Trigeminal neuralgia: the diagnosis and management of this excruciating and poorly understood facial pain
Postgraduate Medical Journal, 06/13/2011
Zakrzewska JM et al. – Surgical procedures result in markedly improved quality of life. Patient support groups provide information and support to those in pain and play a crucial role.
- Most trigeminal neuralgia is idiopathic, but a small percentage is due to secondary causes—for example, tumours or multiple sclerosis—which can be picked up on CT or MRI.
- Recently published international guidelines suggest that carbamazepine and oxcarbazepine are the first–line drugs.
- There is limited evidence for the use of lamotrigine and baclofen.
- If there is a decrease in efficacy or tolerability of medication, surgery needs to be considered.
- Neurosurgical opinion should be sought early.
- There are several ablative, destructive procedures that can be carried out either at the level of the Gasserian ganglion or in the posterior fossa.
- Only non–destructive procedure is microvascular decompression (MVD).
- Ablative procedures give a 50% chance of patients being pain free for 4 years, compared with 70% of patients at 10 years after MVD.
- Ablative procedures result in sensory loss, and MVD carries a 0.2–0.4% risk of mortality with a 2–4% chance of ipsilateral hearing loss.