Trigeminal neuralgia: a practical guide

Abstract

Trigeminal neuralgia (TN) is a highly disabling disorder characterised by very severe, brief and electric shock like recurrent episodes of facial pain. New diagnostic criteria, which subclassify TN on the basis of presence of trigeminal neurovascular conflict or an underlying neurological disorder, should be used as they allow better characterisation of patients and help in decision-making regarding medical and surgical treatments. MR, including high-resolution trigeminal sequences, should be performed as part of the diagnostic work-up. Carbamazepine and oxcarbazepine are drugs of first choice. Lamotrigine, gabapentin, pregabalin, botulinum toxin type A and baclofen can be used either alone or as add-on therapy. Surgery should be considered if the pain is poorly controlled or the medical treatments are poorly tolerated. Trigeminal microvascular decompression is the first-line surgery in patients with trigeminal neurovascular conflict while neuroablative surgical treatments can be offered if MR does not show any neurovascular contact or where patients are considered too frail for microvascular decompression or do not wish to take the risk.

The Risk of Trigeminal Neuralgia Following Osteoporosis

“…In our study, the impact of osteoporosis on the risk of TN increased differently in the two genders and was more prominent in the patients aged between 50–60 years. In addition, women and the elderly had a relative higher incidence of TN, which is consistent with a previous article [ 23 ]. Regardless of whether comorbidity co-existed or not, osteoporotic patients had a higher TN risk than non-osteoporosis patients.…”

The Molecular Basis and Pathophysiology of Trigeminal Neuralgia

“…Only a small percentage of TN patients present with demonstrable compression or morphological changes in the trigeminal nerve, and neurovascular compression does not always translate to disease [ 27 , 148 , 149 ]. Furthermore, most patients present with a normal physical and neurological exam, and there is a lack of reliable biomarkers for the disease [ 14 , 55 , 150 , 151 ]. Thus, such complex disease presentation makes accurate diagnosis of TN difficult for some patients and may even challenge the utility of the current classification scheme [ 152 ].…”

“…Conventionally, procedural interventions will be offered when medical therapies fail, but there is little data to guide decisions on the timing of this decision. Even though, based on a few studies, surgical and minimally invasive interventions appear to have a promising track record in providing relief, they are also known to accompany a varying degree of complications and recurrence [ 151 ].…”

Trigeminal Nerve White Matter Fiber Abnormalities in Primary Trigeminal Neuralgia: A Diffusion Spectrum Imaging Study

“…Trigeminal neuralgia (TN) is recurrent, unilateral, transient, and electric pain in the trigeminal nerve distribution area. It has been reported that the annual incidence is about 4–29/10 million person-years worldwide ( 1 ). The prevalence rate in women was higher than that in men (F:M = 3:2).…”

“…The prevalence rate in women was higher than that in men (F:M = 3:2). With disease aggravation, pain attacks become more frequent, affecting basic human functions, such as speaking, eating, drinking, or touching the face, resulting in low quality of life ( 1 ).…”