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A Review of Recent Evidence on Trigeminal Neuralgia

  • Mee-Eun Kim (Department of Orofacial Pain and Oral Medicine, College of Dentistry, Dankook University) ;
  • Hye-Kyoung Kim (Department of Orofacial Pain and Oral Medicine, College of Dentistry, Dankook University)
  • Received : 2022.12.07
  • Accepted : 2023.01.11
  • Published : 2023.03.30

Abstract

This review aimed to update our knowledge of the classification, pathophysiology, prognosis, and treatment of trigeminal neuralgia (TN), with the intention of establishing better treatment protocols. The latest version of the International Classification of Headache Disorders uses an etiology-based approach to characterize TN patients, potentially contributing to the development of targeted treatment measures. Noticeable changes in the recent European Academy of Neurology guidelines for the management of TN include the use of magnetic resonance imaging for exclusion of secondary TN and differentiation of idiopathic and classical TN. Additionally, the use of botulinum toxin type A as an addon therapy for mid-term treatment of TN has also been included. Though there has been limited recent progress in the treatment of TN, previous studies emphasize the importance of customized, multidisciplinary management protocols that include drug therapy optimization; provision of continuous education and support; and timely referral of medically refractory patients for surgery in order to achieve favorable prognosis. Furthermore, slow but growing evidence on gene mutations will help elucidate the pathophysiology of TN and contribute to the development of targeted drugs that are effective and safe.

Keywords

References

  1. Merskey H, Bogduk N. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Seattle: IASP Press; 1994.
  2. Cruccu G. Trigeminal neuralgia. Continuum 2017;23:396-420.
  3. Maarbjerg S, Benoliel R. The changing face of trigeminal neuralgia: a narrative review. Headache 2021;61:817-837. https://doi.org/10.1111/head.14144
  4. Zakrzewska JM, Wu J, Mon-Williams M, Phillips N, Pavitt SH. Evaluating the impact of trigeminal neuralgia. Pain 2017;158:1166-1174. https://doi.org/10.1097/j.pain.0000000000000853
  5. Tolle T, Dukes E, Sadosky A. Patient burden of trigeminal neuralgia: results from a cross-sectional survey of health state impairment and treatment patterns in six European countries. Pain Pract 2006;6:153-160. https://doi.org/10.1111/j.1533-2500.2006.00079.x
  6. Melek LN, Devine M, Renton T. The psychosocial impact of orofacial pain in trigeminal neuralgia patients: a systematic review. Int J Oral Maxillofac Surg 2018;47:869-878. https://doi.org/10.1016/j.ijom.2018.02.006
  7. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia 2018;38:1-211. https://doi.org/10.1177/0333102417738202
  8. Bendtsen L, Zakrzewska JM, Abbott J, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol 2019;26:831-849. https://doi.org/10.1111/ene.13950
  9. Cruccu G, Gronseth G, Alksne J, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol 2008;15:1013-1028. https://doi.org/10.1111/j.1468-1331.2008.02185.x
  10. Zakrzewska JM, Wu N, Lee JYK, Werneburg B, Hoffman D, Liu Y. Characterizing treatment utilization patterns for trigeminal neuralgia in the United States. Clin J Pain 2018;34:691-699. https://doi.org/10.1097/AJP.0000000000000595
  11. Bendtsen L, Zakrzewska JM, Heinskou TB, et al. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol 2020;19:784-796. https://doi.org/10.1016/S1474-4422(20)30233-7
  12. Mannerak MA, Lashkarivand A, Eide PK. Trigeminal neuralgia and genetics: a systematic review. Mol Pain 2021;17: 17448069211016139.
  13. Di Stefano G, Yuan JH, Cruccu G, Waxman SG, Dib-Hajj SD, Truini A. Familial trigeminal neuralgia: a systematic clinical study with a genomic screen of the neuronal electrogenisome. Cephalalgia 2020;40:767-777. https://doi.org/10.1177/0333102419897623
  14. Eide PK. Familial occurrence of classical and idiopathic trigeminal neuralgia. J Neurol Sci 2022;434:120101.
  15. Headache Classification Subcommittee of the International Headache Society (IHS). The international classification of headache disorders: 2nd edition. Cephalalgia 2004;24 Suppl 1:9-160. https://doi.org/10.1111/j.1468-2982.2003.00824.x
  16. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 2013;33:629-808. https://doi.org/10.1177/0333102413485658
  17. Antonini G, Di Pasquale A, 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;155:1464-1471. https://doi.org/10.1016/j.pain.2014.04.020
  18. Cruccu G, Finnerup NB, Jensen TS, et al. Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology 2016;87:220-228. https://doi.org/10.1212/WNL.0000000000002840
  19. Leal PR, Hermier M, Souza MA, Cristino-Filho G, Froment JC, Sindou M. Visualization of vascular compression of the trigeminal nerve with high-resolution 3T MRI: a prospective study comparing preoperative imaging analysis to surgical findings in 40 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Neurosurgery 2011;69:15-25; discussion 26. https://doi.org/10.1227/NEU.0b013e318212bafa
  20. Lutz J, Thon N, Stahl R, 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;124:823-830. https://doi.org/10.3171/2015.2.JNS142587
  21. Love S, Coakham HB. Trigeminal neuralgia: pathology and pathogenesis. Brain 2001;124(Pt 12):2347-2360. Erratum in: Brain 2002;125(Pt 3):687.
  22. Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G. Trigeminal neuralgia - diagnosis and treatment. Cephalalgia 2017;37:648-657. https://doi.org/10.1177/0333102416687280
  23. Obermann M, Yoon MS, Ese D, et al. Impaired trigeminal nociceptive processing in patients with trigeminal neuralgia. Neurology 2007;69:835-841. https://doi.org/10.1212/01.wnl.0000269670.30045.6b
  24. Dong W, Jin SC, Allocco A, et al. Exome sequencing implicates impaired GABA signaling and neuronal ion transport in trigeminal neuralgia. iScience 2020;23:101552.
  25. Gambeta E, Chichorro JG, Zamponi GW. Trigeminal neuralgia: an overview from pathophysiology to pharmacological treatments. Mol Pain 2020;16:1744806920901890.
  26. Bai G, Ross H, Zhang Y, Lee K, Ro JY. The role of DNA methylation in transcriptional regulation of pro-nociceptive genes in rat trigeminal ganglia. Epigenet Insights 2020;13:2516865720938677.
  27. Panchagnula S, Sularz AK, Kahle KT. Familial trigeminal neuralgia cases implicate genetic factors in disease pathogenesis. JAMA Neurol 2019;76:9-10. https://doi.org/10.1001/jamaneurol.2018.3322
  28. Maarbjerg S, Gozalov A, Olesen J, Bendtsen L. Concomitant persistent pain in classical trigeminal neuralgia--evidence for different subtypes. Headache 2014;54:1173-1183. https://doi.org/10.1111/head.12384
  29. Devor M, Amir R, Rappaport ZH. Pathophysiology of trigeminal neuralgia: the ignition hypothesis. Clin J Pain 2002;18:4-13. https://doi.org/10.1097/00002508-200201000-00002
  30. Zakrzewska JM. Assessment and treatment of trigeminal neuralgia. Br J Hosp Med (Lond) 2010;71:490-494. https://doi.org/10.12968/hmed.2010.71.9.78158
  31. Burchiel KJ, Slavin KV. On the natural history of trigeminal neuralgia. Neurosurgery 2000;46:152-154; discussion 154-155. https://doi.org/10.1093/neurosurgery/46.1.152
  32. Di Stefano G, La Cesa S, Truini A, Cruccu G. Natural history and outcome of 200 outpatients with classical trigeminal neuralgia treated with carbamazepine or oxcarbazepine in a tertiary centre for neuropathic pain. J Headache Pain 2014;15:34.
  33. Maarbjerg S, Wolfram F, Gozalov A, Olesen J, Bendtsen L. Association between neurovascular contact and clinical characteristics in classical trigeminal neuralgia: a prospective clinical study using 3.0 Tesla MRI. Cephalalgia 2015;35:1077-1084. https://doi.org/10.1177/0333102414566819
  34. Heinskou TB, Maarbjerg S, Wolfram F, et al. Favourable prognosis of trigeminal neuralgia when enrolled in a multidisciplinary management program: a two-year prospective real-life study. J Headache Pain 2019;20:23.
  35. Oomens MA, Forouzanfar T. Pharmaceutical management of trigeminal neuralgia in the elderly. Drugs Aging 2015;32:717-726. https://doi.org/10.1007/s40266-015-0293-6
  36. Okeson JP. Bell's oral and facial pain. 7th ed. Chicago: Quintessence Publishing Co.; 2014. pp. 438-452.
  37. Morra ME, Elgebaly A, Elmaraezy A, et al. Therapeutic efficacy and safety of botulinum toxin A therapy in trigeminal neuralgia: a systematic review and meta-analysis of randomized controlled trials. J Headache Pain 2016;17:63.
  38. Broggi G, Ferroli P, Franzini A, Servello D, Dones I. Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2000;68:59-64. https://doi.org/10.1136/jnnp.68.1.59
  39. Spatz AL, Zakrzewska JM, Kay EJ. Decision analysis of medical and surgical treatments for trigeminal neuralgia: how patient evaluations of benefits and risks affect the utility of treatment decisions. Pain 2007;131:302-310. https://doi.org/10.1016/j.pain.2007.02.009
  40. Zakrzewska JM, Lopez BC, Kim SE, Varian EA, Coakham HB. Patient satisfaction after surgery for trigeminal neuralgia--development of a questionnaire. Acta Neurochir (Wien) 2005;147:925-932. https://doi.org/10.1007/s00701-005-0575-6
  41. Young B, Shivazad A, Kryscio RJ, St Clair W, Bush HM. Longterm outcome of high-dose γ knife surgery in treatment of trigeminal neuralgia. J Neurosurg 2013;119:1166-1175. https://doi.org/10.3171/2013.1.JNS12875