Natural history of trigeminal neuralgia-A hospital-based retrospective study

Trigeminal neuralgia

Trigeminal neuralgia (TN) is a facial pain disorder characterized by intense and paroxysmal pain that profoundly affects quality of life and presents complex challenges in diagnosis and treatment. TN can be categorized as classical, secondary and idiopathic. Epidemiological studies show variable incidence rates and an increased prevalence in women and in the elderly, with familial cases suggesting genetic factors. The pathophysiology of TN is multifactorial and involves genetic predisposition, anatomical changes, and neurophysiological factors, leading to hyperexcitable neuronal states, central sensitization and widespread neural plasticity changes. Neurovascular compression of the trigeminal root, which undergoes major morphological changes, and focal demyelination of primary trigeminal afferents are key aetiological factors in TN. Structural and functional brain imaging studies in patients with TN demonstrated abnormalities in brain regions responsible for pain modulation and emotional processing of pain. Treatment of TN involves a multifaceted approach that considers patient-specific factors, including the type of TN, with initial pharmacotherapy followed by surgical options if necessary. First-line pharmacological treatments include carbamazepine and oxcarbazepine. Surgical interventions, including microvascular decompression and percutaneous neuroablative procedures, can be considered at an early stage if pharmacotherapy is not sufficient for pain control or has intolerable adverse effects or contraindications.

Systematic review on the frequency of occurrence in nerve branches and the side of the face involved in trigeminal neuralgia and its clinical implication

Purpose

The purpose of this systematic review is to answer the focused question, "What is the commonly affected nerve branch and the side of the face involved in trigeminal neuralgia?"

Types of studies reviewed

This systematic review included studies reporting commonly affected trigeminal nerve branches and the side of the face involved in trigeminal neuralgia. To find the potential studies published, the authors utilized specific search databases such as PubMed, and Google scholar.

Results

Among 132 published studies, the authors selected only 11 to be included for this systematic review. The sample size ranged from 50 to 43,518 study subjects. This review identified that the mandibular branches of the trigeminal nerve were the most affected, followed by the maxillary branch. The review also identified that the right side of the face was predominantly affected.

Conclusion and practical implications

The authors of this review identified a higher occurrence of trigeminal neuralgia in the mandibular division of the nerve, commonly affected on the right side of the face. Further prospective-based research and meta-analysis are required to validate the commonly occurring trigeminal nerve branch and sidedness of the face involved with its clinical implications in trigeminal neuralgia.

Comparison of the safety and efficacy of radiofrequency thermocoagulation with percutaneous balloon compression for treating trigeminal neuralgia: a systematic review and meta-analysis

Objective

This study aimed to systematically assess the efficacy and complications of radiofrequency thermocoagulation (RFT) and percutaneous balloon compression (PBC) for treating trigeminal neuralgia (TN).

Methods

Chinese and English studies on RFT and PBC in the treatment of TN were systematically searched using CNKI, Wanfang Data, VIP, PubMed, EMBASE, Cochrane Library, and until December 31, 2022. Further, the literature was strictly screened using specific inclusion and exclusion criteria. The RevMan 5.4 software was used for data processing and meta-analysis.

Results

Overall, 16 studies with 3,326 patients were included. The results of meta-analysis revealed that no significant difference was present between the two groups in terms of the rate of efficacy immediately after surgery, 1 month after surgery, and 3 months after surgery (odds ratio [OR] = 0.73, 95% confidence interval [CI] 0.35-1.54, p = 0.41; OR = 0.41, 95% CI 0.13-1.32, p = 0.13; OR = 0.40, 95% CI 0.10-1.60, p = 0.20); however, at 12 months after surgery, the difference was statistically significant (OR = 0.27, 95% CI 0.10-0.75, p = 0.01). Notably, there was no significant difference in the postoperative sleep quality index between the two groups immediately after surgery and 1 month after surgery (SMD = -0.01, 95% CI -2.47 to 2.44, p = 0.99; SMD = 0.14, 95% CI -3.95 to 4.22, p = 0.95). Further, statistically significant differences were observed between the two groups in the incidence of postoperative masticatory muscle strength decline and oral herpes (OR = 0.37; 95% CI 0.21-0.63, p = 0.0003; OR = 0.25, 95% CI 0.10-0.61, p = 0.003). In addition, a statistically significant difference was found in the recurrence rate at 1-year follow-up (OR = 2.23, 95% CI 1.03-4.81, p = 0.04); however, no statistically significant differences were found in the recurrence rate at the 2-year follow-up (OR = 1.95, 95% CI 0.33-11.59, p = 0.46).

Conclusion

In the treatment of TN, both RFT and PBC can achieve good short-term efficacy, and no significant differences were noted between the outcomes of the two approaches. Compared with RFT, PBC may result in a lower pain score and recurrence rate in the medium and long terms, but it is a higher incidence of cold sores, and the decrease of masticatory muscle strength is more obvious.

Neurapraxia in patients with trigeminal neuralgia but no identifiable neurovascular conflict during microvascular decompression: a retrospective analysis of 26 cases

Background

Microvascular decompression (MVD) is the first choice in patients with classic trigeminal neuralgia (TGN) that could not be sufficiently controlled by pharmacological treatment. However, neurovascular conflict (NVC) could not be identified during MVD in all patients. To describe the efficacy and safety of treatment with aneurysm clips in these situations.

Methods

A total of 205 patients underwent MVD for classic TGN at our center from January 1, 2015 to December 31, 2019. In patients without identifiable NVC upon dissection of the entire trigeminal nerve root, neurapraxia was performed using a Yasargil temporary titanium aneurysm clip (force: 90 g) for 40 s (or a total of 60 s if the process must be suspended temporarily due to bradycardia or hypertension).

Results

A total of 26 patients (median age: 64 years; 15 women) underwent neurapraxia. Five out of the 26 patients received prior MVD but relapsed. Immediate complete pain relief was achieved in all 26 cases. Within a median follow-up of 3 years (range: 1.0–6.0), recurrence was noted in 3 cases (11.5%). Postoperative complications included hemifacial numbness, herpes labialis, masseter weakness; most were transient and dissipated within 3–6 months.

Conclusions

Neurapraxia using aneurysm clip is safe and effective in patients with classic TGN but no identifiable NVC during MVD. Whether this method could be developed into a standardizable method needs further investigation.

Invasive and Non-Invasive Electrical Neuromodulation in Trigeminal Nerve Neuralgia: A Systematic Review and Meta-Analysis

BACKGROUND

Trigeminal neuralgia is a chronic disease characterized by intense facial pain that is caused by trigeminal nerve affectation. It usually affects adults from 50 years of age, and is more frequent in women. Additionally, it presents serious psychological effects that often lead to depression, which is why it is considered highly disabling. The therapeutic approach is based on the modification of nerve activity through electrical, surgical or chemical stimulation in specific regions of the nervous system.

OBJECTIVE

To perform a meta-analysis of the scientific literature related to invasive and non-invasive electrical neuromodulation of trigeminal neuralgia, in order to assess their effects over pain and adverse effects.

METHODS

A literature search was conducted in 4 databases, followed by a manual search of articles on invasive or non-invasive electrical neuromodulation to control the pain of trigeminal neuralgia, including the last 15 years.

RESULTS

Regarding non-invasive methods, clinical trials did not present enough results in order to perform a meta-analysis. Regarding invasive methods, clinical trials meta-analysis showed no statistical differences between different treatment methods. In all cases, improvements in patients' pain were reported, although results regarding adverse effects were variable.

CONCLUSION

In the treatment of trigeminal neuralgia, the continuous radiofrequency provides better short and medium-term results, but pulsed radiofrequency shows less adverse effects after treatment, and has better results in the long-term.

Chronic Facial Pain: Trigeminal Neuralgia, Persistent Idiopathic Facial Pain, and Myofascial Pain Syndrome-An Evidence-Based Narrative Review and Etiological Hypothesis

Trigeminal neuralgia (TN), the most common form of severe facial pain, may be confused with an ill-defined persistent idiopathic facial pain (PIFP). Facial pain is reviewed and a detailed discussion of TN and PIFP is presented. A possible cause for PIFP is proposed. (1) Methods: Databases were searched for articles related to facial pain, TN, and PIFP. Relevant articles were selected, and all systematic reviews and meta-analyses were included. (2) Discussion: The lifetime prevalence for TN is approximately 0.3% and for PIFP approximately 0.03%. TN is 15-20 times more common in persons with multiple sclerosis. Most cases of TN are caused by neurovascular compression, but a significant number are secondary to inflammation, tumor or trauma. The cause of PIFP remains unknown. Well-established TN treatment protocols include pharmacotherapy, neurotoxin denervation, peripheral nerve ablation, focused radiation, and microvascular decompression, with high rates of relief and varying degrees of adverse outcomes. No such protocols exist for PIFP. (3) Conclusion: PIFP may be confused with TN, but treatment possibilities differ greatly. Head and neck muscle myofascial pain syndrome is suggested as a possible cause of PIFP, a consideration that could open new approaches to treatment.