Trigeminal neuralgia – diagnosis and treatment

Abstract

Introduction Trigeminal neuralgia (TN) is characterized by touch-evoked unilateral brief shock-like paroxysmal pain in one or more divisions of the trigeminal nerve. In addition to the paroxysmal pain, some patients also have continuous pain. TN is divided into classical TN (CTN) and secondary TN (STN). Etiology and pathophysiology Demyelination of primary sensory trigeminal afferents in the root entry zone is the predominant pathophysiological mechanism. Most likely, demyelination paves the way for generation of ectopic impulses and ephaptic crosstalk. In a significant proportion of the patients, the demyelination is caused by a neurovascular conflict with morphological changes such as compression of the trigeminal root. However, there are also other unknown etiological factors, as only half of the CTN patients have morphological changes. STN is caused by multiple sclerosis or a space-occupying lesion affecting the trigeminal nerve. Differential diagnosis and treatment Important differential diagnoses include trigeminal autonomic cephalalgias, posttraumatic or postherpetic pain and other facial pains. First line treatment is prophylactic medication with sodium channel blockers, and second line treatment is neurosurgical intervention. Future perspectives Future studies should focus on genetics, unexplored etiological factors, sensory function, the neurosurgical outcome and complications, combination and neuromodulation treatment as well as development of new drugs with better tolerability.

The association between auditory nerve neurovascular conflict and sudden unilateral sensorineural hearing loss

“…The most recognized, studied, and clinically common NVC is TN, followed by HFS and GN. First‐line management involves medical therapy, and an invasive procedure is warranted in some refractory cases . Currently, MVD of the CN5, CN7, and CN9 is widely accepted .…”

Combination of trigeminal neuralgia and cerebellopontine angle tumors. Modern approaches to diagnosis and treatment: literature review

“…В настоящее время существуют многочисленные теории, объясняющие патогенез классической НТН [3,[27][28][29][30][31][32]. Выделяют 2 основные гипотезы, первая -"периферическая", которую поддерживают боль-шинство исследователей, ее же считают основной причиной формирования классической НТН (в 75-90% наблюдений).…”

“…Так, приступы боли рассматривают как следствие демиелинизации корешка V ЧН в REZ, где централь-ный миелин переходит в периферический. Именно к этому "слабому месту" ТН чаще всего прилежит петля ВМА, обусловливающая НВК [28,29]. Вторая гипотеза "центральная" рассматривает НТН как подобие фо-кальной эпилепсии, связанной с раздражением ядер ТН [30].…”

Tics in TACs: A Step into an Avalanche? Systematic Literature Review and Conclusions

“…With respect to TN, the diagnosis of classical TN requires paroxysmal unilateral severe shock‐like pain occurring in one or more divisions of the trigeminal nerve (Table ) . Classical TN is frequently caused by neurovascular compression, whereas painful trigeminal neuropathy is attributed to other disorders, such as herpes zoster, trauma, multiple sclerosis, or space‐occupying lesions …”