Gronseth G, Cruccu G, Alksne J, 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.71(15):1183-1190

American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN55116, USA.
Neurology (Impact Factor: 8.29). 09/2008; 71(15):1183-90. DOI: 10.1212/01.wnl.0000326598.83183.04
Source: PubMed


Trigeminal neuralgia (TN) is a common cause of facial pain.
To answer the following questions: 1) In patients with TN, how often does routine neuroimaging (CT, MRI) identify a cause? 2) Which features identify patients at increased risk for symptomatic TN (STN; i.e., a structural cause such as a tumor)? 3) Does high-resolution MRI accurately identify patients with neurovascular compression? 4) Which drugs effectively treat classic and symptomatic trigeminal neuralgia? 5) When should surgery be offered? 6) Which surgical technique gives the longest pain-free period with the fewest complications and good quality of life?
Systematic review of the literature by a panel of experts.
In patients with trigeminal neuralgia (TN), routine head imaging identifies structural causes in up to 15% of patients and may be considered useful (Level C). Trigeminal sensory deficits, bilateral involvement of the trigeminal nerve, and abnormal trigeminal reflexes are associated with an increased risk of symptomatic TN (STN) and should be considered useful in distinguishing STN from classic trigeminal neuralgia (Level B). There is insufficient evidence to support or refute the usefulness of MRI to identify neurovascular compression of the trigeminal nerve (Level U). Carbamazepine (Level A) or oxcarbazepine (Level B) should be offered for pain control while baclofen and lamotrigine (Level C) may be considered useful. For patients with TN refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma knife, and microvascular decompression may be considered (Level C). The role of surgery vs pharmacotherapy in the management of TN in patients with MS remains uncertain.

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    • "Blockade or destruction of portions of trigeminal nerve distal to the Gasserian ganglion is a well‑demonstrated procedure to manage neuralgic pain in the distribution of the nerve. [1,2] Mandibular nerve block with alcohol is a frequently implemented procedure customarily in an outpatient context with minimal monitoring to treat trigeminal neuralgia with predominant pain in mandibular region. [3] This procedure is periodically used and is generally considered a safe procedure resulting in desiderata pain control. "
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    • "The changes include abnormalities in the relationship between opposing teeth, and the function of the muscles of the frontal and medial part of the skull and neck, working in a symmetrical manner in physiological conditions of the temporomandibular joints. Increasing stress levels lead to intensification of adverse motion habits within the stomatognathic system and the rapid increase in the number of patients observed in recent years is associated with the drop in the age of patients with dysfunctions manifested with pain symptoms [14, 15, 17, 18]. "
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    • "In our series, only one case demonstrated vascular compression on high resolution MRI imaging. Indeed, Burchiel et al. demonstrated that the negative predictive value of high resolution MR imaging makes it difficult to utilize preoperative imaging as a tool to justify routine use of imaging as a determinant of whether to perform surgery or not [6]. All patients were consented and informed that glycerol rhizotomy would be performed during the microvascular decompression regardless of the intraoperative findings. "
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