Pharmacotherapy of Trigeminal Neuralgia

@article{Sindrup2002PharmacotherapyOT,
  title={Pharmacotherapy of Trigeminal Neuralgia},
  author={S{\o}ren Hein Sindrup and Troels Staehelin Jensen},
  journal={The Clinical Journal of Pain},
  year={2002},
  volume={18},
  pages={22-27}
}
  • S. Sindrup, T. Jensen
  • Published 1 January 2002
  • Medicine, Biology, Psychology
  • The Clinical Journal of Pain
The efficacy of the anticonvulsant drug carbamazepine in the management of trigeminal neuralgia is evidenced in several controlled trials, and the numbers needed to treat to obtain one patient with at least 50% pain relief (NNT) is 1.7. Single small trials have shown that baclofen alone provides pain relief (NNT = 1.4) and that lamotrigine has an additional effect in patients with insufficient relief using carbamazepine or phenytoin (NNT = 2.1). Uncontrolled observations and clinical practice… 
Topiramate versus Carbamazepine for the Treatment of Classical Trigeminal Neuralgia
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A meta-analysis of six randomized controlled trials conducted in China showed that the overall effectiveness and tolerability of topiramate did not seem to differ from carbamazepine in the treatment of classical trigeminal neuralgia.
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TLDR
The article provides current, evidence-based knowledge about the pharmacological treatment of trigeminal neuralgia, and suggests a practical approach to the various drugs, including starting dose, titration and side effects.
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TLDR
It is not possible to give an evidence-based recommendation for first-line pharmaceutical management of CTN specifically for the elderly, as there is a lack of research on the use of antiepileptics in the elderly.
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TLDR
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TLDR
This study design utilizes a method of survival analysis and is novel in chronic pain research that allows for both early departure from the study and voluntary crossover upon non-response, and may be applicable to the analysis of IVIG efficacy in other chronic pain syndromes.
Treatment of refractory trigeminal neuralgia with intravenous phenytoin.
  • R. Tate, L. Rubin, Kristin C Krajewski
  • Medicine
    American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
  • 2011
TLDR
Phenytoin sodium 15 mg/kg i.v. divided into two doses separated by four hours was safe and effective in treating an acute exacerbation of refractory TN.
Oxcarbazepine monotherapy in carbamazepine-unresponsive trigeminal neuralgia
Comparative efficacy and acceptability of antiepileptic drugs for classical trigeminal neuralgia: a Bayesian network meta-analysis protocol
TLDR
To compare the efficacy and acceptability of all currently available antiepileptic agents for the treatment of patients with classical TN, a network meta-analysis is fit to a Bayesian framework using the JAGS and pcnetmeta packages of the R project.
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References

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TLDR
The results of treating 143 patients with trigeminal neuralgia with carbamazepine with CBZ over a 16-year period have been reviewed and it is shown that it may continue to be effective for many years.
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TLDR
It is concluded that oxcarbazepine has potent antineuralgic properties in the absence of significant side effects and therefore may be useful in the management of intractable trigeminal neuralgia.
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Seven patients with trigeminal neuralgia were treated with carbamazepine at three dose levels, each period lasting for six days. A single-blind technique was used, the patients being unaware of the
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TLDR
Lamotrigine (Lamictal, GlaxoWellcome), at a mean dosage of 362 mg (median: 400 mg; range: 150– 600 mg), in divided doses, achieved 100% pain relief in 7 patients, almost complete relief in 4 patients with ITN.
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TLDR
The present study evaluated the side effects and also the application of this drug in some of the other neuralgias such as postherpetic, tabetic, and atypical facial neuralgia, using a double-blind technique.
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  • Medicine, Psychology
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TLDR
Gabapentin offers an effective, safe alternative therapy or co-therapy for the listed painful conditions and tremor; it does not affect the metabolism of other medications and is well tolerated.
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TLDR
Baclofen is a useful drug in the treatment of trigeminal neuralgia and an open trial in 50 patients refractory to or unable to tolerate carbamazepine showed that 37 patients were relieved of their attacks by bacl ofen.
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