Abstract
The treatment of classical trigeminal neuralgia (TGN) has traditionally revolved around the use of antiepileptic drugs (AEDs), and surgery in drug-refractory cases. Both techniques have variable degrees of success and recurrence is a common theme in many patients. Further, pharmacotherapy and surgery are not devoid of adverse effects or complications. There are also some studies that show good results with other techniques, like ablative procedures [1] and botulinum injections [2], but there are wide differences in their applications, dosing protocols, long-term efficacy, and overall acceptance across various institutes. Neuromodulation is an exciting prospect that utilizes advanced technologies using electrical or chemical methods, targeting either neural stimulation or inhibition, in order to restore normal neurological function. Neuromodulation techniques to treat TGN is still in its nascent stages, with considerable room to evolve and improve. However, there are promising results from some preliminary studies. A broad classification scheme of various neuromodulation techniques is presented in Table 1.
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Udupi BP, Chouhan RS, Dash HH, Bithal PK, Prabhakar H. Comparative evaluation of percutaneous retrogasserian glycerol rhizolysis and radiofrequency thermocoagulation techniques in the management of trigeminal neuralgia. Neurosurgery. 2012;70:407–12; discussion 12–3
Bohluli B, Motamedi MH, Bagheri SC, Bayat M, Lassemi E, Navi F, et al. Use of botulinum toxin A for drug-refractory trigeminal neuralgia: preliminary report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111:47–50.
Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. Lancet. 1985;1:1106–7.
Cantello R. Applications of transcranial magnetic stimulation in movement disorders. J Clin Neurophysiol. 2002;19:272–93.
Lipton RB, Dodick DW, Silberstein SD, Saper JR, Aurora SK, Pearlman SH, et al. Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomised, double-blind, parallel-group, sham-controlled trial. Lancet Neurol. 2010;9:373–80.
Lefaucheur JP, Drouot X, Nguyen JP. Interventional neurophysiology for pain control: duration of pain relief following repetitive transcranial magnetic stimulation of the motor cortex. Neurophysiol Clin. 2001;31:247–52.
Khedr EM, Kotb H, Kamel NF, Ahmed MA, Sadek R, Rothwell JC. Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain. J Neurol Neurosurg Psychiatry. 2005;76:833–8.
Zaghi S, DaSilva AF, Acar M, Lopes M, Fregni F. One-year rTMS treatment for refractory trigeminal neuralgia. J Pain Symptom Manage. 2009;38:e1–5.
Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Chronic motor cortex stimulation for the treatment of central pain. Acta Neurochir Suppl (Wien). 1991;52:137–9.
Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Chronic motor cortex stimulation in patients with thalamic pain. J Neurosurg. 1993;78:393–401.
Cha M, Um SW, Kwon M, Nam TS, Lee BH. Repetitive motor cortex stimulation reinforces the pain modulation circuits of peripheral neuropathic pain. Sci Rep. 2017;7:7986.
Meyerson BA, Lindblom U, Linderoth B, Lind G, Herregodts P. Motor cortex stimulation as treatment of trigeminal neuropathic pain. Acta Neurochir Suppl (Wien). 1993;58:150–3.
Raslan AM, Nasseri M, Bahgat D, Abdu E, Burchiel KJ. Motor cortex stimulation for trigeminal neuropathic or deafferentation pain: an institutional case series experience. Stereotact Funct Neurosurg. 2011;89:83–8.
Delavallee M, Rooijakkers H, Koerts G, Raftopoulos C. Motor cortex stimulation in a three-year-old child with trigeminal neuropathic pain caused by a malignant glioma in the cerebellopontine angle: case report. Neurosurgery. 2011;69:E494–6.
Lefaucheur JP, Drouot X, Cunin P, Bruckert R, Lepetit H, Creange A, et al. Motor cortex stimulation for the treatment of refractory peripheral neuropathic pain. Brain. 2009;132:1463–71.
Cruccu G, Garcia-Larrea L, Hansson P, Keindl M, Lefaucheur JP, Paulus W, et al. EAN guidelines on central neurostimulation therapy in chronic pain conditions. Eur J Neurol. 2016;23:1489–99.
Benabid AL, Pollak P, Louveau A, Henry S, de Rougemont J. Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol. 1987;50:344–6.
Perlmutter JS, Mink JW. Deep brain stimulation. Annu Rev Neurosci. 2006;29:229–57.
Leone M. Deep brain stimulation in headache. Lancet Neurol. 2006;5:873–7.
Broggi G, Franzini A, Leone M, Bussone G. Update on neurosurgical treatment of chronic trigeminal autonomic cephalalgias and atypical facial pain with deep brain stimulation of posterior hypothalamus: results and comments. Neurol Sci. 2007;28(Suppl 2):S138–45.
Franzini A, Messina G, Cordella R, Marras C, Broggi G. Deep brain stimulation of the posteromedial hypothalamus: indications, long-term results, and neurophysiological considerations. Neurosurg Focus. 2010;29:E13.
Oakley JC, Prager JP. Spinal cord stimulation: mechanisms of action. Spine (Phila PA 1976). 2002;27:2574–83.
Chivukula S, Tempel ZJ, Weiner GM, Gande AV, Chen CJ, Ding D, et al. Cervical and cervicomedullary spinal cord stimulation for chronic pain: efficacy and outcomes. Clin Neurol Neurosurg. 2014;127:33–41.
Singla S, Prabhakar V, Singla RK. Role of transcutaneous electric nerve stimulation in the management of trigeminal neuralgia. J Neurosci Rural Pract. 2011;2:150–2.
Yameen F, Shahbaz NN, Hasan Y, Fauz R, Abdullah M. Efficacy of transcutaneous electrical nerve stimulation and its different modes in patients with trigeminal neuralgia. J Pak Med Assoc. 2011;61:437–9.
Gibson W, Wand BM, O’Connell NE. Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults. Cochrane Database Syst Rev. 2017;9:Cd011976.
Stidd DA, Wuollet AL, Bowden K, Price T, Patwardhan A, Barker S, et al. Peripheral nerve stimulation for trigeminal neuropathic pain. Pain Physician. 2012;15:27–33.
Abd-Elsayed AA, Grandhi R, Sachdeva H. Effective management of trigeminal neuralgia by neurostimulation. Ochsner J. 2015;15:193–5.
Weiner RL, Garcia CM, Vanquathem N. A novel miniature, wireless neurostimulator in the management of chronic craniofacial pain: preliminary results from a prospective pilot study. Scand J Pain. 2017;17:350–4.
Simpson BA, Nannapaneni R. Trigemino-cervical neuropathic pain relieved by serially repeated peripheral nerve field stimulation without tolerance: case report. Neuromodulation. 2017;20:383–5.
Slavin KV, Colpan ME, Munawar N, Wess C, Nersesyan H. Trigeminal and occipital peripheral nerve stimulation for craniofacial pain: a single-institution experience and review of the literature. Neurosurg Focus. 2006;21:E5.
Klein J, Sandi-Gahun S, Schackert G, Juratli TA. Peripheral nerve field stimulation for trigeminal neuralgia, trigeminal neuropathic pain, and persistent idiopathic facial pain. Cephalalgia. 2016;36:445–53.
Ellis JA, Mejia Munne JC, Winfree CJ. Trigeminal branch stimulation for the treatment of intractable craniofacial pain. J Neurosurg. 2015;123:283–8.
Fricova J, Englerova K, Rokyta R. Noninvasive transcranial direct current stimulation (tDCS) for the treatment of orofacial pain. Neuro Endocrinol Lett. 2016;37:368–72.
Van Buyten JP. Trigeminal ganglion stimulation. Prog Neurol Surg. 2015;29:76–82.
Poon CY. Cryotherapy in the management of trigeminal neuralgia: a review of the literature and report of three cases. Singapore Dent J. 2000;23:49–55.
Falaki F, Nejat AH, Dalirsani Z. The effect of low-level laser therapy on trigeminal neuralgia: a review of literature. J Dent Res Dent Clin Dent Prospects. 2014;8:1–5.
Kreiner M. Use of streptomycin-lidocaine injections in the treatment of the cluster-tic syndrome. Clinical perspectives and a case report. J Craniomaxillofac Surg. 1996;24:289–92.
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Lamsal, R., Rath, G.P. (2019). Neuromodulation in Trigeminal Neuralgia. In: Rath, G. (eds) Handbook of Trigeminal Neuralgia. Springer, Singapore. https://doi.org/10.1007/978-981-13-2333-1_24
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