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Trigeminal Neuralgia: Etiology, Diagnosis, and Treatment

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Abstract

Trigeminal neuralgia (TN), the most common of the facial neuralgias, is an extremely debilitating disorder that is characterized by severe electric shock-like neuropathic pain that is localized to one or more branches of the trigeminal nerve. It can have a serious impact on an individual’s life and is often first encountered by dentists and general practitioners. Although a treatable and usually manageable condition, appropriate diagnosis remains a factor that plagues this disease. The objective of this article is to summarize the current literature surrounding the classification, epidemiology, presentation, and pathophysiology of TN while also including the current and evidence-based knowledge on the diagnosis and treatment options. It provides a baseline from which dental and medical colleagues alike can help manage patients suffering from this devastating neuralgia.

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References

  1. Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, di Stefano G, Donnet A, et al. European academy of neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019;26(6):831–49. https://doi.org/10.1111/ene.13950.

    Article  CAS  PubMed  Google Scholar 

  2. Turton M, Malan-Roux P. Trigeminal neuralgia: case report and literature review. Stomatological Disease and Science. 2019;3(7):1–10. https://doi.org/10.20517/2573-0002.2019.08.

    Article  Google Scholar 

  3. Khan M, Nishi SE, Hassan SN, Islam MA, Gan SH. Trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome: an update. Pain Research and Management. 2017;2017:1–18. https://doi.org/10.1155/2017/7438326.

    Article  Google Scholar 

  4. Mahtani AA, Sehtu G. Review on Trigeminal Neuralgia Review on trigeminal neuralgia. 2016;8(6):570–574.

  5. Haller S, Etienne L, Ko Vari E, Varoquaux AD, Urbach H, Becker M. Imaging of neurovascular compression syndromes: trigeminal neuralgia, hemifacial spasm, vestibular paroxysmia, and glossopharyngeal neuralgia. Am J Neuroradiol. 2016;37(8):1384–92. https://doi.org/10.3174/ajnr.a4683.

    Article  CAS  PubMed  Google Scholar 

  6. Leclercq D, Thiebaut J-B, Héran F. Trigeminal neuralgia. Diagnostic and Interventional Imaging. 2013;94(10):993–1001. https://doi.org/10.1016/j.diii.2013.08.002.

    Article  CAS  PubMed  Google Scholar 

  7. Voiticovschi-Iosob CD, Allena MD, Cillis ID, Nappi GD, Sjaastad OD, Antonaci FD. Diagnostic and therapeutic errors in cluster headache: a hospital-based study. The Journal of Headache and Pain. 2014;15(1):1–6. https://doi.org/10.1186/1129-2377-15-56.

    Article  Google Scholar 

  8. Antonaci FD, Arceri SC, Mundefined R, et al. Pitfalls in recognition and management of trigeminal neuralgia. The Journal of Headache and Pain. 2020;21(1):1–8. https://doi.org/10.1186/s10194-020-01149-8.

    Article  Google Scholar 

  9. Majeed MH, Arooj S, Khokhar MA, Mirza T, Ali AA, Bajwa ZH. Trigeminal neuralgia: a clinical review for the general physician. Cureus. 2018;10(12):1–8. https://doi.org/10.7759/cureus.3750.

    Article  Google Scholar 

  10. Zakrzewska J. Differential diagnosis of facial pain and guidelines for management. Br J Anaesth 2013;111(1):95–104. doi:https://doi.org/10.1093/bja/aet125.

  11. Yoo J-H, Oh J-H, Kang S-H, Kim J-B. Management of traumatic neuralgia in a patient with the extracted teeth and alveoloplasty: a case report. Journal of Dental Anesthesia and Pain Medicine. 2015;15(4):241–5. https://doi.org/10.17245/jdapm.2015.15.4.241.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yamazaki Y, Sakamoto M, Imura H, Shimada M. Pre-trigeminal neuralgia similar to atypical odontalgia: a case report. Journal of Pain & Relief. 2017;06(03):1–3. https://doi.org/10.4172/2167-0846.1000291.

    Article  Google Scholar 

  13. Scholz JB, Finnerup NI, Attal ND, Aziz Q, Baron R, Bennett MI, et al. The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. Pain. 2019;160(1):53–9. https://doi.org/10.1097/j.pain.0000000000001365.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211. doi:https://doi.org/10.1177/0333102417738202

  15. Montano NN, Conforti G, Bonaventura RD, Meglio M, Fernandez E, Papacci F. Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag. 2015;11:289–99. https://doi.org/10.2147/tcrm.s37592.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Maarbjerg S, Stefano GD, Bendtsen L, Cruccu G. Trigeminal neuralgia – diagnosis and treatment. Cephalalgia. 2017;37(7):648–57. https://doi.org/10.1177/0333102416687280.

    Article  PubMed  Google Scholar 

  17. Mueller D, Obermann M, Yoon M-S, Poitz F, Hansen N, Slomke MA, et al. Prevalence of trigeminal neuralgia and persistent idiopathic facial pain: a population-based study. Cephalalgia. 2011;31(15):1542–8. https://doi.org/10.1177/0333102411424619.

    Article  PubMed  Google Scholar 

  18. Katusic S, Beard CM, Bergstralth E, Kurland LT. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. Ann Neurol. 1990;27(1):89–95. https://doi.org/10.1002/ana.410270114.

    Article  CAS  PubMed  Google Scholar 

  19. Hall GC, Carroll D, Parry D, Mcquay HJ. Epidemiology and treatment of neuropathic pain: the UK primary care perspective. Pain. 2006;122(1):156–62. https://doi.org/10.1016/j.pain.2006.01.030.

    Article  PubMed  Google Scholar 

  20. Dieleman JP, Kerklaan J, Huygen FJ, Bouma PA, Sturkenboom MC. Incidence rates and treatment of neuropathic pain conditions in the general population. Pain. 2008;137(3):681–8. https://doi.org/10.1016/j.pain.2008.03.002.

    Article  PubMed  Google Scholar 

  21. Toledo IPD, Réus JC, Fernandes M, et al. Prevalence of trigeminal neuralgia. The Journal of the American Dental Association. 2016;147(7):570–6. https://doi.org/10.1016/j.adaj.2016.02.014.

    Article  PubMed  Google Scholar 

  22. Bennetto L, Patel NK, Fuller G. Trigeminal neuralgia and its management. BMJ. 2007;334:201–5. https://doi.org/10.1136/bmj.39085.614792.be.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Koopman JS, Dieleman JP, Huygen FJ, Mos MD, Martin CG, Sturkenboom MC. Incidence of facial pain in the general population. Pain. 2009;147:122–7. https://doi.org/10.1016/j.pain.2009.08.023.

    Article  PubMed  Google Scholar 

  24. Sabalys G, Juodzbalys G, Wang H-L. Aetiology and pathogenesis of trigeminal neuralgia: a comprehensive review. Journal of Oral and Maxillofacial Research. 2012;3(4):1–12. https://doi.org/10.5037/jomr.2012.3402.

    Article  Google Scholar 

  25. McMillan R. Trigeminal neuralgia—a debilitating facial pain. Reviews in Pain. 2011;5(1):26–34. https://doi.org/10.1177/204946371100500105.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mistry AM, Niesner KJ, Lake WB, Forbes JA, Shannon CN, Kasl RA, et al. Neurovascular compression at the root entry zone correlates with trigeminal neuralgia and early microvascular decompression outcome. World Neurosurgery. 2016;95:208–13. https://doi.org/10.1016/j.wneu.2016.08.040.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Peker S, Kurtkaya Ö, Üzün I, Pamir MN. Microanatomy of the central myelin-peripheral myelin transition zone of the trigeminal nerve. Neurosurgery. 2006;59(2):354–9. https://doi.org/10.1227/01.neu.0000223501.27220.69.

    Article  PubMed  Google Scholar 

  28. Maarbjerg S, Wolfram F, Gozalov A, Olesen J, Bendtsen L. Significance of neurovascular contact in classical trigeminal neuralgia. Brain. 2014;138(2):311–9. https://doi.org/10.1093/brain/awu349.

    Article  PubMed  Google Scholar 

  29. Antonini G, Pasquale AD, Cruccu G, et al. Magnetic resonance imaging contribution for diagnosing symptomatic neurovascular contact in classical trigeminal neuralgia: a blinded case-control study and meta-analysis. Pain. 2014;155:1464–71. https://doi.org/10.1016/j.pain.2014.04.020.

    Article  PubMed  Google Scholar 

  30. Lutz J, Thon N, Stahl R, Lummel N, Tonn JC, Linn J, et al. Microstructural alterations in trigeminal neuralgia determined by diffusion tensor imaging are independent of symptom duration, severity, and type of neurovascular conflict. J Neurosurg. 2016;124(3):823–30. https://doi.org/10.3171/2015.2.jns142587.

    Article  PubMed  Google Scholar 

  31. Toda K. Etiology of trigeminal neuralgia. Oral Science International. 2007;4(1):10–8. https://doi.org/10.1016/s1348-8643(07)80007-3.

    Article  Google Scholar 

  32. Maarbjerg S, Gozalov A, Olesen J, Bendtsen L. Trigeminal neuralgia - a prospective systematic study of clinical characteristics in 158 patients. Headache: The Journal of Head and Face Pain. 2014;54(10):1574–82. https://doi.org/10.1111/head.12441.

    Article  Google Scholar 

  33. Srivastava R, Jyoti B, Shukla A, Priyadarshi P. Diagnostic criteria and management of trigeminal neuralgia: a review. Asian Pacific Journal of Health Sciences. 2015;2(1):108–18. https://doi.org/10.21276/apjhs.2015.2.1.20.

    Article  Google Scholar 

  34. Zakrzewska JM, Linskey ME. Trigeminal neuralgia. Bmj. 2015;350:1–3. https://doi.org/10.1136/bmj.h1238.

    Article  Google Scholar 

  35. Santos MM, Freire AR, Rossi AC, Pradi FB, Caria PHF, Botacin PR. Trigeminal neuralgia: literature review. Journal of Morphological Sciences. 2013;30(1):1–5.

    Google Scholar 

  36. Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, et al. Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology. 2016;87(2):220–8. https://doi.org/10.1212/wnl.0000000000002840.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Carbamazepine. In: Lexi-Drugs. Wolters Kluwer Clinical Drug Information, Inc. [Updated May 26 2020; Accessed May 26 2020].

  38. Oxcarbazepine. In: Lexi-Drugs. Wolters Kluwer Clinical Drug Information, Inc. [Updated May 15, 2020; Accessed May 26, 2020].

  39. Lamotrigine. In: Lexi-Drugs. Wolters Kluwer Clinical Drug Information, Inc. [Updated May 23 2020; Accessed May 26, 2020].

  40. Gabapentin. In: Lexi-Drugs. Wolters Kluwer Clinical Drug Information, Inc. [Updated May 26, 2020; Accessed May 26, 2020].

  41. Baclofen. In: Lexi-Drugs. Wolters Kluwer Clinical Drug Information, Inc. [Updated May 26, 2020; Accessed May 26, 2020].

  42. Tuleasca C, Régis J, Sahgal A, de Salles A, Hayashi M, Ma L, et al. Stereotactic radiosurgery for trigeminal neuralgia: a systematic review. J Neurosurg. 2019;130(3):733–57. https://doi.org/10.3171/2017.9.jns17545.

    Article  Google Scholar 

  43. Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008;15(10):1013–28. https://doi.org/10.1111/j.1468-1331.2008.02185.x.

    Article  CAS  PubMed  Google Scholar 

  44. Wiffen PJ, Derry S, Moore RA, Mcquay HJ. Carbamazepine for acute and chronic pain in adults. Cochrane Database Syst Rev. 2011:1–40. https://doi.org/10.1002/14651858.cd005451.pub2.

  45. Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, 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. 2008;71(15):1183–90. https://doi.org/10.1212/01.wnl.0000326598.83183.04.

    Article  CAS  PubMed  Google Scholar 

  46. Han KR, Kim C, Chae YJ, Kim DW. Efficacy and safety of high concentration lidocaine for trigeminal nerve block in patients with trigeminal neuralgia. Int J Clin Pract. 2008;62(2):248–54. https://doi.org/10.1111/j.1742-1241.2007.01568.x.

    Article  CAS  PubMed  Google Scholar 

  47. Zhang H, Lian Y, Ma Y, et al. Two doses of botulinum toxin type A for the treatment of trigeminal neuralgia: observation of therapeutic effect from a randomized, double-blind, placebo-controlled trial. The Journal of Headache and Pain. 2014;15(1). https://doi.org/10.1186/1129-2377-15-65.

  48. Morra ME, Elgebaly A, Elmaraezy A, Khalil AM, Altibi AMA, Vu TLH, et al. Therapeutic efficacy and safety of botulinum toxin A therapy in trigeminal neuralgia: a systematic review and meta-analysis of randomized controlled trials. The Journal of Headache and Pain. 2016;17(63):1–9. https://doi.org/10.1186/s10194-016-0651-8.

    Article  CAS  Google Scholar 

  49. Oesman C, Mooij JJ. Long-term follow-up of microvascular decompression for trigeminal neuralgia. Skull Base. 2011;21(05):313–22. https://doi.org/10.1055/s-0031-1284213.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Burchiel KJ. Trigeminal neuralgia. Neurosurgery. 2016;63(1):52–5. https://doi.org/10.1227/neu.0000000000001276.

    Article  PubMed  Google Scholar 

  51. Kodeeswaran M, Ramesh V, Saravanan N, Udesh R. Percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia: a simple, safe, cost-effective procedure. Neurol India. 2015;63(6):889–94. https://doi.org/10.4103/0028-3886.170103.

    Article  CAS  PubMed  Google Scholar 

  52. Asplund P, Blomstedt P, Bergenheim AT. Percutaneous balloon compression vs percutaneous retrogasserian glycerol Rhizotomy for the primary treatment of trigeminal neuralgia. Neurosurgery. 2015;78(3):421–8. https://doi.org/10.1227/neu.0000000000001059.

    Article  PubMed Central  Google Scholar 

  53. Tang Y, Ma L, Li N, Guo Y, Yang L, Wu B, et al. Percutaneous trigeminal ganglion radiofrequency thermocoagulation alleviates anxiety and depression disorders in patients with classic trigeminal neuralgia. Medicine. 2016;95(49):1–5. https://doi.org/10.1097/md.0000000000005379.

    Article  Google Scholar 

  54. Zakrzewska JM, Linskey ME. Trigeminal neuralgia. Bmj. 2014;10(1207):1–18. https://doi.org/10.1136/bmj.g474.

    Article  Google Scholar 

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Correspondence to Aviv Ouanounou.

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Silva, M., Ouanounou, A. Trigeminal Neuralgia: Etiology, Diagnosis, and Treatment. SN Compr. Clin. Med. 2, 1585–1592 (2020). https://doi.org/10.1007/s42399-020-00415-9

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