|
1
|
Guan G, Polonowita AK, Mei L, Polonowita DA, Polonowita AD. Chronic orofacial pain and pharmacological management: a clinical guide. Oral Surg Oral Med Oral Pathol Oral Radiol 2025; 140:e1-e21. [PMID: 40199716 DOI: 10.1016/j.oooo.2025.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 12/05/2024] [Accepted: 02/10/2025] [Indexed: 04/10/2025]
Abstract
Orofacial pain is a widespread health concern that significantly hinders an individual's capacity to engage in daily activities. This type of pain can be classified into three main categories: nociceptive pain, neuropathic pain, and nociplastic pain. Each category involves different mechanisms and requires specific treatment approaches. For optimal treatment of orofacial pain disorders, a multidisciplinary pain management approach is essential. This approach should integrate both nonpharmacological and pharmacological modalities to address the diverse underlying causes and manifestations of pain. In this review, we focus on the current evidence and advancements in the pharmacological management of chronic orofacial pain. We explored the effectiveness of different medications, their mechanisms of action, and their role within a comprehensive pain management plan.
Collapse
Affiliation(s)
- Guangzhao Guan
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
| | - Athula K Polonowita
- Sir Peter McCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Li Mei
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | | | - Ajith D Polonowita
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| |
Collapse
|
|
2
|
Muñoz-Vendrell A, Valín-Villanueva P, Tena-Cucala R, Campoy S, Martínez-Yélamos S, Huerta-Villanueva M. Second-line pharmacological treatment strategies for trigeminal neuralgia: A retrospective comparison of lacosamide, gabapentin and baclofen. Headache 2025. [PMID: 40341553 DOI: 10.1111/head.14952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Revised: 01/28/2025] [Accepted: 01/29/2025] [Indexed: 05/10/2025]
Abstract
BACKGROUND AND OBJECTIVES Carbamazepine is commonly used as the first-line treatment for trigeminal neuralgia, but therapeutic failure due to adverse effects is frequent. While various second-line alternatives have been suggested, there is limited evidence directly comparing these options. This study aimed to evaluate and compare the effectiveness and tolerability of lacosamide, gabapentin, and baclofen in patients with refractory trigeminal neuralgia. METHODS This retrospective cohort study analyzed patients with trigeminal neuralgia who, after not responding to carbamazepine, were treated with either lacosamide, gabapentin, or baclofen between January 2015 and December 2023. We collected clinical and demographic data and assessed response variables after 3 months of treatment. We compared pain relief (defined as patient-reported pain reduction and absence of additional treatments or emergency consultations within 3 months) and side effects. Secondary endpoints included absence of pain, treatment retention rates, and the need for subsequent surgery. RESULTS A total of 49 patients were included, with 22 receiving lacosamide, 13 receiving gabapentin, and 14 receiving baclofen. The mean (standard deviation) age was 62.1 (14.1) years, with 53% female, and the median duration since diagnosis was 3.4 years. Carbamazepine failure was attributed to inefficacy in 76% of patients and intolerance in 24%. There were no significant demographic or clinical differences among the treatment groups, except for the concurrent use of carbamazepine: 68% in the lacosamide group, 54% in the gabapentin group, and 100% in the baclofen group (p = 0.019). Pain relief rates were 68% for lacosamide, 54% for gabapentin, and 64% for baclofen (p = 0.694). Adverse effects were reported in 46% of lacosamide, 31% of gabapentin, and 36% of baclofen users (p = 0.664). Complete pain relief was achieved in 36% with lacosamide, 53% with gabapentin, and 21% with baclofen (p = 0.218). The treatment discontinuation rates due to intolerance were 23% for lacosamide, 31% for gabapentin, and 21% for baclofen (p = 0.825). CONCLUSION Lacosamide may be a viable second-line treatment option for refractory trigeminal neuralgia, showing comparable outcomes to gabapentin and baclofen.
Collapse
Affiliation(s)
- Albert Muñoz-Vendrell
- Neurology Service, Headache Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- Neurology and Neurogenetics Group, Neuroscience Program, Department of Neurology, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paloma Valín-Villanueva
- Neurology Service, Headache Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Raquel Tena-Cucala
- Neurology Service, Headache Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- Neurology Department, Hospital de Tortosa Verge de la Cinta, Tortosa, Spain
| | - Sergio Campoy
- Neurology Service, Headache Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- Neurology Department, Hospital de Viladecans-IDIBELL, Barcelona, Spain
| | - Sergio Martínez-Yélamos
- Neurology and Neurogenetics Group, Neuroscience Program, Department of Neurology, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mariano Huerta-Villanueva
- Neurology Service, Headache Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- Neurology Department, Hospital de Viladecans-IDIBELL, Barcelona, Spain
| |
Collapse
|
|
3
|
Masyhudi ANF, Subianto H, Fahmi A, Susilo RI, Utomo B, Parenrengi MA, Turchan A. Contributing factors to pain-free outcome in trigeminal neuralgia following microvascular decompression. Surg Neurol Int 2025; 16:54. [PMID: 40041070 PMCID: PMC11878699 DOI: 10.25259/sni_1121_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Accepted: 01/23/2025] [Indexed: 03/06/2025] Open
Abstract
Background Trigeminal neuralgia (TN) is a disease that impairs patients' daily activities. Microvascular decompression (MVD) is known as the best procedure to relieve pain, yet a small portion of patients still experience pain after surgery. This study will analyze the prognostic factor of MVD for TN patients. Methods This is a retrospective cohort study of patients with TN who underwent MVD in an Indonesian tertiary hospital from January 2012 to December 2023. It combines medical records and patient interviews followed by statistical analysis to identify prognostic factors influencing the outcome of MVD for TN. Results Good response to carbamazepine is a favorable factor for short-term pain-free following MVD (P = 0.01). The type of pain emerged as the sole significant prognostic indicator for short-term (P < 0.001) and long-term (P = 0.04) pain relief following MVD. The duration of pain, the type of blood vessels compressing, and the location of compression demonstrated no statistically significant prognostic value on post-MVD pain-free outcomes. Conclusion MVD outcomes are influenced by several factors, including trigeminal pain type (for short and long-term outcomes) and response to carbamazepine (short-term outcomes). Conversely, other factors thought to influence MVD outcomes, such as the duration of pain, the type of blood vessel compressing the nerve, or the site of nerve compression, have not been proven to influence the procedure's outcome.
Collapse
Affiliation(s)
- Akmal Niam Firdausi Masyhudi
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Heri Subianto
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Achmad Fahmi
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Rahadian Indarto Susilo
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Budi Utomo
- Department of Public Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Muhammad Arifin Parenrengi
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Agus Turchan
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| |
Collapse
|
|
4
|
Ruscheweyh R, Gierthmühlen J, Hedderich DM, Goßrau G, Leis S. [Trigeminal neuralgia: drug therapy : The new German guideline]. Schmerz 2024; 38:283-292. [PMID: 38689064 DOI: 10.1007/s00482-024-00810-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 05/02/2024]
Abstract
Trigeminal neuralgia is characterized by severe, lightning-like attacks of pain, which are mandatory for the diagnosis. The pain typically occurs on one side and is often triggered by simply touching the face, chewing or talking. In acute exacerbations, this can also hinder food and fluid intake, resulting in a life-threatening clinical picture. A distinction is made between classical, secondary and idiopathic trigeminal neuralgia. For the diagnosis of trigeminal neuralgia, the medical history and imaging procedures are key for classification. The only active substances approved for the treatment of trigeminal neuralgia in Germany are carbamazepine and phenytoin, which is why off-label drugs often need to be used if there is no or insufficient effect or inacceptable side effects. Cooperation between research and clinical practice to improve the care of affected patients is therefore essential.
Collapse
Affiliation(s)
- Ruth Ruscheweyh
- Neurologische Klinik und Poliklinik, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Janne Gierthmühlen
- Interdisziplinäres Zentrum für Schmerz- und Palliativmedizin, Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Dennis M Hedderich
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, School of Medicine and Health, Technische Universität München, München, Deutschland
| | - Gudrun Goßrau
- Kopfschmerzambulanz, Interdisziplinäres UniversitätsSchmerzCentrum, Medizinische Fakultät, Universitätsklinikum Dresden, TU Dresden, Dresden, Deutschland
| | - Stefan Leis
- Christian-Doppler-Klinik, Universitätsklinik für Neurologie, neurologische Intensivmedizin und Neurorehabilitation, Paracelsus Medizinische Universität, Salzburg, Österreich
| |
Collapse
|
|
5
|
Rana MH, Khan AAG, Khalid I, Ishfaq M, Javali MA, Baig FAH, Kota MZ, Khader MA, Hameed MS, Shaik S, Das G. Therapeutic Approach for Trigeminal Neuralgia: A Systematic Review. Biomedicines 2023; 11:2606. [PMID: 37892981 PMCID: PMC10604820 DOI: 10.3390/biomedicines11102606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/05/2023] [Accepted: 09/13/2023] [Indexed: 10/29/2023] Open
Abstract
This umbrella review aimed to determine the various drugs used to treat trigeminal neuralgia (TN) and to evaluate their efficacies as well as side effects by surveying previously published reviews. An online search was conducted using PubMed, CRD, EBSCO, Web of Science, Scopus, and the Cochrane Library with no limits on publication date or patients' gender, age, and ethnicity. Reviews and meta-analyses of randomized controlled trials pertaining to drug therapy for TN, and other relevant review articles added from their reference lists, were evaluated. Rapid reviews, reviews published in languages other than English, and reviews of laboratory studies, case reports, and series were excluded. A total of 588 articles were initially collected; 127 full-text articles were evaluated after removing the duplicates and screening the titles and abstracts, and 11 articles were finally included in this study. Except for carbamazepine, most of the drugs had been inadequately studied. Carbamazepine and oxcarbazepine continue to be the first choice for medication for classical TN. Lamotrigine and baclofen can be regarded as second-line drugs to treat patients not responding to first-line medication or for patients having intolerable side effects from carbamazepine. Drug combinations using carbamazepine, baclofen, gabapentin, ropivacaine, tizanidine, and pimozide can yield satisfactory results and improve the tolerance to the treatment. Intravenous lidocaine can be used to treat acute exaggerations and botulinum toxin-A can be used in refractory cases. Proparacaine, dextromethorphan, and tocainide were reported to be inappropriate for treating TN. Anticonvulsants are successful in managing trigeminal neuralgia; nevertheless, there have been few studies with high levels of proof, making it challenging to compare or even combine their results in a statistically useful way. New research on other drugs, combination therapies, and newer formulations, such as vixotrigine, is awaited. There is conclusive evidence for the efficacy of pharmacological drugs in the treatment of TN.
Collapse
Affiliation(s)
- Muhammad Haseeb Rana
- Department of Prosthodontics, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia;
| | - Abdul Ahad Ghaffar Khan
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia; (A.A.G.K.); (I.K.); (M.I.); (F.A.H.B.); (M.Z.K.)
| | - Imran Khalid
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia; (A.A.G.K.); (I.K.); (M.I.); (F.A.H.B.); (M.Z.K.)
| | - Muhammad Ishfaq
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia; (A.A.G.K.); (I.K.); (M.I.); (F.A.H.B.); (M.Z.K.)
| | - Mukhatar Ahmed Javali
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia; (M.A.J.); (M.A.K.)
| | - Fawaz Abdul Hamid Baig
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia; (A.A.G.K.); (I.K.); (M.I.); (F.A.H.B.); (M.Z.K.)
| | - Mohammad Zahir Kota
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia; (A.A.G.K.); (I.K.); (M.I.); (F.A.H.B.); (M.Z.K.)
| | - Mohasin Abdul Khader
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia; (M.A.J.); (M.A.K.)
| | - Mohammad Shahul Hameed
- Department of Diagnostic Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia;
| | - Sharaz Shaik
- Department of Prosthetic Dentistry, Lenora Institute of Dental Sciences, Rajahmundry 533101, India;
| | - Gotam Das
- Department of Prosthodontics, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia;
| |
Collapse
|
|
6
|
De Stefano G, Di Pietro G, Truini A, Cruccu G, Di Stefano G. Considerations When Using Gabapentinoids to Treat Trigeminal Neuralgia: A Review. Neuropsychiatr Dis Treat 2023; 19:2007-2012. [PMID: 37745191 PMCID: PMC10517700 DOI: 10.2147/ndt.s407543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/14/2023] [Indexed: 09/26/2023] Open
Abstract
Despite the exemplary efficacy of voltage-gated sodium channel blockers as a first-line treatment of trigeminal neuralgia, the pharmacological management of this excruciating facial pain condition remains a major issue, as these first-line drugs produce intolerable side effects in a significant portion of patients. In addition, in patients with concomitant continuous pain, the efficacy of these drugs may drop, thus suggesting the opportunity to test the efficacy of different drug categories. The aim of this review is to provide current, evidence-based, knowledge about the use of gabapentin and other α2δ ligands in patients with trigeminal neuralgia. We searched for relevant papers within PubMed, EMBASE, the Cochrane Database of Systematic Reviews and the Clinical Trials database (ClinicalTrials.gov), considering publications up to April 2023. Two authors independently selected studies for inclusion and data extraction. The efficacy of α2δ ligands, gabapentin and pregabalin, has been assessed in seven controlled or open-label studies. Despite the low quality of evidence, the favorable tolerability profile and the possible action on concomitant continuous pain make this drug category of interest for future trials in trigeminal neuralgia.
Collapse
Affiliation(s)
| | | | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Giorgio Cruccu
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | | |
Collapse
|
|
7
|
Patel B, Pugazenthi S, Dowling J. Cranial Nerve IX and X Neurectomy for Glossopharyngeal Neuralgia: Case Report and Operative Video. NEUROSURGERY PRACTICE 2023; 4:e00041. [PMID: 39958790 PMCID: PMC11809991 DOI: 10.1227/neuprac.0000000000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/21/2023] [Indexed: 02/18/2025]
Abstract
BACKGROUND AND IMPORTANCE Glossopharyngeal neuralgia (GPN) is a rare condition that is often misdiagnosed as trigeminal neuralgia. The condition is characterized by intermittent, severe pain in the distribution of the glossopharyngeal nerve. We present an illustrative case of GPN with an operative video detailing neurectomy of the glossopharyngeal nerve and the upper rootlets of the vagus nerve for treatment of idiopathic GPN in a patient with a history of squamous cell carcinoma. CLINICAL PRESENTATION A 62-year-old man with a history of left mandibular alveolar squamous cell carcinoma status postresection presented with left-sided severe, paroxysmal pain in the posterior one-third of his tongue refractory to medical treatment and without evidence of recurrent malignancy or vascular compression on imaging studies. After he failed medical management, glossopharyngeal neurectomy was performed through a left suboccipital craniotomy during which cranial nerves IV, V, VI, VII/VII, IX, X, and XI were visually inspected for malignant recurrence, and the glossopharyngeal nerve and the upper 2 to 3 nerve rootlets of the vagus nerve were severed. The patient had immediate, complete, and durable resolution of his symptoms without any new neurological deficits. CONCLUSION Glossopharyngeal neurectomy has been shown to be an efficacious surgical treatment for GPN, as first described by Walter Dandy in 1920. In this report, we describe the workup and treatment of GPN with important diagnostic considerations and present a detailed video demonstrating technical and anatomic considerations when performing glossopharyngeal neurectomy.
Collapse
Affiliation(s)
- Bhuvic Patel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sangami Pugazenthi
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joshua Dowling
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
|
8
|
Lee EK, Lee S, Kwon JH, Lee SH, Park SJ, Kim Y, Kang R, Jeong JS, Lee JJ. The Efficacy of Scalp Nerve Block in Postoperative Pain Management after Microvascular Decompression: A Randomized Clinical Trial. J Clin Med 2023; 12:4242. [PMID: 37445277 DOI: 10.3390/jcm12134242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/11/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The scalp nerve block, created by injecting local anesthetics around the scalp nerves, is reported to effectively reduce pain after surgery. In this study, we evaluated the efficacy of scalp nerve block in patients with hemifacial spasm (HFS) undergoing microvascular decompression (MVD). Seventy-four patients who underwent MVD for HFS were enrolled. The block group received scalp nerve block with 0.5% ropivacaine before surgery. The primary outcome was cumulative dose of rescue analgesics 24 h postoperatively. The secondary outcomes were included pain scores, postoperative antiemetic consumption, and Quality of Recovery-15 scale. The cumulative dose of rescue analgesics at 24 h postoperatively was not significantly different between the two groups (4.80 ± 3.64 mg vs. 5.92 ± 3.95 mg, p = 0.633). However, the pain score was significantly reduced in the block group at 6, 12, and 24 h postoperatively. Postoperative antiemetic consumption was lower in the block group than the control group at 12 h. There were no significant differences between the two groups for other secondary outcomes. In MVD for HFS, a preoperative scalp nerve block might reduce postoperative pain in the early postoperative period, but a larger study using a multimodal approach is needed to confirm the efficacy of a scalp block.
Collapse
Affiliation(s)
- Eun Kyung Lee
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
| | - Seungwon Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Ji-Hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Seung Hoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Soo Jung Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Yunghun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - RyungA Kang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Ji Seon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jeong Jin Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| |
Collapse
|
|
9
|
Mu G, Li Q, Lu B, Yu X. Amelioration of nerve demyelination by hydrogen-producing silicon-based agent in neuropathic pain rats. Int Immunopharmacol 2023; 117:110033. [PMID: 36933448 DOI: 10.1016/j.intimp.2023.110033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023]
Abstract
Trigeminal neuralgia (TN) is a complex orofacial neuropathic pain. The crippling condition's underlying mechanism is still not completely understood. The main cause of lightning-like pain in patients with TN may be chronic inflammation that causes nerve demyelination. Nano-silicon (Si) can safely and continuously produce hydrogen in the alkaline environment of the intestine to exert systemic anti-inflammatory effects. Hydrogen has a promising anti-neuroinflammatory impact. The study aimed to determine how intra-intestinal application of a hydrogen-producing Si-based agent affected the demyelination of the trigeminal ganglion in TN rats. We discovered that increased expression of the NLRP3 inflammasome and inflammatory cell infiltration occurred concurrently with demyelination of the trigeminal ganglion in TN rats. We could determine that the neural effect of the hydrogen-producing Si-based agent was connected to the inhibition of microglial pyroptosis by using transmission electron microscopy. The results demonstrated that the Si-based agent reduced the infiltration of inflammatory cells and the degree of neural demyelination. In a subsequent study, it was discovered that hydrogen produced by a Si-based agent regulates the pyroptosis of microglia may through the NLRP3-caspase-1-GSDMD pathway, preventing the development of chronic neuroinflammation and consequently lowering the incidence of nerve demyelination. This study offers a novel strategy for elucidating the pathogenesis of TN and developing potential therapeutic drugs.
Collapse
Affiliation(s)
- Guo Mu
- Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, Sichuan Province 643000, PR China; Laboratory of Anesthesiology, Southwest Medical University, Luzhou, Sichuan Province 646000, PR China
| | - Qiang Li
- Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, Sichuan Province 643000, PR China
| | - Bin Lu
- Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, Sichuan Province 643000, PR China.
| | - Xuan Yu
- Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, Sichuan Province 643000, PR China.
| |
Collapse
|
|
10
|
Jeyaraj P. Efficiency and Efficacy of Real-Time Fluoroscopic Image-Guided Percutaneous Gasserian Glycerol Rhizotomy (PGGR), for Intractable Cases of Trigeminal Neuralgia. J Maxillofac Oral Surg 2022; 21:1053-1064. [PMID: 36896085 PMCID: PMC9989047 DOI: 10.1007/s12663-021-01682-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/15/2021] [Indexed: 11/27/2022] Open
Abstract
Aim & Objectives To evaluate the ease, efficiency, effectiveness, and associated complications of the technique of percutaneous Gasserian glycerol rhizotomy (PGGR) under real-time fluoroscopic image guidance, for management of severe and refractory cases of primary trigeminal neuralgia, in medical compromised patients. To also assess the long-term efficacy and the necessity, if any, for repeat procedures to salvage recurrences. Study Design & Setting In a prospective study conducted at a single institution over a period of three years, 25 cases of Idiopathic Trigeminal Neuralgia refractory to conservative modalities of treatment including medication were managed with PGGR under real-time fluoroscopic image guidance. All the 25 patients included in this study were known surgical risks for relatively invasive treatment procedures, owing to factors such as advanced age and/or presence of co-morbidities. Material & Methods In order to minimize the risks related to the conventional techniques of Trigeminal root rhizotomy based on cutaneous landmarks alone, and to eliminate the need for frequent repositioning of the needle/cannula, we adopted a technique of real-time fluoroscopic image-guided negotiation of a 22 gauge (0.7 mm dia), 10-cm-long spinal nerve block needle through the foramen ovale, to reach the trigeminal cistern within the Meckel's cave. The efficiency of the technique was assessed in terms of time taken, effort, and ease in performing it. Associated intra- and post-procedural complications were recorded. The immediate and long-term effectiveness of the procedure was evaluated by analysing the degree and duration of pain control achieved, time to recurrence, and the necessity for repeat procedures. Results & Conclusion There were nil intra- or post-procedural complications encountered, and no failures associated with this procedure. Real-time fluoroscopic imaging enabled easy, quick, and successful negotiation of the nerve-block needle through the Foramen Ovale, so as to reach the Trigeminal cistern within the Meckel's cave, within 11 min on an average. An immediate and long lasting post-procedural pain relief was achieved in all the patients. During the follow-up period of 36 months, recurrence of pain was observed in six cases, the mean timing of the recurrence being 26 months or more. Five of these cases were manageable with medication alone, and only one required a repeat procedure. These results indicate that PGGR under real-time fluoroscopic image guidance is a safe, simple, time-efficient, convenient, efficacious, reliable, and minimally invasive means of treating refractory and intractable cases of trigeminal neuralgia.
Collapse
Affiliation(s)
- Priya Jeyaraj
- Classified Specialist (Oral & Maxillofacial Surgery), Commanding Officer 33 CDU and 33 Corps Dental Adviser, Indian Army, West Bengal, India
| |
Collapse
|
|
11
|
Yu G, Leng J, Xia Y, Min F, Xiang H. Microvascular decompression: Diversified of imaging uses, advantages of treating trigeminal neuralgia and improvement after the application of endoscopic technology. Front Neurol 2022; 13:1018268. [PMID: 36438943 PMCID: PMC9681918 DOI: 10.3389/fneur.2022.1018268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/25/2022] [Indexed: 09/08/2024] Open
Abstract
Classical trigeminal neuralgia (CTN) is a unilateral and severe facial pain disease, which seriously affects the patient's quality of life. Microvascular decompression (MVD) is currently the most effective surgical method, and it is the only treatment for the etiology of CTN. Imaging for MVD has been increasingly used, and the advantages and disadvantages of endoscopy-assisted vascular decompression surgery have been controversially debated. In this review, we aimed to discuss the advantages of MVD in the treatment of patients with CTN, the importance of using imaging in disease management, and the improvements of vascular decompression surgery through the application and maturity of endoscopic techniques. Compared with other surgical methods, MVD has more prominent short- and long-term treatment effects. Its selection depends on the accurate discovery of neurovascular compression by preoperative imaging. Moreover, magnetic resonance imaging plays a diverse role in MVD, not only in identifying the responsible vessels but also in determining the prognosis and as a tool for scientific research. The use of endoscopic techniques provides improved visualization of the MVD and additional benefits for vascular decompression surgery.
Collapse
Affiliation(s)
- Gui Yu
- The First Clinical Medical College of Gannan Medical University, Ganzhou, China
- Jiangxi Provincial People's Hospital, Nanchang, China
| | - Jingxing Leng
- Jiangxi Provincial People's Hospital, Nanchang, China
| | - Yinghua Xia
- Jiangxi Provincial People's Hospital, Nanchang, China
- Medical College of Nanchang University, Nanchang, China
| | - Feixiang Min
- Jiangxi Provincial People's Hospital, Nanchang, China
- Medical College of Nanchang University, Nanchang, China
| | - Hui Xiang
- Jiangxi Provincial People's Hospital, Nanchang, China
| |
Collapse
|
|
12
|
Fernandez-Vial D, Sangalli L, Perez C. A Rare Case of Idiopathic Painful Nervus Intermedius Neuropathy in a 13-Year-Old Female: A Case Report and Discussion in the Context of the Literature. CHILDREN 2022; 9:children9081234. [PMID: 36010124 PMCID: PMC9406721 DOI: 10.3390/children9081234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: Painful nervus intermedius neuropathy involves continuous or near-continuous pain affecting the distribution of the intermedius nerve(s). The diagnosis of this entity is challenging, particularly when the clinical and demographic features do not resemble the typical presentation of this condition. To the best of our knowledge, only three case reports have described the occurrence of nervus intermedius neuropathy in young patients. (2) Case Description: A 13-year-old female referred to the orofacial pain clinic with a complaint of pain located deep in the right ear and mastoid area. The pain was described as constant, throbbing and dull, with an intensity of 7/10 on numerical rating scale, characterized by superimposed brief paroxysms of severe sharp pain. The past treatments included ineffective pharmacological and irreversible surgical approaches. After a comprehensive evaluation, a diagnosis of idiopathic painful nervus intermedius neuropathy was given, which was successfully managed with the use of gabapentin. (3) Conclusions and Practical Implications: The diagnosis and treatment of neuropathic pain affecting the nervus intermedius can be challenging due to the complex nature of the sensory innervation of the ear. The diagnosis can be even more challenging in cases of atypical clinical and demographic presentations, which in turn may result in unsuccessful, unnecessary, and irreversible treatments. Multidisciplinary teams and constant knowledge update are fundamental to provide good quality of care to our patients and not to overlook any relevant signs or symptoms.
Collapse
|
|
13
|
Patel S, Mittal R, Sarantopoulos KD, Galor A. Neuropathic ocular surface pain: Emerging drug targets and therapeutic implications. Expert Opin Ther Targets 2022; 26:681-695. [PMID: 36069761 PMCID: PMC9613591 DOI: 10.1080/14728222.2022.2122438] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 09/05/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Dysfunction at various levels of the somatosensory system can lead to ocular surface pain with a neuropathic component. Compared to nociceptive pain (due to noxious stimuli at the ocular surface), neuropathic pain tends to be chronic and refractory to therapies, making it an important source of morbidity in the population. An understanding of the options available for neuropathic ocular surface pain, including new and emerging therapies, is thus an important topic. AREAS COVERED This review will examine studies focusing on ocular surface pain, emphasizing those examining patients with a neuropathic component. Attention will be placed toward recent (after 2017) studies that have examined new and emerging therapies for neuropathic ocular surface pain. EXPERT OPINION Several therapies have been studied thus far, and continued research is needed to identify which individuals would benefit from specific therapies. Gaps in our understanding exist, especially with availability of in-clinic diagnostics for neuropathic pain. A focus on improving diagnostic capabilities and researching gene-modulating therapies could help us to provide more specific mechanism-based therapies for patients. In the meantime, continuing to uncover new modalities and examining which are likely to work depending on pain phenotype remains an important short-term goal.
Collapse
Affiliation(s)
- Sneh Patel
- University of Miami Miller School of Medicine, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rhiya Mittal
- University of Miami Miller School of Medicine, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Konstantinos D. Sarantopoulos
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Anat Galor
- University of Miami Miller School of Medicine, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Surgical services, Miami Veterans Affairs Medical Center, Miami, FL, USA
| |
Collapse
|
|
14
|
Pergolizzi JV, Gharibo C, Magnusson P, Breve F, LeQuang JA, Varrassi G. Pharmacotherapeutic management of trigeminal neuropathic pain: an update. Expert Opin Pharmacother 2022; 23:1155-1164. [PMID: 35695796 DOI: 10.1080/14656566.2022.2087507] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Guidelines recommend a number of pharmacotherapeutic options used as monotherapy or in combination with others for treating the pain of trigeminal neuropathy. AREAS COVERED The authors examine the pharmacotherapeutic options for treating trigeminal neuralgia and supporting evidence in the literature. Guidelines reported the most effective treatment for trigeminal neuropathy, in particular trigeminal neuralgia, appears to be carbamazepine or oxcabazepine, but side effects can be treatment limiting. Lamotrigine and gabapentin are also recommended in guidance. In real-world clinical practice, baclofen, cannabinoids, eslicarbazepine, levetiracetam, brivaracetam, lidocaine, misoprostol, opioids, phenytoin, fosphenytoin, pimozide, sodium valproate, sumatriptan, tizanidine, tocainide, tricyclic antidepressants, and vixotrigine are sometimes used, either as monotherapy or in combination. The relatively small patient population has limited the number of large-scale studies and there is limited evidence on which to base prescribing choices. EXPERT OPINION While there is no optimal pharmacotherapy for treating trigeminal neuropathy, advancements in our understanding of the underlying mechanisms of this condition and drug development indicate promise for NaV inhibitors, despite the fact that not all patients respond to them and they may have potentially treatment-limiting side effects. Nevertheless, better understanding of NaV channels may be important avenues for future drug development for trigeminal neuropathy.
Collapse
Affiliation(s)
| | | | - Peter Magnusson
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden.,Department of Medicine, Cardiology Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Frank Breve
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, Pennsylvania, USA
| | | | | |
Collapse
|
|
15
|
Munoz A, Maxwell C, Gofman N, Liebman K, Veznedaroglu E. The management of trigeminal neuralgia with triptans, a narrative review of the literature. Headache 2022; 62:543-547. [DOI: 10.1111/head.14321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Alfredo Munoz
- Drexel University College of Medicine Philadelphia Pennsylvania USA
| | | | - Natalie Gofman
- Global Neurosciences Institute Pennington New Jersey USA
| | | | | |
Collapse
|
|
16
|
Chen Q, Yi DI, Perez JNJ, Liu M, Chang SD, Barad MJ, Lim M, Qian X. The Molecular Basis and Pathophysiology of Trigeminal Neuralgia. Int J Mol Sci 2022; 23:3604. [PMID: 35408959 PMCID: PMC8998776 DOI: 10.3390/ijms23073604] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023] Open
Abstract
Trigeminal neuralgia (TN) is a complex orofacial pain syndrome characterized by the paroxysmal onset of pain attacks in the trigeminal distribution. The underlying mechanism for this debilitating condition is still not clearly understood. Decades of basic and clinical evidence support the demyelination hypothesis, where demyelination along the trigeminal afferent pathway is a major driver for TN pathogenesis and pathophysiology. Such pathological demyelination can be triggered by physical compression of the trigeminal ganglion or another primary demyelinating disease, such as multiple sclerosis. Further examination of TN patients and animal models has revealed significant molecular changes, channelopathies, and electrophysiological abnormalities in the affected trigeminal nerve. Interestingly, recent electrophysiological recordings and advanced functional neuroimaging data have shed new light on the global structural changes and the altered connectivity in the central pain-related circuits in TN patients. The current article aims to review the latest findings on the pathophysiology of TN and cross-examining them with the current surgical and pharmacologic management for TN patients. Understanding the underlying biology of TN could help scientists and clinicians to identify novel targets and improve treatments for this complex, debilitating disease.
Collapse
Affiliation(s)
- QiLiang Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Dae Ik Yi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Josiah Nathan Joco Perez
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Monica Liu
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Meredith J Barad
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Xiang Qian
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| |
Collapse
|
|
17
|
Jay GW, Barkin RL. Trigeminal neuralgia and persistent idiopathic facial pain (atypical facial pain). Dis Mon 2022; 68:101302. [PMID: 35027171 DOI: 10.1016/j.disamonth.2021.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gary W Jay
- Department of Neurology, Division: Headache/Pain, University of North Carolina, Chapel Hill, USA.
| | - Robert L Barkin
- Departmentts of Anesthesilogy, Family Medicine, Pharrmacology, Rush University Medical College, Chicago Illinois, USA
| |
Collapse
|
|
18
|
Microvascular decompression in trigeminal neuralgia: predictors of pain relief, complication avoidance, and lessons learned. Acta Neurochir (Wien) 2021; 163:3321-3336. [PMID: 34674027 PMCID: PMC8599248 DOI: 10.1007/s00701-021-05028-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/06/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To analyze characteristics associated with long-term pain relief after microvascular decompression (MVD) for trigeminal neuralgia (TGN). Description of associated morbidity and complication avoidance. METHODS One hundred sixty-five patients with TGN underwent 171 MVD surgeries at the authors' institution. Patient characteristics and magnetic resonance imaging (MRI) datasets were obtained through the hospital's archiving system. Patients provided information about pre- and post-operative pain characteristics and neurologic outcome. Favorable outcome was defined as a Barrow Neurological Institute (BNI) pain intensity score of I to III with post-operative improvement of I grade. RESULTS Type of TGN pain with purely paroxysmal pain (p = 0.0202*) and TGN classification with classical TGN (p = 0.0372*) were the only significant predictors for long-term pain relief. Immediate pain relief occurred in 90.6% of patients with a recurrence rate of 39.4% after 3.5 ± 4.6 years. MRI reporting of a neurovascular conflict had a low negative predictive value of 39.6%. Mortality was 0% with major complications observed in 8.2% of patients. Older age was associated with lower complication rates (p = 0.0009***). Re-MVD surgeries showed improved long-term pain relief in four out of five cases. CONCLUSIONS MVD is a safe and effective procedure even in the elderly. It has the unique potential to cure TGN if performed on a regular basis, and if key surgical steps are respected. Early MVD should be offered in case of medical treatment failure and paroxysmal pain symptoms. The presence of a neurovascular conflict on MRI is not mandatory. In case of recurrence, re-MVD is a good treatment option that should be discussed with patients. HIGHLIGHTS • Long-term analysis of pain relief after MVD. • Positive predictors for outcome: classical TGN and purely paroxysmal pain. • Presence of neurovascular conflict in MRI is not mandatory for MVD surgery. • Analysis of complications and surgical nuances for avoidance. • MVD is a safe procedure also in the elderly.
Collapse
|
|
19
|
Tang D, Zhang X, Xu Y, Dai L, Sun J, Hu H, Jiang H, Jin P, Chen L, Fang J. The Central Response of Electroacupuncture on Trigeminal Neuralgia Based on Resting-State Functional Magnetic Resonance Imaging: A Protocol for a Pre-Experimental, Single-Centre, Randomized, Controlled Trial. J Pain Res 2021; 14:3321-3331. [PMID: 34707400 PMCID: PMC8543029 DOI: 10.2147/jpr.s334078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/30/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To verify the efficacy of electroacupuncture (EA) on classical trigeminal neuralgia (CTN), and to observe the brain functional status of patients with CTN and the intervention effects of EA on brain function by resting-state functional magnetic resonance imaging (rs-fMRI). METHODS AND ANALYSIS Thirty CTN patients will be randomly divided into EA combined with carbamazepine group and carbamazepine group in 2:1 ratio by using a random number table. Patients in EA combined with carbamazepine will receive EA treatment and carbamazepine for four weeks. The carbamazepine group will only receive carbamazepine treatment. VAS (visual analogue scale), HAMA (Hamilton Anxiety Scale), HAMD (Hamilton Depression Scale) and SF-36 (short form 36 health survey) will be performed before, after four-week treatments and at three-month follow-up in CTN patients. Six CTN patients will be randomly selected from EA combined with carbamazepine group and carbamazepine group, respectively, before treatment, and twelve paired healthy participants will be recruited at the same time. The twelve CTN patients will be scanned by rs-fMRI before and after treatment, and the healthy participants will be scanned by rs-fMRI only at baseline. Regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) analysis will be carried out to compare the dysfunctional brain regions between CTN patients and healthy participants, as well as the differences between two groups of patients with CTN after treatment. TRIAL REGISTRATION ChiCTR-1900027873.
Collapse
Affiliation(s)
- Ding Tang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Xufen Zhang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yani Xu
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Linglin Dai
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Jianlan Sun
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Hantong Hu
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Huangwei Jiang
- Department of Radiological, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Ping Jin
- Department of Radiological, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Lifang Chen
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Jianqiao Fang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| |
Collapse
|
|
20
|
Parascandolo E, Levinson K, Rizzoli P, Sharon R. Efficacy of Erenumab in the Treatment of Trigeminal Neuralgia: A Retrospective Case Series. Neurol Clin Pract 2021; 11:227-231. [PMID: 34484889 DOI: 10.1212/cpj.0000000000001075] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/15/2021] [Indexed: 12/27/2022]
Abstract
Objective Trigeminal neuralgia (TN) is a chronic, often refractory, pain condition, which adversely affects the lives of patients. Current treatments are only mildly effective. Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies have been successfully studied in the treatment of migraines. CGRP plays a role in both TN and migraine. It is prudent to attempt CGRP monoclonal antibody therapy in TN. Erenumab, a human anti-CGRP monoclonal antibody medication, modulates CGRP, which is elevated in patients with TN. The primary objective of this study was to evaluate the efficacy of erenumab for patients with TN. Methods Retrospective analysis was performed on data collected from 10 patients diagnosed with TN and treated with erenumab for 6 months. Pain was tracked using a numeric pain rating scale (NPRS) from 0 to 10. The effect of erenumab on NPRS after 6 months' time was the primary end point. Secondary end points included side effects to therapy, improvement in headache frequency in those with comorbid migraine, evaluating mood following therapy, and global mood improvement using scale (worse, no change, improved). Results Nine of 10 patients (90.0%) reported improvement in pain severity and in global mood improvement. Three patients reported resolution of anxiety and/or depression. Side effects were minimal, with 3 patients reporting constipation, injection site reactions, or both. Conclusions Based on these results, erenumab appears to be an efficacious treatment option for patients with refractory TN. Patients experienced improvement in pain, reduced frequency of headache, and improvement in mood. Treatment was well tolerated with only mild side effects reported. Classification of Evidence This study provides Class IV evidence that erenumab increases the probability of improved pain control in patients with medication-resistant TN.
Collapse
Affiliation(s)
- Eliot Parascandolo
- Sackler Faculty of Medicine (EP, KL, RS), Tel Aviv University, Israel; Graham Headache Center (PR), Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA; and Department of Neurology (RS), Sheba-Tel HaShomer, Ramat Gan, Israel
| | - Kelsey Levinson
- Sackler Faculty of Medicine (EP, KL, RS), Tel Aviv University, Israel; Graham Headache Center (PR), Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA; and Department of Neurology (RS), Sheba-Tel HaShomer, Ramat Gan, Israel
| | - Paul Rizzoli
- Sackler Faculty of Medicine (EP, KL, RS), Tel Aviv University, Israel; Graham Headache Center (PR), Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA; and Department of Neurology (RS), Sheba-Tel HaShomer, Ramat Gan, Israel
| | - Roni Sharon
- Sackler Faculty of Medicine (EP, KL, RS), Tel Aviv University, Israel; Graham Headache Center (PR), Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA; and Department of Neurology (RS), Sheba-Tel HaShomer, Ramat Gan, Israel
| |
Collapse
|
|
21
|
Maarbjerg S, Benoliel R. The changing face of trigeminal neuralgia-A narrative review. Headache 2021; 61:817-837. [PMID: 34214179 DOI: 10.1111/head.14144] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/11/2021] [Accepted: 04/21/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This narrative review aims to update the reader on the new classification of trigeminal neuralgia (TN), clinical signs, pathophysiologic evidence, and their implications on management. This review is based on the authors' collective experience and knowledge of the literature in addition to a literature search. BACKGROUND In recent years, the phenotype of TN has been intensively studied leading to discrete groups of patients. These include patients with TN with additional continuous pain, and patients with and without neurovascular compression of the trigeminal dorsal root entry zone. A number of associated clinical signs such as tearing and sensory changes need further research. METHODS The literature on TN was searched in PubMed with the aims of providing evidence for the recently published third edition of the International Classification of Headache Disorders (ICHD) and update the clinical phenotype and management of the TN subcategories. RESULTS The ICHD's new classification for TN is based on reliable clinical data, imaging, and neurophysiologic studies. The TN classification reflects current knowledge and has improved the possibility for clinicians to choose adequate management options. However, there is a lack of effective, safe drugs for the management of TN and sparse, robust data on neurosurgical options. CONCLUSION Research into all aspects of TN-diagnosis, pharmacotherapy, surgery, long-term management prognosis, and natural history-is needed. Research should adhere to the ICHD's schema for TN. Improved drugs are needed along with rigorous research into surgical options and their efficacy for different subtypes of TN.
Collapse
Affiliation(s)
- Stine Maarbjerg
- Danish Headache Center, Department of Neurology, Rigshospitalet, Glostrup, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Copenhagen, Denmark
| | - Rafael Benoliel
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
| |
Collapse
|
|
22
|
Abstract
Background Trigeminal neuralgia (TN) is a painful condition, often leading to poor quality of life. Objective The aim of this review was to discuss the various treatment modalities for the medical management of TN. Materials and Methods We reviewed the available literature on TN in clinical databases including PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews, with a specific focus on the pharmacological treatment and newer drugs under development for the treatment of TN. Results Carbamazepine (CBZ) is the gold standard of treatment for TN. The first-line drugs for the treatment of TN are CBZ and oxcarbazepine (OXC). A proportion of cases (30%) are initially resistant to the first-line drugs. Alternative drugs need to be considered if the first-line drugs are not well tolerated or become ineffective with prolonged therapy. The second-line drugs comprise lamotrigine, baclofen, gabapentin, and pregabalin used as monotherapy or in combination with CBZ/OXC. Botulinum toxin A may be a promising presurgical option. Newer drug like vixotrigine has shown good results in phase two randomized control trials. About 50% of cases develop treatment resistance to oral drugs over the subsequent years of therapy and require surgical options. Conclusion The first-line drugs for the treatment of TN (irrespective of the age group or type) are CBZ and OXC. Combination therapy with second-line or other drugs may become necessary with poor response to CBZ/OXC, or if adverse events occur. Patients should be offered surgical options if there is poor response or tolerance to the medical therapy.
Collapse
Affiliation(s)
- Satish V Khadilkar
- Department of Neurology, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India
| | - Varsha A Patil
- Associate Consultant Neurologist , Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India
| |
Collapse
|
|
23
|
Sindou M, Brinzeu A, Laurent B. Aspetti clinici e terapeutici della nevralgia dei nervi trigemino e glossofaringeo. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)44502-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
|
24
|
Bendtsen L, Zakrzewska JM, Heinskou TB, Hodaie M, Leal PRL, Nurmikko T, Obermann M, Cruccu G, Maarbjerg S. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol 2020; 19:784-796. [PMID: 32822636 DOI: 10.1016/s1474-4422(20)30233-7] [Citation(s) in RCA: 229] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Abstract
Trigeminal neuralgia is a very painful neurological condition with severe, stimulus-evoked, short-lasting stabbing pain attacks in the face. The past decade has offered new insights into trigeminal neuralgia symptomatology, pathophysiology, and treatment, leading to a change in the classification of the condition. An accurate diagnosis is crucial because neuroimaging interpretation and clinical management differ among the various forms of facial pain. MRI using specific sequences should be a part of the diagnostic workup to detect a possible neurovascular contact and exclude secondary causes. Demonstration of a neurovascular contact should not be used to confirm a diagnosis but rather to facilitate surgical decision making. Carbamazepine and oxcarbazepine are drugs of first choice for long-term treatment, whereas microvascular decompression is the first-line surgery in medically refractory patients. Advances in neuroimaging techniques and animal models will provide further insight into the causes of trigeminal neuralgia and its pathophysiology. Development of more efficacious treatment options is highly warranted.
Collapse
Affiliation(s)
- Lars Bendtsen
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark.
| | - Joanna Maria Zakrzewska
- Pain Management Centre, National Hospital for Neurology and Neurosurgery, London, UK; Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | - Tone Bruvik Heinskou
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Paulo Roberto Lacerda Leal
- Department of Neurosurgery, Faculty of Medicine of Sobral, Federal University of Cearà, Sobral, Brazil; University of Lyon, Lyon, France
| | - Turo Nurmikko
- Neuroscience Research Centre, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany
| | - Giorgio Cruccu
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Stine Maarbjerg
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark
| |
Collapse
|
|
25
|
Knezevic NN, Jovanovic F, Candido KD, Knezevic I. Oral pharmacotherapeutics for the management of peripheral neuropathic pain conditions - a review of clinical trials. Expert Opin Pharmacother 2020; 21:2231-2248. [PMID: 32772737 DOI: 10.1080/14656566.2020.1801635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Epidemiological studies have shown that 6.9-10% of people suffer from neuropathic pain, a complex painful condition which is often undertreated. Data regarding the effectiveness of treatment options for patients with neuropathic pain is inconsistent, and there is no single treatment option that shows cost-effectiveness across studies. AREAS COVERED In this narrative review, the authors present the results of different prospective, randomized controlled trials, systematic reviews and meta-analyses assessing the effects of different oral medications in the management of various peripheral neuropathic pain conditions. The authors discuss the effectiveness of commonly used oral medications such as voltage-gated calcium channels antagonists, voltage-gated sodium channel antagonists, serotonin-norepinephrine reuptake inhibitors, NMDA antagonists, and medications with other mechanisms of action. EXPERT OPINION Most of the presented medications were more effective than placebo; however, when compared to each other, none of them were significantly superior. The heterogeneity of the studies looking into different oral neuropathic conditions has been the major issue that prevents us from making stronger recommendations. There are multiple reasons including high placebo responsiveness, improperly treated underlying comorbidities (particularly anxiety and depression), and inter-patient variability. Different sensory phenotypes should also be taken into consideration when designing future clinical trials for neuropathic pain.
Collapse
Affiliation(s)
- Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center , Chicago, IL, US.,Department of Anesthesiology, College of Medicine, University of Illinois , Chicago, IL, US.,Department of Surgery, College of Medicine, University of Illinois , Chicago, IL, US
| | - Filip Jovanovic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center , Chicago, IL, US
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center , Chicago, IL, US.,Department of Anesthesiology, College of Medicine, University of Illinois , Chicago, IL, US.,Department of Surgery, College of Medicine, University of Illinois , Chicago, IL, US
| | - Ivana Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center , Chicago, IL, US
| |
Collapse
|
|
26
|
Park S, Park JW. Various diagnostic possibilities for zygomatic arch pain: Seven case reports and review of literature. World J Clin Cases 2020; 8:2294-2304. [PMID: 32548159 PMCID: PMC7281041 DOI: 10.12998/wjcc.v8.i11.2294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/24/2020] [Accepted: 05/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pain of the zygomatic arch region is common among patients with orofacial pain, especially in those with temporomandibular disorder-related pain of a myogenic origin. Since zygomatic arch pain may occur due to various causes other than muscle pain, appropriate diagnosis and treatment planning is essential to ensure its successful management. Unfortunately, zygomatic arch pain has not been handled as an independent clinical feature until now, and studies have mainly focused on pain resulting from trauma and surgical procedures.
CASE SUMMARY We describe 7 independent cases, all of which presented with the identical chief complaint of pain in the zygomatic arch region. However, the underlying causes were different for each, being myofascial pain, myositis, tooth crack, dental caries, sinusitis, neuropathic pain, and salivary gland tumor respectively. In this case report, the clinical features of each case are investigated and diseases to be considered in the diagnostic process are suggested, along with the diagnostic modalities (including computed tomography and magnetic resonance imaging) that can lead to the appropriate final diagnosis.
CONCLUSION Zygomatic arch pain is a common complaint encountered in the orofacial pain clinic but may lead to misdiagnosis. Clinicians must have in-depth knowledge of the possible differential diagnoses and evaluation tools.
Collapse
Affiliation(s)
- Seoeun Park
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul 03080, South Korea
| | - Ji Woon Park
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul 03080, South Korea
| |
Collapse
|
|
27
|
Shi J, Qian Y, Han W, Dong B, Mao Y, Cao J, Guan W, Zhou Q. Risk Factors for Outcomes After Microvascular Decompression for Trigeminal Neuralgia. World Neurosurg 2020; 136:e559-e566. [DOI: 10.1016/j.wneu.2020.01.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 01/21/2023]
|
|
28
|
Holste K, Chan AY, Rolston JD, Englot DJ. Pain Outcomes Following Microvascular Decompression for Drug-Resistant Trigeminal Neuralgia: A Systematic Review and Meta-Analysis. Neurosurgery 2020; 86:182-190. [PMID: 30892607 PMCID: PMC8253302 DOI: 10.1093/neuros/nyz075] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 02/14/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Microvascular decompression (MVD) is a potentially curative surgery for drug-resistant trigeminal neuralgia (TN). Predictors of pain freedom after MVD are not fully understood. OBJECTIVE To describe rates and predictors for pain freedom following MVD. METHODS Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, PubMed, Cochrane Library, and Scopus were queried for primary studies examining pain outcomes after MVD for TN published between 1988 and March 2018. Potential biases were assessed for included studies. Pain freedom (ie, Barrow Neurological Institute score of 1) at last follow-up was the primary outcome measure. Variables associated with pain freedom on preliminary analysis underwent formal meta-analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for possible predictors. RESULTS Outcome data were analyzed for 3897 patients from 46 studies (7 prospective, 39 retrospective). Overall, 76.0% of patients achieved pain freedom after MVD with a mean follow-up of 1.7 ± 1.3 (standard deviation) yr. Predictors of pain freedom on meta-analysis using random effects models included (1) disease duration ≤5 yr (OR = 2.06, 95% CI = 1.08-3.95); (2) arterial compression over venous or other (OR = 3.35, 95% CI = 1.91-5.88); (3) superior cerebellar artery involvement (OR = 2.02, 95% CI = 1.02-4.03), and (4) type 1 Burchiel classification (OR = 2.49, 95% CI = 1.32-4.67). CONCLUSION Approximately three-quarters of patients with drug-resistant TN achieve pain freedom after MVD. Shorter disease duration, arterial compression, and type 1 Burchiel classification may predict more favorable outcome. These results may improve patient selection and provider expectations.
Collapse
Affiliation(s)
- Katherine Holste
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Alvin Y Chan
- Department of Neurosurgery, University of California, Irvine, Irvine, California
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
|
29
|
Araya EI, Claudino RF, Piovesan EJ, Chichorro JG. Trigeminal Neuralgia: Basic and Clinical Aspects. Curr Neuropharmacol 2020; 18:109-119. [PMID: 31608834 PMCID: PMC7324879 DOI: 10.2174/1570159x17666191010094350] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/17/2019] [Accepted: 10/01/2019] [Indexed: 12/27/2022] Open
Abstract
The trigeminal nerve is the largest of all cranial nerves. It has three branches that provide the main sensory innervation of the anterior two-thirds of the head and face. Trigeminal neuralgia (TN) is characterized by sudden, severe, brief, and stabbing recurrent episodes of facial pain in one or more branches of the trigeminal nerve. Pain attacks can occur spontaneously or can be triggered by non-noxious stimuli, such as talking, eating, washing the face, brushing teeth, shaving, a light touch or even a cool breeze. In addition to pain attacks, a proportion of the patients also experience persistent background pain, which along with autonomic signs and prolonged disease duration, represent predictors of worse treatment outcomes. It is now widely accepted that the presence of a neurovascular compression at the trigeminal root entry zone is an anatomic abnormality with a high correlation with classical TN. However, TN may be related to other etiologies, thus presenting different and/or additional features. Since the 1960s, the anticonvulsant carbamazepine is the drug of choice for TN treatment. Although anti-epileptic drugs are commonly used to treat neuropathic pain in general, the efficacy of carbamazepine has been largely limited to TN. Carbamazepine, however, is associated with dose-limiting side-effects, particularly with prolonged usage. Thus, a better understanding and new treatment options are urgently warranted for this rare, but excruciating disease.
Collapse
|
|
30
|
Bista P, Imlach WL. Pathological Mechanisms and Therapeutic Targets for Trigeminal Neuropathic Pain. MEDICINES (BASEL, SWITZERLAND) 2019; 6:E91. [PMID: 31443547 PMCID: PMC6789505 DOI: 10.3390/medicines6030091] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 12/31/2022]
Abstract
Trigeminal neuropathic pain is a chronic pain condition caused by damage or inflammation of the trigeminal nerve or its branches, with both peripheral and central nervous system dysfunction contributing to the disorder. Trigeminal pain conditions present with diagnostic and therapeutic challenges to healthcare providers and often require multiple therapeutic approaches for pain reduction. This review will provide the overview of pathophysiology in peripheral and central nociceptive circuits that are involved in neuropathic pain conditions involving the trigeminal nerve and the current therapeutics that are used to treat these disorders. Recent advances in treatment of trigeminal pain, including novel therapeutics that target ion channels and receptors, gene therapy and monoclonal antibodies that have shown great promise in preclinical studies and clinical trials will also be described.
Collapse
Affiliation(s)
- Pawan Bista
- Department of Physiology & Monash Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3800, Australia
| | - Wendy L Imlach
- Department of Physiology & Monash Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3800, Australia.
| |
Collapse
|
|
31
|
Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, Eide PK, Leal PRL, Maarbjerg S, May A, Nurmikko T, Obermann M, Jensen TS, Cruccu G. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol 2019; 26:831-849. [DOI: 10.1111/ene.13950] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/08/2019] [Indexed: 12/19/2022]
Affiliation(s)
- L. Bendtsen
- Department of Neurology Faculty of Health and Medical Sciences Danish Headache Center Rigshospitalet‐Glostrup University of Copenhagen Glostrup Denmark
| | - J. M. Zakrzewska
- Pain Management Centre National Hospital for Neurology and Neurosurgery London UK
- Eastman Dental Hospital UCLH NHS Foundation Trust London UK
| | - J. Abbott
- Trigeminal Neuralgia Association UK Oxted Surrey UK
| | | | - G. Di Stefano
- Department of Human Neuroscience Sapienza University Rome Italy
| | - A. Donnet
- Headache and Pain Department CHU La Timone APHM Marseille France
| | - P. K. Eide
- Department of Neurosurgery Oslo University Hospital‐Rikshospitalet Oslo Norway
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
| | - P. R. L. Leal
- Department of Neurosurgery Faculty of Medicine of Sobral Federal University of Ceará Sobral Brazil
- University of Lyon 1 Lyon France
| | - S. Maarbjerg
- Department of Neurology Faculty of Health and Medical Sciences Danish Headache Center Rigshospitalet‐Glostrup University of Copenhagen Glostrup Denmark
| | - A. May
- Department of Systems Neuroscience Universitäts‐Krankenhaus Eppendorf Hamburg Germany
| | - T. Nurmikko
- Neuroscience Research Centre Walton Centre NHS Foundation Trust Liverpool UK
| | - M. Obermann
- Center for Neurology Asklepios Hospitals Schildautal Seesen Germany
| | - T. S. Jensen
- Department of Neurology and Danish Pain Research Center Aarhus University Hospital University of Aarhus Aarhus C Denmark
| | - G. Cruccu
- Department of Human Neuroscience Sapienza University Rome Italy
| |
Collapse
|
|
32
|
Di Stefano G, Truini A, Cruccu G. Current and Innovative Pharmacological Options to Treat Typical and Atypical Trigeminal Neuralgia. Drugs 2018; 78:1433-1442. [PMID: 30178160 PMCID: PMC6182468 DOI: 10.1007/s40265-018-0964-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Trigeminal neuralgia is a representative neuropathic facial pain condition, characterised by unilateral paroxysmal pain in the distribution territory of one or more divisions of the trigeminal nerve, triggered by innocuous stimuli. A subgroup of patients with trigeminal neuralgia [TN (previously defined as atypical TN)] also suffer from concomitant continuous pain, i.e. a background pain between the paroxysmal attacks. The aim of this review is to provide current, evidence-based, knowledge about the pharmacological treatment of typical and atypical TN, with a specific focus on drugs in development. We searched for relevant papers within PubMed, EMBASE, the Cochrane Database of Systematic Reviews and the Clinical Trials database (ClinicalTrials.gov), taking into account publications up to February 2018. Two authors independently selected studies for inclusions, data extraction, and bias assessment. Carbamazepine and oxcarbazepine are the first-choice drugs for paroxysmal pain. When sodium channel blockers cannot reach full dosage because of side effects, an add-on treatment with lamotrigine or baclofen should be considered. In patients with atypical TN, both gabapentin and antidepressants are expected to be efficacious and should be tried as an add-on to oxcarbazepine or carbamazepine. Although carbamazepine and oxcarbazepine are effective in virtually the totality of patients, they are responsible for side effects causing withdrawal from treatment in an important percentage of cases. A new, better tolerated, Nav1.7 selective state-dependent, sodium channel blocker (vixotrigine) is under development. Future trials testing the effect of combination therapy in patients with TN are needed, especially in patients with concomitant continuous pain and in TN secondary to multiple sclerosis.
Collapse
Affiliation(s)
- G Di Stefano
- Department of Human Neuroscience, Sapienza University, viale Università 30, 00185, Rome, Italy
| | - A Truini
- Department of Human Neuroscience, Sapienza University, viale Università 30, 00185, Rome, Italy
| | - G Cruccu
- Department of Human Neuroscience, Sapienza University, viale Università 30, 00185, Rome, Italy.
| |
Collapse
|
|
33
|
Marmura MJ, Kumpinsky AS. Refining the Benefit/Risk Profile of Anti-Epileptic Drugs in Headache Disorders. CNS Drugs 2018; 32:735-746. [PMID: 30073584 DOI: 10.1007/s40263-018-0555-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Anti-epileptic drugs are among the most effective drugs for migraine prophylaxis, and will likely continue to have a role even as new therapies emerge. Topiramate and valproate are effective for the preventive treatment of migraine, and other medications such as gabapentin or lamotrigine may have a role in the treatment of those with allodynia or frequent aura, respectively. Oxcarbazepine, carbamazepine, phenytoin, gabapentin, and others may alleviate pain in trigeminal neuralgia. While many anti-epileptic drugs can be effective in those with migraine or other headaches, most of these agents can potentially cause serious side effects. In particular, valproate, topiramate, carbamazepine, and phenytoin may lead to adverse outcomes for infants of exposed mothers. Valproate should not be given to women of childbearing potential for migraine prevention.
Collapse
Affiliation(s)
- Michael J Marmura
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, 900 Walnut ST #200, Philadelphia, PA, 19107, USA.
| | - Aliza S Kumpinsky
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, 900 Walnut ST #200, Philadelphia, PA, 19107, USA
| |
Collapse
|
|
34
|
Qin Z, Xie S, Mao Z, Liu Y, Wu J, Furukawa TA, Kwong JS, Tian J, Liu Z. Comparative efficacy and acceptability of antiepileptic drugs for classical trigeminal neuralgia: a Bayesian network meta-analysis protocol. BMJ Open 2018; 8:e017392. [PMID: 29358420 PMCID: PMC5780694 DOI: 10.1136/bmjopen-2017-017392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/24/2017] [Accepted: 11/08/2017] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Trigeminal neuralgia (TN) affects 4 to 28.9/100 000 people worldwide, and antiepileptic drugs such as carbamazepine and oxcarbazepine are the firstline treatment options. However, the efficacy and safety of other antiepileptic drugs remain unclear due to insufficient direct comparisons. OBJECTIVE To compare the efficacy and acceptability of all currently available antiepileptic agents for the treatment of patients with classical TN. METHODS We will search the PubMed, EMBASE, Cochrane Library and Web of Science databases for unpublished or undergoing research listed in registry platforms. We will include all randomised controlled trials comparing two different antiepileptic drugs or one antiepileptic drug with placebo in patients with classical TN. The primary outcomes will be the proportion of responders and the number of subjects who dropout during the treatment. The secondary outcomes will include the two primary outcomes but in the follow-up period, changes in the self-reporting assessment scale for neuralgia and quality of life assessment. In terms of network meta-analysis, we will fit our model to a Bayesian framework using the JAGS and pcnetmeta packages of the R project. ETHICS AND DISSEMINATION This protocol will not disseminate any private patient data. The results of this review will be disseminated through peer reviewed publication. PROSPERO REGISTRATION NUMBER CRD42016048640.
Collapse
Affiliation(s)
- Zongshi Qin
- Department of Acupuncture and Neurology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Shang Xie
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhi Mao
- Department of Critical Care Medicine, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yan Liu
- Data Centre of Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiani Wu
- Department of Acupuncture and Neurology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Joey S.W. Kwong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
| | - Jinhui Tian
- Evidence Based Medicine Centre, Lanzhou University, Lanzhou, China
| | - Zhishun Liu
- Department of Acupuncture and Neurology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|