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Therapeutic Outcome and Future Scopes in the Management of Trigeminal Neuralgia

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Handbook of Trigeminal Neuralgia

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Abstract

Trigeminal neuralgia (TGN) is an elusive medical condition with debilitating consequences. Treatment options for TGN have evolved and improved over the years; however, many existing drugs and percutaneous procedures have variable efficacy and recurrence is possible in many patients. Many new molecules acting on novel pain targets are being studied, which are in pre-clinical, or early clinical development phases. Various surgical therapies have been tried for the management of drug-resistant TGN. Among them, microvascular decompression (MVD) is performed to address the primary problem of aberrant vascular loops impinging on the trigeminal nerve. On the other hand, percutaneous destructive procedures aim at reducing the overall sensory input from the trigeminal ganglion.

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References

  1. Sindrup SH, Jensen TS. Pharmacotherapy of trigeminal neuralgia. Clin J Pain. 2002;18:22–7.

    Article  Google Scholar 

  2. Cruccu G, Sommer C, Anand P, Attal N, Baron R, Garcia-Larrea L, et al. EFNS guidelines on neuropathic pain assessment: revised 2009. Eur J Neurol. 2010;17:1010–8.

    Article  CAS  Google Scholar 

  3. Beydoun A. Clinical use of tricyclic anticonvulsants in painful neuropathies and bipolar disorders. Epilepsy Behav. 2002;3:S18–22.

    Article  Google Scholar 

  4. Beydoun A. Safety and efficacy of oxcarbazepine: results of randomized, double-blind trials. Pharmacotherapy. 2000;20:152S–8S.

    Article  CAS  Google Scholar 

  5. Liebel JT, Menger N, Langohr H. Oxcarbazepine in derBehandlung der Trigeminusneuralgie. Nervenheilkunde. 2001;20:461–5.

    Google Scholar 

  6. Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F. Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag. 2015;11:289–99.

    Article  Google Scholar 

  7. Zakrzewska JM, Chaudhry Z, Nurmikko TJ, Patton DW, Mullens EL. Lamotrigine (Lamictal) in refractory trigeminal neuralgia: results from a double-blind placebo-controlled crossover trial. Pain. 1997;73:223–30.

    Article  CAS  Google Scholar 

  8. Wiffen PJ, Derry S, Moore RA. Lamotrigine for acute and chronic pain. Cochrane Database Syst Rev. 2011;2:CD006044.

    Google Scholar 

  9. Fromm GH, Aumentado D, Terrence CF. A clinical and experimental investigation of the effects of tizanidine in trigeminal neuralgia. Pain. 1993;53:265–71.

    Article  CAS  Google Scholar 

  10. Nurmikko TJ, Eldridge PR. Trigeminal neuralgia–pathophysiology, diagnosis and current treatment. Br J Anaesth. 2001;87:117–32.

    Article  CAS  Google Scholar 

  11. Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ. 2014;348:g474.

    Article  Google Scholar 

  12. Hu Y, Guan X, Fan L, Li M, Liao Y, Nie Z, Jin L. Therapeutic efficacy and safety of botulinum toxin type A in trigeminal neuralgia: a systematic review. J Headache Pain. 2013;14:72.

    Article  Google Scholar 

  13. Cruccu G, Truini A. Refractory trigeminal neuralgia. Non-surgical treatment options. CNS Drugs. 2013;27:91–6.

    Article  Google Scholar 

  14. Zakrzewska JM, Palmer J, Morisset V, Giblin GM, Obermann M, Ettlin D, et al., Study Investigators. Safety and efficacy of a Nav1.7 selective sodium channel blocker in patients with trigeminal neuralgia: a double-blind, placebo-controlled, randomised withdrawal phase 2A trial. Lancet Neurol. 2017;16:291–300.

    Article  CAS  Google Scholar 

  15. Nurmikko TJ, Elderidge PR. Trigeminal neuralgia-pathophysiology, diagnosis and current treatment. Br J Anaesth. 2001;87:117–32.

    Article  CAS  Google Scholar 

  16. Oturai AB, Jensen K, Erikson J, Marsden F. Neurosurgery for trigeminal neuralgia: comparison of alcohol block, neurectomy and radiofrequency coagulation. Clin J Pain. 1996;12:311–5.

    Article  CAS  Google Scholar 

  17. Zakrzewska JM, Nally FF. The role of cryotherapy (cryoanalgesia) in the management of paroxysmal trigeminal neuralgia: a six-year experience. Br J Oral Maxillofac Surg. 1988;26:18–25.

    Article  CAS  Google Scholar 

  18. Stefanoff V. Treatment of trigeminal neuralgia (TN) with local laser irradiation and laser puncture. Int J Oral Maxillofac Surg. 1990;19:379–80.

    Google Scholar 

  19. Samosiuk IZ, Kozhanova AK, Samosiuk NI. Physiopuncture therapy of trigeminal neuralgia. Vopr Kurortol Fizioter Lech Fiz Kult. 2000:29–32.

    Google Scholar 

  20. Scrivani SJ, Keith DA, Mathews ES, Kaban LB. Percutaneous stereotactic differential radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia. J Oral Maxillofac Surg. 1999;57:104–11.

    Article  CAS  Google Scholar 

  21. Hakansson S. Trigeminal neuralgia treated by the injection into the trigeminal cistern. Neurosurgery. 1981;9:638–46.

    Article  Google Scholar 

  22. Kouzounias K, Schechtmann G, Lind G, Winter J, Linderoth B. Factors that influence outcome of percutaneous balloon compression in the treatment of trigeminal neuralgia. Neurosurgery. 2010;67:925–34.

    Article  Google Scholar 

  23. Abdennebi B, Mahfouf L, Nedjahi T. Long-term results of percutaneous compression of the gasserian ganglion in trigeminal neuralgia. Stereotact Funct Neurosurg. 1997;68:190–5.

    Article  CAS  Google Scholar 

  24. Lichtor T, Mullan JF. A 10-year follow-up review of percutaneous micro-compression of the trigeminal ganglion. J Neurosurg. 1990;72:49–54.

    Article  CAS  Google Scholar 

  25. Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008;15:1013–28.

    Article  CAS  Google Scholar 

  26. Gu W, Zhao W. Microvascular decompression for recurrent trigeminal neuralgia. J Clin Neurosci. 2014;21:1549–53.

    Article  Google Scholar 

  27. Broggi G, Ferroli P, Franzini A, Servello D, Dones I. Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2000;68:59–64.

    Article  CAS  Google Scholar 

  28. Oesman C, Mooij JJ. Long-term follow-up of microvascular decompression for trigeminal neuralgia. Skull Base. 2011;21:313–22.

    Article  Google Scholar 

  29. Kondo A. Follow-up results of microvascular decompression in trigeminal neuralgia and hemifacial spasm. Neurosurgery. 1997;40:46–52.

    CAS  PubMed  Google Scholar 

  30. Jafree DJ, Williams AC, Zakrzewska JM. Impact of pain and postoperative complications on patient-reported outcome measures 5 years after microvascular decompression or partial sensory rhizotomy for trigeminal neuralgia. Acta Neurochir. 2018;160:125–34.

    Article  Google Scholar 

  31. Han JH, Kim DG, Chung HT, Paek SH, Kim YH, Kim CY, et al. Long-term outcome of gamma knife radiosurgery for treatment of typical trigeminal neuralgia. Int J Radiat Oncol Biol Phys. 2009;75:822–7.

    Article  Google Scholar 

  32. Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008;71:1183–90.

    Article  CAS  Google Scholar 

  33. Zakrzewska JM, Lopez BC, Kim SE, Coakham HB. Patient reports of satisfaction after microvascular decompression and partial sensory rhizotomy for trigeminal neuralgia. Neurosurgery. 2005;56:1304–11.

    Article  Google Scholar 

  34. Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir. 2008;150:243–55.

    Article  CAS  Google Scholar 

  35. Akram H, Mirza B, Kitchen N, Zakrzewska JM. Proposal for evaluating the quality of reports of surgical interventions in the treatment of trigeminal neuralgia: the surgical trigeminal neuralgia score. Neurosurg Focus. 2013;35:E3.

    Article  Google Scholar 

  36. Jie H, Xuanchen Z, Deheng L, Kun G, Fengyang X, Xiang C, et al. The long-term outcome of nerve combing for trigeminal neuralgia. Acta Neurochir. 2013;155:1703–8.

    Article  Google Scholar 

  37. Sessirisombat S. Carbon-dioxide laser in the treatment of trigeminal neuralgia: a preliminary study. J Interdiscipl Med Dent Sci. 2017;5:1–4.

    Article  Google Scholar 

  38. Fontaine D, Hamani C, Lozano A. Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature. J Neurosurg. 2009;110:251–6.

    Article  Google Scholar 

  39. Buchanan RJ, Darrow D, Monsivais D, Nadasdy Z, Gjini K. Motor cortex stimulation for neuropathic pain syndromes: a case series experience. Neuroreport. 2014;25:715–7.

    Article  Google Scholar 

  40. Lefaucheur JP, Drouot X, Menard-Lefaucheur I, Zerah F, Bendib B, Cesaro P, et al. Neurogenic pain relief by repetitive transcranial magnetic cortical stimulation depends on the origin and the site of pain. J Neurol Neurosurg Psychiatry. 2004;75:612–6.

    Article  Google Scholar 

  41. Khedr EM, Kotb H, Kamel NF, Ahmed MA, Sadek R, Rothwell JC. Long lasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain. J Neurol Neurosurg Psychiatry. 2005;76:833–8.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Anaesthesiologist and Interventional Pain Specialist, Virinchi Hospitals, Hyderabad, Telangana, India

    W. Umamaheshwara Rao

  2. Pain Management Centre, Virinchi Hospitals, Hyderabad, Telangana, India

    Muralidhar Joshi

Authors
  1. W. Umamaheshwara Rao
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  2. Muralidhar Joshi
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Editors and Affiliations

  1. Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India

    Girija Prasad Rath

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Umamaheshwara Rao, W., Joshi, M. (2019). Therapeutic Outcome and Future Scopes in the Management of Trigeminal Neuralgia. In: Rath, G. (eds) Handbook of Trigeminal Neuralgia. Springer, Singapore. https://doi.org/10.1007/978-981-13-2333-1_31

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  • DOI: https://doi.org/10.1007/978-981-13-2333-1_31

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-2332-4

  • Online ISBN: 978-981-13-2333-1

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