AAN‐EFNS guidelines on trigeminal neuralgia management |
| |
| Authors: | G Cruccu G Gronseth J Alksne C Argoff M Brainin K Burchiel T Nurmikko J M Zakrzewska |
| |
| Institution: | 1. Department of Neurological Sciences, La Sapienza University, Rome, Italy;2. Department of Neurology, University of Kansas, Kansas City, USA;3. Division of Neurosurgery, School of Medicine, University of California, San Diego, USA;4. New York University School of Medicine and Cohn Pain Management Center, North Shore University Hospital, Manhasset, USA;5. Clinical Neurosciences, Department of Clinical Medicine and Prevention, Donau‐Universit?t Krems, Krems, Austria;6. Department of Neurological Surgery, Oregon Health & Science University, Portland, USA;7. Pain Research Institute, Division of Neurological Science, School of Clinical Sciences, University of Liverpool, Liverpool, UK;8. University College London Hospitals Eastman Dental Hospital, London, UK |
| |
| Abstract: | 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 structural causes. The presence of trigeminal sensory deficits, bilateral involvement, and abnormal trigeminal reflexes should be considered useful to disclose symptomatic TN, whereas younger age of onset, involvement of the first division, unresponsiveness to treatment and abnormal trigeminal evoked potentials are not useful in distinguishing symptomatic from classic TN. Carbamazepine (stronger evidence) or oxcarbazepine (better tolerability) should be offered as first‐line treatment for pain control. For patients with TN refractory to medical therapy early surgical therapy may be considered. Gasserian ganglion percutaneous techniques, gamma knife and microvascular decompression may be considered. Microvascular decompression may be considered over other surgical techniques to provide the longest duration of pain freedom. The role of surgery versus pharmacotherapy in the management of TN in patients with multiple sclerosis remains uncertain. |
| |
| Keywords: | trigeminal neuralgia diagnosis neurovascular contact MRI trigeminal reflex treatment antiepileptic drugs Gasserian ganglion surgery microvascular decompression gamma knife |
|
|
