Use of single‐ and multi‐drug regimens in the management of classic (idiopathic) trigeminal neuralgia: an 11‐year experience at a single Sri Lankan institution

Ariyawardana, Anura; Pallegama, Ranjith Wasantha; Sitheeque, Mohaideen; Ranasinghe, A. W.

doi:10.1111/j.2041-1626.2011.00109.x

Cited by 8 publications

(14 citation statements)

References 16 publications

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“…[ 63 64 65 ] Multi drugs are useful when patients are unable to tolerate higher doses of CBZ. [ 66 ] With an availability of increasing number of anticonvulsant drugs, it is likely that surgical option may not be offered for many years. [ 67 ]…”

Section: Medical Treatmentmentioning

confidence: 99%

Trigeminal neuralgia

Yadav

Pande

et al. 2017

Asian J Neurosurg

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Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Type 1 as intermittent and Type 2 as constant pain represent distinct clinical, pathological, and prognostic entities. Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Diagnosis is essentially clinically; magnetic resonance imaging is useful to rule out secondary causes, detect pathological changes in affected root and neurovascular compression (NVC). Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine, phenytoin, and topiramate are also useful. Multidrug regimens and multidisciplinary approaches are useful in selected patients. Microvascular decompression is surgical treatment of choice in TN resistant to medical management. Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures. Partial sensory root sectioning is indicated in negative vessel explorations during surgery and large intraneural vein. Endoscopic technique can be used alone for vascular decompression or as an adjuvant to microscope. It allows better visualization of vascular conflict and entire root from pons to ganglion including ventral aspect. The effectiveness and completeness of decompression can be assessed and new vascular conflicts that may be missed by microscope can be identified. It requires less brain retraction.

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Section: Medical Treatmentmentioning

confidence: 99%

Trigeminal neuralgia

Yadav

Pande

et al. 2017

Asian J Neurosurg

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“…Carbamazepine was found to achieve good to excellent pain control in a majority of cases with TN, though statistical significance was not always reported 27,29‐31,35,49,68,70 . More recent studies showed reduction in pain as measured by VAS scores 5,69 . However, cohorts of patients with AFP and other facial neuralgias were largely unresponsive to carbamazepine 65,66 .…”

Section: Resultsmentioning

confidence: 99%

“…There were 24 therapies assessed. Carbamazepine was the most common intervention examined across studies, with 19 observational studies 5,6,[20][21][22][27][28][29][30][31]33,35,[65][66][67][68][69][70][71] and 9 randomized controlled trials, 23,44,[47][48][49]58,59,62,63 followed by botulinum toxin A with 11 observational studies 8,[12][13][14][15][16][17][18][19]41,72 32 oxcarbazepine, 7,36,44 pregabalin, 39 valproic acid, 38 gabapentin, 6,21,73 lamotrigine 21,60,62,64 ), local anesthetics (lidocaine, 37,53,57,61,67 tocainide 48 ), selective serotonin receptor agonists (sumatriptan…”

Section: General Study Interventions and Outcome Measuresmentioning

confidence: 99%

Neuromodulators for Atypical Facial Pain and Neuralgias: A Systematic Review and Meta‐Analysis

et al. 2020

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Objective: To evaluate the effectiveness of neuromodulating agents for the management of atypical facial pain and primary facial neuralgias.Methods: We searched MEDLINE, Embase, CINAHL, and ClinicalTrials.gov databases for original research articles that examine the effectiveness and adverse reactions of pharmacologic therapy for the treatment of trigeminal neuralgia and atypical facial pain. Studies that included surgical interventions for atypical facial pain or facial pain secondary to other causes were excluded. Meta-analysis was conducted for reductions in symptom scores and adverse effects.Results: Of 3,409 articles screened, 73 full-text articles were included, consisting of 45 observational studies and 29 randomized controlled trials. Twenty-four different pharmacological agents were assessed; carbamazepine was the most frequently studied while botulinum toxin A demonstrated the highest consistency in reduction of symptom scores. Pooled estimate of three randomized controlled trials revealed that patients with trigeminal neuralgia who received botulinum toxin A had higher odds (odds ratio 7.46; 95% CI 3.53-15.78) of achieving a ≥50% reduction in visual analogue scale scores compared to controls. Pooled estimate of 15 observational studies showed that three-fourths of patients with trigeminal neuralgia who received carbamazepine experienced clinically significant pain reduction (prevalence proportion 0.75; 95% CI 0.66-0.83).Conclusions: Patients receiving botulinum toxin A for trigeminal neuralgia had higher odds of achieving ≥50% reduction in pain scores. A significant proportion of patients with trigeminal neuralgia experienced positive response to carbamazepine. There was moderate evidence for amitriptyline in patients with atypical facial pain. Standardization of outcome reporting would facilitate future quantitative comparisons of therapeutic effectiveness.

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“…Other drugs, including oxcarbazepine [ 67 ], phenytoin [ 68 , 69 ], baclofen [ 70 , 71 ], lamotrigine [ 72 , 73 ], gabapentin [ 74 , 75 ], and sodium valproate [ 76 , 77 ], are also efficient in reducing the signs-symptoms of TN in most patients. Sometimes, some of the drugs are taken with carbamazepine as an adjuvant for the synergistic effects in relieving the TN symptoms [ 78 , 79 ]. The decreasing relief provided by carbamazepine or other drugs with continual use as well as unacceptable side effect profiles may necessitate the discontinuation of therapy.…”

Section: Trigeminal Neuralgiamentioning

confidence: 99%

“…In fact, it has been reported that approximately 50% of patients eventually require an operation to relieve pain [ 25 ]. Research has indicated that there is no significant influence of age, sex, ethnicity, or the side of the face on the decision of the medication regimen and the length of treatment for pain control [ 79 ].…”

Section: Trigeminal Neuralgiamentioning

confidence: 99%

Trigeminal Neuralgia, Glossopharyngeal Neuralgia, and Myofascial Pain Dysfunction Syndrome: An Update

Khan

Nishi

Hassan

et al. 2017

Pain Research and Management

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Neuropathic pain is a common phenomenon that affects millions of people worldwide. Maxillofacial structures consist of various tissues that receive frequent stimulation during food digestion. The unique functions (masticatory process and facial expression) of the maxillofacial structure require the exquisite organization of both the peripheral and central nervous systems. Neuralgia is painful paroxysmal disorder of the head-neck region characterized by some commonly shared features such as the unilateral pain, transience and recurrence of attacks, and superficial and shock-like pain at a trigger point. These types of pain can be experienced after nerve injury or as a part of diseases that affect peripheral and central nerve function, or they can be psychological. Since the trigeminal and glossopharyngeal nerves innervate the oral structure, trigeminal and glossopharyngeal neuralgia are the most common syndromes following myofascial pain dysfunction syndrome. Nevertheless, misdiagnoses are common. The aim of this review is to discuss the currently available diagnostic procedures and treatment options for trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome.

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Use of single‐ and multi‐drug regimens in the management of classic (idiopathic) trigeminal neuralgia: an 11‐year experience at a single Sri Lankan institution

Cited by 8 publications

References 16 publications

Trigeminal neuralgia

Trigeminal neuralgia

Neuromodulators for Atypical Facial Pain and Neuralgias: A Systematic Review and Meta‐Analysis

Trigeminal Neuralgia, Glossopharyngeal Neuralgia, and Myofascial Pain Dysfunction Syndrome: An Update

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