpectedly and should last seconds to minutes. The non-painful stimulation of trigger points that located ipsilateral side of pain could initiated pain episodes. after the pain attacks, there is often a refractive period (14). The most common etiology for TN is disturbance of TN at the root entry zone by a vessel, generally the superior cerebellar artery. However, TN may be present in the absence of vascular contact (15).The cavernous sinus (CS) is a form of large venous space containing the oculomotor nerve, trochlear nerve, ophthalmic and maxillary divisions of trigeminal nerve (located in the lateral wall) and also has internal carotid artery and abducent nerve (located in the central portion) (10). █ InTRODuCTIOnPituitary adenomas (PAs), which are benign tumors of the adenohypophysis, account for approximately 10% of intracranial tumors and 5% of adenomas, are locally invasive. PAs can be classified as hormone active adenomas and hormone inactive adenomas that can reach huge proportions without any sign or symptom (10).Trigeminal Neuralgia (TN) is one of the most frequent cranial neuralgias. The incidence of TN is approximately 4 per 100 000 persons per year (9). TNs are paroxysmal attacks of pain lasting from a second to 2 minutes and affecting one or more divisions of the trigeminal nerve (3, 12). The pain of TN must have at least one of the following characteristics: as intense, sharp, stabbing, activated by trigger factors, without evident Pituitary adenomas account for approximately 10% of intracranial tumors and 5% are locally invasive. Cavernous sinus invasion by pituitary tumors presents mostly with cranial nerve palsies, especially involving the third, fourth and sixth cranial nerves, which is well documented in the literature. However, an isolated complaint of trigeminal neuralgia due to pituitary adenoma is an extremely rare entity with a limited number of reported cases. A 51-year-old female patient presented to our clinic with complaints of pain and numbness on the left side of face for six months, with each event lasting 5-10 seconds. No improvement was obtained with administration of carbamazepine therapy. Magnetic resonance imaging of the sellar region revealed a mass with the left cavernous sinus invasion. The patient underwent surgery via endoscopic transsphenoidal approach and after than radiosurgery with gammaknife. The patient's complaints resolved totally after gamma-knife radiosurgery. We report herein a case of pituitary adenoma with an isolated complaint of trigeminal neuralgia. Pituitary adenomas may be presented with cavernous sinus invasion and multiple cranial nerve palsies but isolated trigeminal neuralgia due to pituitary adenoma is an extremely rare entity.

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AAN‐EFNS guidelines on trigeminal neuralgia management

Cited by 610 publications

References 86 publications

Diagnosis and Management of Trigeminal Neuropathic Pains

Diagnosis and Management of Trigeminal Neuropathic Pains

Efficacy and safety of lamotrigine in patients with trigeminal neuralgia: a comparison with carbamazepine

Trigeminal neuralgia as an unusual isolated symptom of pituitary adenoma: case report and review of the literature

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