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.
References
References
