Recommendations for the management of trigeminal neuralgia

  • Bendtsen L & al.
  • Eur J Neurol
  • 12 Mar 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • The European Academy of Neurology updated recommendations for the management of patients with trigeminal neuralgia (TN).

Key recommendations

  • Diagnosis
    • MRI along with a combination of 3 high-resolution sequences should be performed in all patients to exclude secondary causes of TN.
    • MRI is strongly recommended as part of work up in patients with TN.
    • When MRI is not possible, trigeminal reflexes should be used to distinguish secondary TN from primary TN.
    • Demonstration of neurovascular contact should not be used to confirm the diagnosis of TN; it may help to decide to refer a patient for microvascular decompression (MVD).
  • Pharmacological Treatment
    • Intravenous fosphenytoin or lidocaine may be used in patients with acute exacerbations of pain.
    • Carbamazepine or oxcarbazepine is recommended for long-term treatment of TN.
    • Lamotrigine, gabapentin, botolinum toxin type A, pregabalin, baclofen and phenytoin may be used either alone or as add-on therapy.
  • Surgical Treatment
    • If pain is not tolerable or medical management is not able to control pain, surgery can be considered.
    • No preference can be given between any neuroablative treatments or between them and MVD.
    • Neuroablative treatments should be the preferred choice if any neurovascular contact is not present in MRI.
  • Management of secondary TN and non-pharmacological and non-surgical management of TN.
    • Medical treatment of patients with secondary TN should be similar to those with primary TN. Surgical interventions should consider Gasserian ganglion procedures and MVD.
    • Patients should be offered psychological and nursing support.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit