Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia

Bendtsen, Lars; Zakrzewska, Joanna M; Heinskou, Tone Bruvik; Hodaie, Mojgan; Leal, Paulo Roberto Lacerda; Nurmikko, Turo; Obermann, Mark; Cruccu, G.; Maarbjerg, Stine

doi:10.1016/s1474-4422(20)30233-7

Cited by 240 publications

(225 citation statements)

References 95 publications

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“…Trigeminal neuralgia (TN) is characterised by very severe attacks of unilateral facial pain that can be triggered by trivial sensory stimuli (1,2). TN and multiple sclerosis (MS) have been known to be associated since the description of demyelinating plaques, which were found at autopsies in the pontine area in patients with MS and TN (TN-MS) patients in 1894 (3).…”

Section: Introductionmentioning

confidence: 99%

Neurovascular contact plays no role in trigeminal neuralgia secondary to multiple sclerosis

et al. 2020

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Introduction A demyelinating plaque and neurovascular contact with morphological changes have both been suggested to contribute to the etiology of trigeminal neuralgia secondary to multiple sclerosis (TN-MS). The aim of this study was to confirm or refute whether neurovascular contact with morphological changes is involved in the etiology of TN-MS. Methods We prospectively enrolled consecutive TN-MS patients from the Danish Headache Center. Clinical characteristics were collected systematically. MRI scans were done using a 3.0 Tesla imager and were evaluated by the same experienced blinded neuroradiologist. Results Sixty-three patients were included. Fifty-four patients were included in the MRI analysis. There was a low prevalence of neurovascular contact with morphological changes on both the symptomatic side (6 (14%)) and the asymptomatic side (4 (9%)), p = 0.157. Demyelinating brainstem plaques along the trigeminal afferents were more prevalent on the symptomatic side compared to the asymptomatic side (31 (58%) vs. 12 (22%), p < 0.001). A demyelinating plaque was highly associated with the symptomatic side (odds ratio = 10.6, p = 0.002). Conclusion The primary cause of TN-MS is demyelination along the intrapontine trigeminal afferents. As opposed to classical trigeminal neuralgia, neurovascular contact does not play a role in the etiology of TN-MS. Microvascular decompression should generally not be offered to patients with TN-MS. The study was registered at ClinicalTrials.gov (number NCT04371575)

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Section: Introductionmentioning

confidence: 99%

Neurovascular contact plays no role in trigeminal neuralgia secondary to multiple sclerosis

et al. 2020

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“…In the effective group, the response to carbamazepine was positive in 53(76.8%) cases, which was signi cantly higher than that in the ineffective group (5, 31.2%). In the effective group, the weak chewing was positive in 7(10.1%) cases, which was signi cantly lower than that in the ineffective group (5,31.2%). In the effective group, the compression severity score was grade II or III in 57(82.6%) cases, which was signi cantly higher than that in the ineffective group (6, 37.5%).…”

Section: Clinical Characteristics Of Patientsmentioning

confidence: 74%

Prognostic Nomogram for Percutaneous Balloon Compression in the Treatment of Trigeminal Neuralgia

Liu

Tang

et al. 2021

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Because of its convenience and safety, percutaneous balloon compression (PBC) has become a more popular remedy for trigeminal neuralgia (TN) recently. The objective of this study was to establish a nomogram that can be used to preoperatively prognosticate the likelihood of pain-free based on preoperative disease characteristics. Clinical data were collected from those TN cases who had undergone PBC during the period of 2015 and 2020 in Qingdao municipal hospital. We excluded the cases caused by space-occupying lesion or had undergone MVD, Percutaneous glycerol rhizotomy (PGR) and glycerol rhizotomy (GR). A nomogram was established based on the results of multivariable logistic analysis. A receiver operating characteristic curve (ROC) analysis was applied to evaluate the reliability of models. The plotted decision curves were also used to assess the net benefit of nomogram-assisted decisions. Internal validation was performed using the ROC by bootstrap sampling. Finally, 16 cases and 69 cases were included into the ineffective and effective groups respectively. In the crude, adjust I and adjust II models, response to carbamazepine positively, the grade II or III compression severity score and classical TN type were all considered to be significant predictors of pain relief (BNI grades I-III) at 3 months follow-up. The AUC, accuracy, specificity, and sensitivity of the nomogram system was 0.83, 0.85, 0.75, 0.87 respectively for predicting patient outcomes. The decision curves showed good performance for the nomogram system in terms of clinical application. While, more research with validation in multiple, external independent patient populations is needed.

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“…At complete pain freedom lasting more than 1 month, it is advised to taper off medication by reducing e.g. carbamazepine by 100 mg or gabapentin by 300 mg every 7th-14th day (or comparable doses of other TN drugs) [73]. Symptomatic TN is treated medically according to the same guidelines as classical and idiopathic TN [71].…”

Section: Preventive Treatmentmentioning

confidence: 99%

“…First choice treatment [73]. Efficacy: only medical treatment with documented efficacy in several controlled studies.…”

Section: Preventive Treatmentmentioning

confidence: 99%

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Reference programme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 3rd edition, 2020

et al. 2021

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Headache and facial pain are among the most common, disabling and costly diseases in Europe, which demands for high quality health care on all levels within the health system. The role of the Danish Headache Society is to educate and advocate for the needs of patients with headache and facial pain. Therefore, the Danish Headache Society has launched a third version of the guideline for the diagnosis, organization and treatment of the most common types of headaches and facial pain in Denmark. The second edition was published in Danish in 2010 and has been a great success, but as new knowledge and treatments have emerged it was timely to revise the guideline. The recommendations for the primary headaches and facial pain are largely in accordance with the European guidelines produced by the European Academy of Neurology. The guideline should be used a practical tool for use in daily clinical practice for primary care physicians, neurologists with a common interest in headache, as well as other health-care professionals treating headache patients. The guideline first describes how to examine and diagnose the headache patient and how headache treatment is organized in Denmark. This description is followed by sections on the characteristics, diagnosis and treatment of each of the most common primary and secondary headache disorders and trigeminal neuralgia. The guideline includes many tables to facilitate a quick overview. Finally, the particular challenges regarding migraine and female hormones as well as headache in children are addressed.

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Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia

Cited by 240 publications

References 95 publications

Neurovascular contact plays no role in trigeminal neuralgia secondary to multiple sclerosis

Neurovascular contact plays no role in trigeminal neuralgia secondary to multiple sclerosis

Prognostic Nomogram for Percutaneous Balloon Compression in the Treatment of Trigeminal Neuralgia

Reference programme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 3rd edition, 2020

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