Recent update on trigeminal neuralgia

2005

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.

International Journal for Research Trends and Innovation, 2021

The fifth cranial nerve, the Trigeminal nerve, is amongst the most widely distributed nerves in the human body. Trigeminal neuralgia (TN) is characterized by recurring occurrences of unilateral, intense, lancinating, stabbing discomfort in the distribution of one or more branches of the trigeminal nerve. When compared to men, women are more likely to develop Trigeminal Neuralgia. The trigeminal nerve is compressed and demyelinated, which causes Trigeminal Neuralgia. Diagnostic tests for Trigeminal Neuralgia include physical examinations, neuroimaging techniques, and neurophysiological studies. Initially, the patient was given a low daily intake of anti-epileptic drugs, with carbamazepine being the first-line treatment for Trigeminal Neuralgia. Surgery is a realistic and successful alternative if medical therapy has failed. Microvascular decompression, gamma knife radio surgery, percutaneous treatments at the Gasserian ganglion level and peripheral approaches are some of the surgical procedures used. The clinical symptoms, aetiology, diagnostic testing, and treatment for TN are all detailed in this review.

2020

Background: Trigeminal neuralgia is a sudden, unilateral, brief, stabbing, recurrent pain in one or more branches of the fifth cranial nerve distribution that affects quality of life of the affected patient. Diagnosis is made using the history alone, based on the pain characteristics. Pain occurs in paroxysms, which can last between a few seconds and a few minutes. The frequency of the paroxysms varies from a few to hundred times per day. Aim: The objective of this article is to provide an up-to-date review regarding the prevalence, etiology, diagnosis, and the management of trigeminal neuralgia. Conclusion: TN is a rare disease but often associated with debilitating pain and disability. TN management is a concern for neurologists and neurosurgeons alike. Progress has been achieved in recent years, leading to the introduction of neuro-radiological approaches for both pathogenesis and surgical treatment. Medical treatment should be done in TN. With an growing variety of medications available, it is possible the surgical alternative may not be available for several years.

2007

T rigeminal neuralgia consists of extremely severe, lightning-like, electric, stabbing ("lancinating") pain in the distribution of one or more divisions of the trigeminal nerve (1). The attacks, which typically last a few seconds each, arise either spontaneously or in response to a triggering stimulus, such as light touch in the cutaneous distribution of the trigeminal nerve, chewing, speaking, swallowing, or tooth-brushing. The pain is disabling and causes marked suffering; often, the sufferer is no longer able to eat. Thus, all patients with trigeminal neuralgia should be started on pharmacological treatment as soon as the condition is diagnosed. Between attacks, the patients are asymptomatic. Multiple attacks can occur daily for periods of weeks or months; in the early stage of the condition, they can also remit spontaneously for periods of weeks or months. The condition usually becomes increasingly severe over time. 29% of patients have only one episode in their lifetime, while 28% have three or more. 21% of patients have attacks every year in the first 5 years after the onset of the condition (2). There are no known factors enabling the physician to predict the long-term prognosis at the onset of the disease. So-called idiopathic or classic trigeminal neuralgia is caused by vascular compression of the trigeminal nerve at its origin from the pons. The vascular compression hypothesis is now generally accepted, both because of the intraoperative findings, which are often impressive, and because of the long-term results of decompressive surgery, which are better than those of other surgical techniques (3, 4). The compressing vessel is usually the superior cerebellar artery; less commonly, it is an elongated and dilated basilar artery or a persistent primitive trigeminal artery. Modern magnetic resonance imaging can often detect a pathological neurovascular contact preoperatively (5). Symptomatic (secondary) trigeminal neuralgia occurs in demyelinating diseases such as multiple sclerosis and as a manifestation of mass lesions such as nerve tumors, particularly acoustic neuroma, and metastases. It can also be caused by local ischemia or vascular malformations in the brainstem (6). No more than 10% of all cases of trigeminal neuralgia are due to tumors or demyelinating diseases (7).

International Journal of Basic & Clinical Pharmacology

Pain and fear of pain continue to be the commonest and strongest motivation for the people to seek facial pain treatment. Pain is a personal experience of the sufferer that cannot be shared and wholly belongs to the sufferer. Trigeminal neuralgia (TN) is a notable facial pain disorder resulting in periodic severe pain that produces one of the most severe kinds of pain known to mankind. Treatment of this debilitating condition may be varied, ranging from medical to surgical interventions. However antiepileptic drugs are commonly used for its treatment. This article brings out the recent approaches in diagnosis and treatment of trigeminal neuralgia.

World Journal of Dentistry, 2010

Trigeminal neuralgia (TN), also known as tic douloureux, is characterized by recurrent attacks of lancinating pain in the trigeminal nerve distribution. Typically, brief attacks are triggered by talking, chewing, teeth brushing, shaving, a light touch, or even a cool breeze. The pain is nearly always unilateral, and it may occur repeatedly throughout the day. The condition is characterized by intermittent one-sided facial pain. Trigeminal neuralgia can be classified based on the symptoms as typical and atypical trigeminal and according to etiology as primary or idiopathic and secondary or symptomatic. An early and accurate diagnosis of TN is important, because therapeutic interventions can reduce or eliminate pain attacks in the large majority of TN patients. Although various drugs have been used in the management of TN such as baclofen, gabapentin, phenytoin sodium, carbamazepine remains the gold standard drug of choice. Surgical approaches to pain management are performed when medication cannot control pain or patients cannot tolerate the adverse effects of the medication.

Therapeutics and Clinical Risk Management, 2015

Various drugs and surgical procedures have been utilized for the treatment of trigeminal neuralgia (TN). Despite numerous available approaches, the results are not completely satisfying. The need for more contemporaneous drugs to control the pain attacks is a common experience. Moreover, a number of patients become drug resistant, needing a surgical procedure to treat the neuralgia. Nonetheless, pain recurrence after one or more surgical operations is also frequently seen. These facts reflect the lack of the precise understanding of the TN pathogenesis. Classically, it has been related to a neurovascular compression at the trigeminal nerve root entry-zone in the prepontine cistern. However, it has been evidenced that in the pain onset and recurrence, various neurophysiological mechanisms other than the neurovascular conflict are involved. Recently, the introduction of new magnetic resonance techniques, such as voxel-based morphometry, diffusion tensor imaging, three-dimensional time-of-flight magnetic resonance angiography, and fluid attenuated inversion recovery sequences, has provided new insight about the TN pathogenesis. Some of these new sequences have also been used to better preoperatively evidence the neurovascular conflict in the surgical planning of microvascular decompression. Moreover, the endoscopy (during microvascular decompression) and the intraoperative computed tomography with integrated neuronavigation (during percutaneous procedures) have been recently introduced in the challenging cases. In the last few years, efforts have been made in order to better define the optimal target when performing the gamma knife radiosurgery. Moreover, some authors have also evidenced that neurostimulation might represent an opportunity in TN refractory to other surgical treatments. The aim of this work was to review the recent literature about the pathogenesis, diagnosis, and medical and surgical treatments, and discuss the significant advances in all these fields.

Bmj British Medical Journal, 2007

2014

Trigeminal neuralgia (TN), the most common and the most serious of the facial neuralgias, is characterized by an extremely severe electric shock like or lancinating pain limited to one or more branches of the trigeminal nerve. Among the very many diagnostic and treatment options in the management of TN only very few have proven their efficacy to modern evidence-based medicine standards. For thorough and accurate management, a stepwise diagnostic and treatment approach is recommended. Surgical management should be recommended if sufficient and compliant medical therapy failed. The aim of this review article is to discuss the etiopathogenesis, diagnostic criteria, and treatment strategies for trigeminal neuralgia.

Journal of Neuroanaesthesiology and Critical Care

Trigeminal neuralgia (TN) is a chronic facial pain condition that affects one or more divisions of the trigeminal nerve (5th cranial nerve). It can be idiopathic, primary, or secondary. The cornerstone of the therapy has been antiepileptic medications, peripheral nerve blocks with various neurolytic agents, and surgical procedures. With the advent of newer technologies, minimally invasive neurolytic techniques like low-level laser therapy and ozone injection have revolutionized the management of TN. Novel drugs like vixotrigine and eslicarbazepine have been promising in reducing the frequency and severity of attacks. Inhaled carbon dioxide too has shown promising results in initial trials. Neuromodulation has given robust data in controlling neuralgic pain especially refractory to medical management. Pulsed radiofrequency has been used with increasing success and the side effects like dysesthesia and paresthesia are less. Cryotherapy, neural prolotherapy, and fiber knife techniques ...