Trigeminal Neuralgia

This article delves into Trigeminal Neuralgia (TN), a condition characterized by recurrent episodes of unilateral electric shock-like pain in the distribution of the trigeminal nerve. It outlines the triggers, clinical presentation, and the importance of brain MRI for diagnosis. The article discusses various pharmacological therapies, including carbamazepine, oxcarbazepine, gabapentin, and lamotrigine, as well as adjunctive therapies like baclofen and pimozole. The role of intravenous rescue therapies and the potential for surgical intervention in refractory cases are also explored.

Clinical Presentation and Diagnosis of Trigeminal Neuralgia

TN is characterized by brief episodes of unilateral electric shock-like pain, triggered by stimuli from the oral cavity, paranasal sinus, or everyday activities like chewing or smiling. Brain MRI is essential to rule out neurovascular compression or structural brain lesions.

Pharmacological Therapy for Trigeminal Neuralgia

The first-line treatment for TN includes carbamazepine or oxcarbazepine. For patients not responding to initial treatment, gabapentin or lamotrigine may be beneficial. Baclofen and pimozole serve as adjunctive therapies.

Rescue Therapy and Medication Weaning

Intravenous infusions of lidocaine or fosphenytoin can provide analgesia during acute exacerbations. After disease control, gradual withdrawal of medications is recommended, with a slow tapering schedule.

Surgical Therapy for Refractory Trigeminal Neuralgia

In cases refractory to medical therapy, surgical options like microvascular decompression, various types of rhizotomy, or gamma knife radiosurgery are considered.

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