AAN‐EFNS guidelines on trigeminal neuralgia management

@article{Cruccu2008AANEFNSGO,
  title={AAN‐EFNS guidelines on trigeminal neuralgia management},
  author={Giorgio Cruccu and Gary S. Gronseth and John F. Alksne and Charles Argoff and Michael Brainin and Kim Burchiel and Turo Nurmikko and Janna Zakrzewska},
  journal={European Journal of Neurology},
  year={2008},
  volume={15}
}
Several issues regarding diagnosis, pharmacological treatment, and surgical treatment of trigeminal neuralgia (TN) are still unsettled. The American Academy of Neurology and the European Federation of Neurological Societies launched a joint Task Force to prepare general guidelines for the management of this condition. After systematic review of the literature the Task Force came to a series of evidence‐based recommendations. In patients with TN MRI may be considered to identify patients with… 

Trigeminal Neuralgia: Current Approaches and Emerging Interventions

Fundamentally, TN remains a clinical diagnosis that must be distinguished from other types of trigeminal neuropathic pain and/or facial pain associated with other neuralgias or headache syndromes, and elucidation of the molecular mechanisms underlying trigeminals neuralgia will pave the way for novel, more effective and less invasive therapies.

Trigeminal Neuralgia: Role of Interventional Pain Physician

Evidence suggests that the likely etiology is vascular compression of the trigeminal nerve leading to focal demyelination and aberrant neural discharge, and Gasserian ganglion percutaneous techniques, gamma knife surgery and microvascular decompression are the most promising invasive treatment options.

Cranial neuralgias.

Trigeminal Neuralgia

It is proposed that the diagnosis of trigeminal neuralgia, with or without concomitant continuous pain, must rely on clinical grounds only and precise MRI criteria for differentiating a real neurovascular compression from an irrelevant contact will be of benefit in better selecting patients for microvascular decompression.

Pitfals in recognition and management of trigeminal neuralgia

There is a need to improve the neurological knowledge in order to promptly recognize the clinical picture of TN and properly adhere to the specific guidelines and this may result in a favorable outcome for patients, whose quality of life is usually severely impaired.

Comment on AAN‐EFNS guidelines on trigeminal neuralgia management

The authors considered that there is insufficient evidence to support or refute the efficacy of clonazepam, gabapentin, phenytoin, tizanidine, topical capsaicin, lamotrigine, topiramate and misoprostol for controlling pain in patients with CTN and STN.

A Comprehensive Review of Trigeminal Neuralgia

Deep brain and motor cortex neuro-modulatory stimulation are off label emerging techniques which may offer relief to TN that is otherwise refractory to pharmacological management and surgery.

Trigeminal Neuralgia

Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures.

Trigeminal Neuralgia—A Debilitating Facial Pain

Both percutaneous techniques targeting the Gasserian ganglion and microvascular decompression can be considered effective in the management of TN and both are considered to provide on average, the longest pain free period post surgery.
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References

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Operative Findings and Outcomes of Microvascular Decompression for Trigeminal Neuralgia in 35 Patients Affected by Multiple Sclerosis

Results of MVD in trigeminal neuralgia MS patients are much less satisfactory than in the idiopathic group, indicating that central mechanisms play a major role in pain genesis.

Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis

MVD was found to be a safe and effective procedure to relieve typical TN in patients of all ages and should be proposed as first choice surgery to all patients affected by TN, even in selected cases with multiple sclerosis.

Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors.

Although less effective than MVD, GKS remains a reasonable treatment option for those unwilling or unable to undergo more invasive surgical approaches and offers a low risk of side effects.

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Although MVD provides good initial pain relief, the recurrence rate is much higher than that obtained in ‘idiopathic’ TGN and it is concluded that because of the highRecurrence rate together with the morbidity associated with the procedure MVD should not be offered to patients with TGN.

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Surgical procedures to treat trigeminal neuralgia in MS are generally less effective than in patients with the idiopathic form, and surgery in refractory cases may provide pain relief, though patients may be reluctant to consider surgical options.

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  • B. GohC. PoonR. Peck
  • Medicine
    Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics
  • 2001
The frequency of structural lesions associated with TN in the sample was relatively high and it is not possible to reliably identify high risk patients for selective MRI indication on the basis of history and clinical features, so it may be prudent to consider routine MRI for all patients with TN to exclude structural lesions.
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