Trigeminal Neuralgia

Cruccu, G.; Stefano, Giulia Di; Truini, Andrea

doi:10.1056/nejmra1914484

Cited by 235 publications

(182 citation statements)

References 48 publications

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“…The TN diagnosis was confirmed by at least two clinicians. The diagnosis of secondary TN relied on trigeminal reflex testing abnormalities and MRI scans with specifications optimized for identification of the TN aetiology (Bendtsen et al, 2019;Cruccu et al, 2020;Maarbjerg et al, 2015). Patients with a follow-up period less than one year were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Regardless of the aetiology, the key mechanism underlying paroxysmal pain in TN is the focal demyelination of primary trigeminal afferents near the entry of the trigeminal root into the pons, causing myelinated axons to become hyperexcitable and increasing their susceptibility to ectopic excitation, ephaptic transmission and high-frequency discharge (Cruccu et al, 2020). Consistent with this pathophysiological mechanism, voltage-gated, frequency-dependent, sodium channel blockers are ideal candidates to reduce the high-frequency discharge causing the electric shock-like pain (Cruccu et al, 2020). Accordingly, the European Academy of Neurology (EAN) guidelines on TN (Bendtsen et al, 2019) indicates that carbamazepine (CBZ) and oxcarbazepine (OXC) are the first-line drugs for the long-term treatment of TN.…”

Section: Introductionmentioning

confidence: 99%

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Real‐world effectiveness and tolerability of carbamazepine and oxcarbazepine in 354 patients with trigeminal neuralgia

Stefano

Leone

et al. 2021

European Journal of Pain

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Background: We aimed at evaluating the differential involvement of large myelinated Aβ-, small myelinated Aδ-, and unmyelinated C-fibers in patients with diabetic polyneuropathy and how they contribute to neuropathic pain. Methods: We collected clinical and diagnostic test variables in 133 consecutive patients with diabetic polyneuropathy. All patients underwent Aβ-fiber mediated nerve conduction study, Aδ-fiber mediated laser-evoked potentials and skin biopsy mainly assessing unmyelinated C-fibers. Results: Pure large-fiber and small-fiber polyneuropathy were relatively uncommon; conversely mixed-fiber polyneuropathy was the most common type of diabetic polyneuropathy (74%). The frequency of neuropathic pain was similar in the three different polyneuropathies. Ongoing burning pain and dynamic mechanical allodynia were similarly associated with specific small-fiber related variables. Conclusions: Diabetic polyneuropathy mainly manifests as a mixed-fiber polyneuropathy, simultaneously involving Aβ-, Aδ-, and C-fibers. In most patients, neuropathic pain is distinctly associated with small-fiber damage. The evidence that the frequency of neuropathic pain does not differ across pure large-, pure small-, and mixed-fiber polyneuropathy, raises the possibility that in patients with pure largefiber polyneuropathy nociceptive nerve terminal involvement might be undetected by standard diagnostic techniques.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Real‐world effectiveness and tolerability of carbamazepine and oxcarbazepine in 354 patients with trigeminal neuralgia

Stefano

Leone

et al. 2021

European Journal of Pain

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“…Recently, improving the effects of nerve ablation 19,20 and reducing complications 21 have attracted more and more attention. We devised the “air‐to‐air meeting” technique for cases where the facial topography near the inner mouth corner is uneven.…”

Section: Discussionmentioning

confidence: 99%

Air‐to‐Air Meeting Technique in Radiofrequency Thermocoagulation of Trigeminal Neuralgia: A Case Report

Wang

Gao

et al. 2021

Pain Practice

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Background In a minority of cases, foramen ovales (FOs) are difficult to access due to single confounding anatomical variations. However, there is no method reported where the FO has been successfully targeted via a single puncture in the presence of two or more anatomical variations. Objectives To observe the effect of a new stereotactic bidirectional approach guiding technique utilized in a patient who harbored a particularly difficult‐to‐access FO due to multiple anatomical variations. Methods During operation of a unique facial entry point’s trigeminal neuralgia patient, make one plane which identified by a three‐dimensional (3D) coordinates of the FO target and arc angle value on stereotactic frame, make this plane intersected with another plane which determined by the 3D CT‐reconstruction’s facial entry point data on a ruler, so as to elucidate the appropriate trajectory. The authors coined the approach “Air‐to‐air meeting” method. Results We completed the radiofrequency thermocoagulation (RFT) with a single puncture to successfully target the FO according to the preoperative plan confirmed by C‐arm radiography. Postoperative pain scores using a visual analog scale decreased from 10 to 3 by the first day after the procedure. There were no permanent complications or morbidity from the surgery. Conclusions To the authors’ knowledge, this is the first report describing a unique facial entry point determined by this technique for the treatment of a patient with trigeminal neuralgia.

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“…electric shock-like, shooting, stabbing or sharp in quality, and (4) precipitated by innocuous stimuli on the affected side of the face (9). Atypical TN usually involves pain lasting more than a few minutes or burning pain (10).…”

Section: Clinical Features Of Recurrent Trigeminal Neuralgiamentioning

confidence: 99%

Long-Term Retrospective Analysis of Microvascular Decompression in Patients With Recurrent Trigeminal Neuralgia

Liu

Xiang

et al. 2020

Front. Neurol.

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Objective: To explore the clinical characteristics of patients with recurrent trigeminal neuralgia (TN) and the experience of microvascular decompression (MVD) in the treatment of such patients.Methods: We retrospectively analyzed clinical data, imaging examination results, surgical methods, and treatment efficacies in 127 patients with recurrent typical TN from January 2005 to December 2014.Results: The age of the recurrent group was higher than that of the non-recurrent group (p < 0.05). The duration of pain before the first MVD procedure was longer in the recurrent group than in the non-recurrent group (p < 0.05). Patients in the recurrent group were more likely to have compression of the trigeminal nerve by the vertebrobasilar artery (VBA) or multiple vessels than patients in the non-recurrent group (p < 0.05). A Kaplan–Meier curve showed a median pain-free survival of 12 months after the first MVD procedure. The severity of pain (preoperative visual analog scale [VAS] score) in patients with recurrence was lower than that in patients with first-onset TN (p < 0.05). Vessel compression, Teflon compression or granuloma and arachnoid adhesion were considered the main causes of recurrence. Postoperative Barrow Neurological Institute (BNI) scores in the redo MVD group were excellent (T = 2) for 69 patients (53.33%) and good (T = 3) for 46 patients (36.22%). The postoperative follow-up was 63–167 months (105.92 ± 25.66). During the follow-up, no recurrence was noted. All complications were cured or improved.Conclusions: Microvascular decompression (MVD) is an effective surgical method for the treatment of TN. For recurrent patients, reoperation can achieve good results.

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Trigeminal Neuralgia

Cited by 235 publications

References 48 publications

Real‐world effectiveness and tolerability of carbamazepine and oxcarbazepine in 354 patients with trigeminal neuralgia

Real‐world effectiveness and tolerability of carbamazepine and oxcarbazepine in 354 patients with trigeminal neuralgia

Air‐to‐Air Meeting Technique in Radiofrequency Thermocoagulation of Trigeminal Neuralgia: A Case Report

Long-Term Retrospective Analysis of Microvascular Decompression in Patients With Recurrent Trigeminal Neuralgia

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