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AAN-EFNS guidelines on trigeminal neuralgia management
Open accessAbstract
Several issues regarding diagnosis, pharmacological treatment, and surgical treatment of trigeminal neuralgia (TN) are still unsettled. The American Academy of Neurology and the European Federation of Neurological Societies launched a joint Task Force to prepare general guidelines for the management of this condition. After systematic review of the literature the Task Force came to a series of evidence‐based recommendations. In patients with TN MRI may be considered to identify patients with structural causes. The presence of trigeminal sensory deficits, bilateral involvement, and abnormal trigeminal reflexes should be considered useful to disclose symptomatic TN, whereas younger age of onset, involvement of the first division, unresponsiveness to treatment and abnormal trigeminal evoked potentials are not useful in distinguishing symptomatic from classic TN. Carbamazepine (stronger evidence) or oxcarbazepine (better tolerability) should be offered as first‐line treatment for pain control. For patients with TN refractory to medical therapy early surgical therapy may be considered. Gasserian ganglion percutaneous techniques, gamma knife and microvascular decompression may be considered. Microvascular decompression may be considered over other surgical techniques to provide the longest duration of pain freedom. The role of surgery versus pharmacotherapy in the management of TN in patients with multiple sclerosis remains uncertain.
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“Of note, studies of less than 3 weeks’ duration found efficacy of 5% lidocaine patch.24”
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“In accordance with previous reports24 results of our meta-analysis show that the efficacy of systemic drug treatments is generally not dependent on the aetiology of the underlying disorder (appendix 4).”
From Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis (2015) · cites this paper as [24]
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Metadata
- Authors
- Cruccu, G., Gronseth, G., Alksne, J., Argoff, C., Brainin, M., Burchiel, K., Nurmikko, T., & Zakrzewska, J. M.
- Affiliations
- Sapienza University of Rome (IT)
- University of Kansas (US)
- University of California San Diego (US)
- North Shore University Hospital (US)
- Universität für Weiterbildung Krems (AT)
- Oregon Health & Science University (US)
- University of Liverpool (GB)
- Eastman Dental Hospital (GB)
- Corresponding author
- Cruccu, G.
- Venue
- European Journal of Neurology
- Publisher
- Wiley
- Published
- 2008-09-05
- Volume
- 15
- Issue
- 10
- Pages
- 1013-1028
- ISSN
- 1351-5101 (ISSN-L)
- 1468-1331
- OpenAlex
- W2066791546
- Cited by
- 726
- References
- 92
- Citations by year
- 2026: 20 · 2025: 27 · 2024: 41 · 2023: 49 · 2022: 51 · 2021: 55 · 2020: 54 · 2019: 58 · 2018: 51 · 2017: 52 · 2016: 40 · 2015: 38 · 2014: 47 · 2013: 32 · 2012: 29
- FWCI
- 19.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Neurology (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Trigeminal Neuralgia and Treatments
- Health Sciences › Dentistry › Oral Surgery › Temporomandibular Joint Disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- trigeminal neuralgia, diagnosis, carbamazepine, oxcarbazepine, microvascular decompression, gamma knife radiosurgery, surgical treatment, refractory trigeminal neuralgia, multiple sclerosis, trigeminal evoked potentials, pain management
- MeSH terms
- Oxcarbazepine, Adolescent, Adult, Aged, Aged, 80 and over, Analgesics, Anticonvulsants, Carbamazepine, Child, Child, Preschool, Combined Modality Therapy, Diagnostic Imaging, Double-Blind Method, Female, Humans, Male, Middle Aged, Trigeminal Ganglion, Sensitivity and Specificity, Trigeminal Neuralgia, Randomized Controlled Trials as Topic, Radiosurgery, Decompression, Surgical, Evidence-Based Medicine, Disease Management
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