The progress in diagnosis and treatment of trigeminal neuralgia

Abstract

Trigeminal neuralgia (TN) is characterized by recurrent facial acupuncture like, electric shock like, burning like pain and other common clinical cranial nerve diseases in the trigeminal nerve distribution area. Around the world, people who are 40 or more are at risk. The incidence rate of TN of female is slightly higher than that of male and most of the affecting areas are on the right side unilaterally, which affects maxillary nerve and mandibular nerve, yet seldom ophthalmic nerve. Although controversy exists in the pathogenesis of TN, the most accepted theory is microvascular compression, which forces on the demyelination of the sensory axon of the trigeminal nerve root. Additionally, slight touch, conversation and chewing may cause intolerable pain. The diagnosis of TN mainly depends on clinical manifestation. The treatment mainly includes medicine, operation, and some supplementary methods. Among them, antiepileptics and tricyclic antidepressants are the first-line treatment. Surgical treatment is mainly used for patients with TN who have failed in drug treatment or have intolerable side effects. The methods of operation include destructive or non-destructive operation. Deep brain stimulation (DBS) and motor cortex stimulation (MCS) are new therapeutic techniques emerged recently. This method is expected to alleviate the refractory TN with poor drug control or ineffective conventional surgical treatment. At present,this method has not been approved for clinical treatment. Of course, more clinical data collection processes are in progress.

Keywords

trigeminal neuralgia (TN) / chronic pain / neuropathic pain / anticonvulsant drugs / microvascular decompression (MVD) / nerve regulation