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trigeminal neuralgia treatment

Jong-In Kim, Hee-Jung Kim, Jung Ju Lee, Ji Hee Jun, Tae-Young Choi, Myeong Soo Lee
BACKGROUND: The ability of acupuncture to successfully control pain has been reported in the past. However, currently no systematic reviews exist regarding the effect of acupuncture on trigeminal neuralgia (TN). This proposed review aims to evaluate the current evidence on the efficacy of acupuncture for the management of pain in TN. METHODS: A total of 11 databases were searched from their inception. These include MEDLINE, AMED, EMBASE, the Cochrane Library, 6 Korean medical databases, and 1 Chinese Medical Database...
March 2018: Medicine (Baltimore)
M Marin-Gracia, D Cantero-Lozano, E Garces-Anton, A Lopez-Bravo, A Garrido-Fernandez, M P Navarro-Perez, S Santos-Lasaosa, M Garces-Redondo
INTRODUCTION: Lacosamide is an antiepileptic drug whose exact mechanism of action remains unknown. It acts by increasing the slow inactivation of the voltage-dependent sodium channels of the cell membranes. It is indicated in the treatment of focal seizures with or without secondary generalisation and is occasionally used as adjunct treatment in neuropathic pain. Although the most frequent side effects are mild (dizziness, diplopia, blurred vision, headache, tremor, etc.), others such as supraventricular tachyarrhythmias, changes in repolarisation, atrioventricular blocks and even cardiac arrest or sudden death have been reported...
March 16, 2018: Revista de Neurologia
Loraine Van Slyke, Mia Scott
HIV pre-exposure prophylaxis (PrEP) with emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) fixed-dose combination (FTC/TDF) is undergoing rapid scale-up in the United States. While FTC/TDF is typically well tolerated, to our knowledge, cranial nerve pathology associated with FTC/TDF has not been previously described. We report the case of a 35-year-old patient who began FTC/TDF PrEP and developed acute trigeminal neuralgia. The neurologic symptoms resolved after treatment discontinuation and recurred upon rechallenge, resulting in permanent discontinuation of PrEP treatment...
January 2018: Journal of the International Association of Providers of AIDS Care
L N Melek, M Devine, T Renton
Trigeminal neuralgia (TN) is characterized by sharp, electric shock-like pain, which can be triggered by trivial stimuli. Although medical and surgical treatments are available for TN, some patients experience refractory pain, which has a significant impact on their quality of life. The aim of this systematic review was to determine the psychosocial impact of orofacial pain in patients with diagnosed TN. A search was initiated in three electronic databases (Embase, MEDLINE, PubMed) to identify potential studies for inclusion in the review...
March 8, 2018: International Journal of Oral and Maxillofacial Surgery
Qian Du, Chi Zhang, Xiaofeng Zhu, Xiaoying Liang, Chi Zhang, Vivek Verma, Kenneth Follet, Shuo Wang, Qiyong Fan, Rongtao Ma, Sumin Zhou, Dandan Zheng
OBJECTIVES: To apply advanced statistical and computational methodology in evaluating the impact of anatomical and technical variables on normal tissue dosimetry of trigeminal neuralgia (TN) stereotactic radiosurgery (SRS). METHODS: Forty patients treated with LINAC-based TN SRS with 90 Gy maximum dose were randomly selected for the study. Parameters extracted from the treatment plans for the study included three dosimetric output variables: the maximum dose to the brainstem (BSmax), the volume of brainstem that received at least 10 Gy (V10BS), and the volume of normal brain that received at least 12 Gy (V12)...
March 9, 2018: Medical Physics
Min Wu, Xianming Fu, Ying Ji, Wanhai Ding, Dali Deng, Yehan Wang, Xiaofeng Jiang, Chaoshi Niu
BACKGROUND: Microvascular decompression (MVD) of the trigeminal nerve is the most effective treatment for trigeminal neuralgia (TN). However, when encountering with classical trigeminal neuralgia caused by venous compression, the procedure becomes much more difficult, and failure or recurrence due to incomplete decompression may become frequent. This study aimed to investigate the anatomical variation of the culprit veins, and discuss the surgical strategy for different types respectively...
March 3, 2018: World Neurosurgery
Jehad Zakaria, Michael Wemhoff, Douglas Anderson
Vascular compression of neural structures has long been established as an etiology for dysfunction of multiple cranial nerves. Classically, as is the case of trigeminal neuralgia, vascular compression by an offending artery and sometimes vein exerting pressure at the root entry zone of the trigeminal nerve can lead to the characteristic pain syndrome. In these cases, microvascular decompression is an effective, durable surgical intervention to relieve the neuralgia. In this report, we present a unique case of a patient with direct compression of the medulla oblongata by an arachnoid cyst and associated vascular loops, with subsequent resolution of the patient's symptoms following fenestration of cyst and microvascular decompression...
February 24, 2018: World Neurosurgery
John P Marinelli, Jamie J Van Gompel, Michael J Link, Matthew L Carlson
No abstract text is available yet for this article.
February 21, 2018: World Neurosurgery
Manjula Chandragomi Caldera, Sameera Jayan Senanayake, Sujith Priyankara Perera, Nadeeke Nidhan Perera, Ranjanie Gamage, Inuka Kishara Gooneratne
Introduction: The antinociceptive effect of botulinum toxin-A (BTX-A) in trigeminal neuralgia (TN) has been described. We evaluated effects of BTX-A in relieving pain in patients with refractory TN at National Hospital of Sri Lanka. Materials and Methods: Pain in patients with TN was assessed using a visual analog from 0 to 10. Three months after commencement of drug therapy with ≥2 drugs including one first-line drug (carbamazepine/oxcarbazepine), pain scores were re-assessed...
January 2018: Journal of Neurosciences in Rural Practice
Ma Kai, Li Yongjie
BACKGROUND: It is difficult to differentiate patients with cerebellopontine angle (CPA) cholesteatoma and patients with primary trigeminal neuralgia(TN) just according to early symptoms. We aimed to explore the clinical characteristics, early diagnosis and microneurosurgical techniques for CPA cholesteatoma presented as trigeminal neuralgia. METHODS: The data of 26 patients who complained trigeminal neuralgia with cerebellopontine angle cholesteatoma between January 2009 and December 2015 were collected and studied retrospectively, they were diagnosed by MRI preoperatively and confirmed by pathology postoperatively...
February 15, 2018: World Neurosurgery
Michael Zhang, Layton A Lamsam, Matthew K Schoen, Swapnil S Mehta, Geoffrey Appelboom, John K Adler, Scott G Soltys, Steven D Chang
INTRODUCTION: CyberKnife stereotactic radiosurgery (SRS) for trigeminal neuralgia (TGN) administers non-isometric, conformational high-dose radiation to the trigeminal nerve with risk of subsequent hypoesthesia. METHODS: We performed a retrospective, single-institution review of 66 TGN patients, treated by CyberKnife, to compare outcomes from two distinct treatment periods (standard dosing, N = 38 and reduced dosing, N = 28). Standard and reduced dosing permitted a maximum brainstem dose of 45 Gy and 25 Gy, respectively, each with a prescription dose of 60 Gy...
February 14, 2018: World Neurosurgery
Saleem I Abdulrauf, Jorge F Urquiaga, Ritesh Patel, J Andrew Albers, Varun B Sampat, Meghan Baumer, Eric Marvin, Matthew Pierson, Raquel Kragel, Jodi Walsh
OBJECTIVE: The option of performing MVD under awake anesthesia protocol ("awake" MVD) was examined in this initial series to assess whether intraoperative pain evaluation can identify and mitigate insufficient decompression of the trigeminal nerve, improving surgical outcomes. Additionally, "awake" MVD could expand procedure indications for those with comorbidities that would prohibit general endotracheal anesthesia (GEA). METHODS: An IRB-approved prospective study of 10 consecutive adults who underwent MVD for TN was conducted...
February 13, 2018: World Neurosurgery
Joanna M Zakrzewska, Ning Wu, John Y K Lee, Brian Werneburg, Deborah Hoffman, Ying Liu
BACKGROUND AND AIM: Trigeminal neuralgia (TN) is a rare orofacial disorder characterized by severe unilateral paroxysmal pain in the region of the fifth cranial nerve. Clinical guidelines recommend carbamazepine (only US Food and Drug Administration-approved drug for TN) and oxcarbazepine as first-line therapies. We utilized the US Truven Health MarketScan database to examine treatment patterns among patients with TN. METHODS: Included patients were aged ≥18 years, newly diagnosed with TN (≥2 TN diagnoses ≥14 days apart; no diagnosis in the prior year), continuously enrolled 1 year pre-index, with ≥3 years' follow-up post-index...
February 19, 2018: Clinical Journal of Pain
Stefanie Rehm, Moritz Groβkopf, Maria Kabelitz, Thomas Keller, Rainer Freynhagen, Thomas R Tölle, Ralf Baron
Introduction: Animal experimental evidence suggests that mechanisms of pain generation and response to treatment differ between neuropathic pain in the cephalic and the extracephalic innervation territories. Objectives: The objective of the study was to examine whether in humans an identical peripheral painful neuropathy is associated with different pain qualities and sensory abnormalities in the face as compared with the thoracic region. Methods: We retrospectively analysed epidemiological and clinical data of 639 patients with postherpetic neuralgia (PHN) in the face and at the trunk who were collected within a cross-sectional cohort survey and compared the respective sensory symptom profiles captured with the painDETECT questionnaire...
January 2018: Pain Reports (Baltimore, Md.)
Jian-Xiong An, Hui Liu, Ruo-Wen Chen, Yong Wang, Wen-Xing Zhao, Derek Eastwood, John P Williams
Objective: The aim of this study was to evaluate the therapeutic effect of computed tomography (CT)-guided percutaneous ozone injection for refractory trigeminal neuralgia. Design: A retrospective evaluation was performed in the study. Setting: The study was conducted at a university hospital pain center. Patients and methods: A total of 29 patients with a clinical diagnosis of refractory trigeminal neuralgia were enrolled...
2018: Journal of Pain Research
Audrey M Selecman, Swati A Ahuja
An ill-fitting complete denture has the potential to create pain and discomfort as well as conceal or confound the diagnosis of other primary sources of orofacial pain such as trigeminal neuralgia. Guidelines of the American Academy of Orofacial Pain offer an evidence-based approach for the assessment, diagnosis, and management of orofacial pain. A complete and accurate differential diagnosis is paramount to the success of treatment as well as to the circumvention of unnecessary therapy. The purpose of this clinical report was to emphasize an evidence-based approach to the diagnosis and treatment of orofacial pain in a patient with edentulism and a history of prolonged denture wear...
February 8, 2018: Journal of Prosthetic Dentistry
Ronak H Jani, Marion A Hughes, Michael S Gold, Barton F Branstetter, Zachary E Ligus, Raymond F Sekula
BACKGROUND: While high-resolution imaging is increasingly used in guiding decisions about surgical interventions for the treatment of trigeminal neuralgia, direct assessment of the extent of vascular contact of the trigeminal nerve is still considered the gold standard for the determination of whether nerve decompression is warranted. OBJECTIVE: To compare intraoperative and magnetic resonance imaging (MRI) findings of the prevalence and severity of vascular compression of the trigeminal nerve in patients without classical trigeminal neuralgia...
February 6, 2018: Neurosurgery
M K Hamad, K He, H F Abdulrazeq, A M Mustafa, J Nakhla, M M Herzallah, A Mammis
Neuropathic pain is a subset of chronic pain that is caused by neurons that are damaged or firing aberrantly in the peripheral or central nervous systems. The treatment guidelines for neuropathic pain include antidepressants, calcium channel α 2 delta ligands, topical therapy, and opioids as a second line option. Unfortunately, pharmacotherapy has not been effective in the treatment of neuropathic pain except in the treatment of trigeminal neuralgia with carbamazepine. The inability to properly treat neuropathic pain causes frustration in both the patients and their treating physicians...
February 5, 2018: World Neurosurgery
Thien Nguyen, Courtney Duong, John P Sheppard, Seung Jin Lee, Amar U Kishan, Percy Lee, Stephen Tenn, Robert Chin, Tania B Kaprealian, Isaac Yang
Vestibular schwannomas (VS) are benign tumors stemming from the eighth cranial nerve. Treatment options for VS include conservative management, microsurgery, stereotactic radiosurgery, and fractionated radiotherapy. Though microsurgery has been the standard of care for larger lesions, hypo-fractionated stereotactic radiotherapy (hypo-FSRT) is an emerging modality. However, its clinical efficacy and safety have yet to be established. We conducted a systematic review and meta-analysis of manuscripts indexed in PubMed, Scopus, Web of Science, Embase, and Cochrane databases reporting outcomes of VS cases treated with hypo-FSRT...
March 2018: Clinical Neurology and Neurosurgery
Yanyang Zhang, Zhiqi Mao, Cui Zhiqiang, Zhipei Ling, Longsheng Pan, Xinyun Liu, Jun Zhang, Xinguang Yu
Trigeminal neuralgia (TN) is commonly associated with pathological factors of axonopathy and demyelination resulting from neurovascular compression at the trigeminal root entry zone (REZ). Decompression surgery can relieve TN pain, likely by resolving such structural abnormalities. To test this hypothesis, we used diffusion tensor imaging (DTI) to capture the full extent of trigeminal microarchitecture changes in vivo in TN patients. Twenty-four TN patients were compared to 28 controls. DTI metrics of fractional anisotropy (FA) as well as mean, parallel, and perpendicular diffusivities (MD,λǁ, and λ⊥, respectively) were calculated in isolation at each trigeminal REZ...
February 1, 2018: World Neurosurgery
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