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Amaya Pascasio L, De La Casa-Fages B, Esteban de Antonio E, Grandas F, García-Leal R, Ruiz Juretschke F. Microvascular decompression for trigeminal neuralgia: A retrospective analysis of long-term outcomes and prognostic factors. Neurologia 2023; 38:625-634. [PMID: 37996213 DOI: 10.1016/j.nrleng.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/02/2021] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Microvascular decompression is considered to be the most effective and only etiological surgical treatment for classical trigeminal neuralgia, relieving the neurovascular compression found in up to 95% of cases. This study aims to report the long-term outcomes and to identify prognostic factors in a series of patients with trigeminal neuralgia treated by microvascular decompression. METHODS A retrospective observational study of 152 consecutive patients operated by microvascular decompression with at least six months of follow-up. The surgical results, including pain relief according to the Barrow Neurological Institute pain scale, complications and the medical treatment during the follow-up period were reviewed. Binary regression analysis was performed to identify factors associated with a good long-term outcome. RESULTS A total of 152 patients with a mean age of 60 years and a mean follow-up of 43 months were included. At the final follow-up visit, 83% of the patients had achieved significant relief of the pain and 63% could reduce the absolute drug doses by 50% or more. The most frequent complications were wound infection (4.5%) and CSF fistula (7%). Being over 70 years of age and having paroxysmal pain were associated with a long-term pain relief. CONCLUSIONS Our results support the notion that microvascular decompression is an effective and safe therapy in patients with trigeminal neuralgia. A multidisciplinary approach with an early referral to a neurosurgical unit many be beneficial in patients who are refractory to pharmacological treatment.
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Affiliation(s)
- L Amaya Pascasio
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
| | - B De La Casa-Fages
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Neurosciences Area, Instituto Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - E Esteban de Antonio
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - F Grandas
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Neurosciences Area, Instituto Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - R García-Leal
- Neurosurgery Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - F Ruiz Juretschke
- Neurosurgery Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
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Romero-Reyes M, Arman S, Teruel A, Kumar S, Hawkins J, Akerman S. Pharmacological Management of Orofacial Pain. Drugs 2023; 83:1269-1292. [PMID: 37632671 DOI: 10.1007/s40265-023-01927-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Abstract
Orofacial pain is a category of complex disorders, including musculoskeletal, neuropathic and neurovascular disorders, that greatly affect the quality of life of the patient. These disorders are within the fields of dentistry and medicine and management can be challenging, requiring a referral to an orofacial pain specialist, essential for adequate evaluation, diagnosis, and care. Management is specific to the diagnosis and a treatment plan is developed with diverse pharmacological and non-pharmacological modalities. The pharmacological management of orofacial pain encompasses a vast array of medication classes and approaches. This includes anti-inflammatory drugs, muscle relaxants, anticonvulsants, antidepressants, and anesthetics. In addition, as adjunct therapy, different injections can be integrated into the management plan depending on the diagnosis and needs. These include trigger point injections, temporomandibular joint (TMJ) injections, and neurotoxin injections with botulinum toxin and nerve blocks. Multidisciplinary management is key for optimal care. New and safer therapeutic targets exclusively for the management of orofacial pain disorders are needed to offer better care for this patient population.
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Affiliation(s)
- Marcela Romero-Reyes
- Brotman Facial Pain Clinic, School of Dentistry, University of Maryland, 650 W. Baltimore St, 1st Floor, Baltimore, MD, 21201, USA.
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th Floor, Baltimore, MD, 21201, USA.
| | - Sherwin Arman
- Orofacial Pain Program, Section of Oral Medicine, Oral Pathology and Orofacial Pain, University of California, Los Angeles, School of Dentistry, Los Angeles, CA, USA
| | | | - Satish Kumar
- Department of Periodontics, Arizona School of Dentistry and Oral Health, A.T. Still University, Mesa, AZ, USA
| | - James Hawkins
- Naval Postgraduate Dental School, Naval Medical Leader and Professional Development Command, Uniformed Services University of the Health Sciences Postgraduate Dental College, Baltimore, MD, USA
| | - Simon Akerman
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th Floor, Baltimore, MD, 21201, USA
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Jeyaraj P. Efficiency and Efficacy of Real-Time Fluoroscopic Image-Guided Percutaneous Gasserian Glycerol Rhizotomy (PGGR), for Intractable Cases of Trigeminal Neuralgia. J Maxillofac Oral Surg 2022; 21:1053-1064. [PMID: 36896085 PMCID: PMC9989047 DOI: 10.1007/s12663-021-01682-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/15/2021] [Indexed: 11/27/2022] Open
Abstract
Aim & Objectives To evaluate the ease, efficiency, effectiveness, and associated complications of the technique of percutaneous Gasserian glycerol rhizotomy (PGGR) under real-time fluoroscopic image guidance, for management of severe and refractory cases of primary trigeminal neuralgia, in medical compromised patients. To also assess the long-term efficacy and the necessity, if any, for repeat procedures to salvage recurrences. Study Design & Setting In a prospective study conducted at a single institution over a period of three years, 25 cases of Idiopathic Trigeminal Neuralgia refractory to conservative modalities of treatment including medication were managed with PGGR under real-time fluoroscopic image guidance. All the 25 patients included in this study were known surgical risks for relatively invasive treatment procedures, owing to factors such as advanced age and/or presence of co-morbidities. Material & Methods In order to minimize the risks related to the conventional techniques of Trigeminal root rhizotomy based on cutaneous landmarks alone, and to eliminate the need for frequent repositioning of the needle/cannula, we adopted a technique of real-time fluoroscopic image-guided negotiation of a 22 gauge (0.7 mm dia), 10-cm-long spinal nerve block needle through the foramen ovale, to reach the trigeminal cistern within the Meckel's cave. The efficiency of the technique was assessed in terms of time taken, effort, and ease in performing it. Associated intra- and post-procedural complications were recorded. The immediate and long-term effectiveness of the procedure was evaluated by analysing the degree and duration of pain control achieved, time to recurrence, and the necessity for repeat procedures. Results & Conclusion There were nil intra- or post-procedural complications encountered, and no failures associated with this procedure. Real-time fluoroscopic imaging enabled easy, quick, and successful negotiation of the nerve-block needle through the Foramen Ovale, so as to reach the Trigeminal cistern within the Meckel's cave, within 11 min on an average. An immediate and long lasting post-procedural pain relief was achieved in all the patients. During the follow-up period of 36 months, recurrence of pain was observed in six cases, the mean timing of the recurrence being 26 months or more. Five of these cases were manageable with medication alone, and only one required a repeat procedure. These results indicate that PGGR under real-time fluoroscopic image guidance is a safe, simple, time-efficient, convenient, efficacious, reliable, and minimally invasive means of treating refractory and intractable cases of trigeminal neuralgia.
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Affiliation(s)
- Priya Jeyaraj
- Classified Specialist (Oral & Maxillofacial Surgery), Commanding Officer 33 CDU and 33 Corps Dental Adviser, Indian Army, West Bengal, India
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4
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Andersen ASS, Heinskou TB, Rochat P, Springborg JB, Noory N, Smilkov EA, Bendtsen L, Maarbjerg S. Microvascular decompression in trigeminal neuralgia - a prospective study of 115 patients. J Headache Pain 2022; 23:145. [PMCID: PMC9675260 DOI: 10.1186/s10194-022-01520-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Trigeminal neuralgia is a severe facial pain disorder. Microvascular decompression is first choice surgical treatment of patients with classical TN. There exist few prospective studies with an independent evaluation of efficacy and complications after MVD. Objectives We aimed to assess outcome and complications after microvascular decompression from our center. Methods We prospectively recorded clinical characteristics, outcome, and complications from consecutive patients with either classical or idiopathic (only patients with a neurovascular contact) trigeminal neuralgia undergoing microvascular decompression. Neurovascular contact was evaluated by 3.0 Tesla MRI. Patients were assessed before and 3, 6, 12, and 24 months after surgery by independent assessors. Results Of 115 included patients, 86% had a clinically significant outcome (i.e., BNI I – BNI IIIb). There was a significant association between an excellent surgical outcome and the male sex (OR 4.9 (CI 1.9–12.8), p = 0.001) and neurovascular contact with morphological changes (OR 2.5 (CI 1.1–6.0), p = 0.036). Significantly more women (12/62 = 19%) than men (2/53 = 4%) had a failed outcome, p = 0.019. The most frequent major complications were permanent hearing impairment (10%), permanent severe hypoesthesia (7%), permanent ataxia (7%), and stroke (6%). Most patients (94%) recommend surgery to others. Conclusion Microvascular decompression is an effective treatment for classical and idiopathic (only patients with a neurovascular contact) trigeminal neuralgia with a high chance of a long-lasting effect. The chance of an excellent outcome was highest in men and in patients with classical trigeminal neuralgia. Complications are relatively frequent warranting thorough patient evaluation and information preoperatively. Trial registration Clinical.trials.gov registration no. NCT04445766. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01520-x.
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Affiliation(s)
- Anne Sofie Schott Andersen
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Tone Bruvik Heinskou
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Per Rochat
- grid.4973.90000 0004 0646 7373Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet – Blegdamsvej, 2100 Copenhagen, Denmark
| | - Jacob Bertram Springborg
- grid.4973.90000 0004 0646 7373Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet – Blegdamsvej, 2100 Copenhagen, Denmark
| | - Navid Noory
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Emil Andonov Smilkov
- grid.475435.4Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet – Glostrup, 2600 Glostrup, Denmark
| | - Lars Bendtsen
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Stine Maarbjerg
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
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Latorre G, González-García N, García-Ull J, González-Oria C, Porta-Etessam J, Molina F, Guerrero-Peral A, Belvís R, Rodríguez R, Bescós A, Irimia P, Santos-Lasaosa S. Diagnóstico y tratamiento de la neuralgia del trigémino: documento de consenso del Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Poole J, Mercadante V, Singhota S, Nizam K, Zakrzewska JM. Exploring patient satisfaction of a joint-consultation clinic for trigeminal neuralgia: Enabling improved decision-making. Br J Pain 2021; 16:237-242. [PMID: 35419201 PMCID: PMC8998520 DOI: 10.1177/20494637211045877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Trigeminal neuralgia (TN) is a relatively rare condition which has a profound impact not only on the patient but also on those around them. There is no cure for TN, and the management of the condition is complex. The most effective forms of treatment are either through medication, neurosurgery, or combination of the two. Each option has risks and implications for the patient. As with all clinical decisions, it is important for patients to understand and be fully informed of the treatments available to them. A London UK unit adopted a joint-consultation clinic approach where the patient meets with both physician and neurosurgeon at the same time to discuss treatment options. The purpose of this evaluation is to understand patients’ level of satisfaction with the joint-consultation clinic and evaluate utilisation of a clinical decision-making tool. Method Patients who had attended the joint-consultation clinic over a period of 12 months were invited to participate in a telephone or paper survey (N = 55). Responses were analysed using descriptive statistics and thematic analysis. Results Forty-one patients (77% response rate) participated in the survey, and the results were overwhelmingly positive for the joint-consultation clinic regarding satisfaction. The benefits were broad ranging including increased understanding, collaboration and confidence in decision-making. Conclusions A joint-consultation clinic comprising a neurosurgeon and a physician for the treatment of TN is valued by patients who become better informed and able to make decisions about their care. Positive application of clinical decision-making aids in this situation offers potential across specialities.
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Affiliation(s)
- Jolyon Poole
- Eastman Dental Hospital, University College London Hospitals NHS, UK
| | - Valeria Mercadante
- Eastman Dental Hospital, University College London Hospitals NHS, UK
- UCL Eastman Dental Institute, London, UK
| | | | | | - Joanna M Zakrzewska
- Eastman Dental Hospital, University College London Hospitals NHS, UK
- UCL Eastman Dental Institute, London, UK
- University College London, London, UK
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7
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Fokina NM, Shavlovskaya OA, Rashidova MA. [A rare form of secondary orofacial pain: Herzenberg's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:71-75. [PMID: 34283533 DOI: 10.17116/jnevro202112106171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A clinical analysis of a patient with a rare form of secondary facial pain (Herzenberg's disease) is presented. The conducted research and pharmacological tests made it possible to exclude such diseases as trigeminal neuralgia, stylohyoid syndrome, TMJ pain dysfunction, dental plexalgia, myofascial facial pain syndrome. The patient is consulted by a dental surgeon to exclude pathology of the parotid salivary gland and sialolithiasis. The patient was treated with broad-spectrum antibiotics for 8 days. Also, supportive therapy was prescribed: desensitizing, vitamins, as well as an anxiolytic and an antidepressant in minimum therapeutic doses for a course of 14 days (with subsequent correction of the dosage and duration of administration) to correct the emotional state of the patient. We recommend a gentle diet (alkaline warm drink, soft food), and a diet that does not provoke salivation. Locally it was recommended to rinse with antimicrobial drugs, phonophoresis, electrophoresis, magnetotherapy. On the 6th day of therapy, the therapeutic effect was obtained. By the 14th day of therapy, the pain syndrome was leveled.
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Affiliation(s)
- N M Fokina
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,Medical University «REAVIZ», Moscow, Russia
| | - O A Shavlovskaya
- International University of Restorative Medicine, Moscow, Russia
| | - M A Rashidova
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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8
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Amaya Pascasio L, De La Casa-Fages B, Esteban de Antonio E, Grandas F, García-Leal R, Ruiz Juretschke F. Microvascular decompression for trigeminal neuralgia: A retrospective analysis of long-term outcomes and prognostic factors. Neurologia 2021; 38:S0213-4853(21)00071-2. [PMID: 34049739 DOI: 10.1016/j.nrl.2021.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/25/2021] [Accepted: 03/02/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Microvascular decompression is considered to be the most effective and only etiological surgical treatment for classical trigeminal neuralgia, relieving the neurovascular compression found in up to 95% of cases. This study aims to report the long-term outcomes and to identify prognostic factors in a series of patients with trigeminal neuralgia treated by microvascular decompression. METHODS A retrospective observational study of 152 consecutive patients operated by microvascular decompression with at least six months of follow-up. The surgical results, including pain relief according to the Barrow Neurological Institute pain scale, complications and the medical treatment during the follow-up period were reviewed. Binary regression analysis was performed to identify factors associated with a good long-term outcome. RESULTS A total of 152 patients with a mean age of 60 years and a mean follow-up of 43 months were included. At the final follow-up visit, 83% of the patients had achieved significant relief of the pain and 63% could reduce the absolute drug doses by 50% or more. The most frequent complications were wound infection (4.5%) and CSF fistula (7%). Being over 70 years of age and having paroxysmal pain were associated with a long-term pain relief. CONCLUSIONS Our results support the notion that microvascular decompression is an effective and safe therapy in patients with trigeminal neuralgia. A multidisciplinary approach with an early referral to a neurosurgical unit many be beneficial in patients who are refractory to pharmacological treatment.
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Affiliation(s)
- L Amaya Pascasio
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
| | - B De La Casa-Fages
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Neurosciences Area, Instituto Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - E Esteban de Antonio
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - F Grandas
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Neurosciences Area, Instituto Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - R García-Leal
- Neurosurgery Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - F Ruiz Juretschke
- Neurosurgery Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
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9
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O'Callaghan L, Floden L, Vinikoor-Imler L, Symonds T, Giblin K, Hartford C, Zakrzewska JM. Burden of illness of trigeminal neuralgia among patients managed in a specialist center in England. J Headache Pain 2020; 21:130. [PMID: 33167869 PMCID: PMC7653862 DOI: 10.1186/s10194-020-01198-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background Trigeminal neuralgia (TN) causes severe episodic, unilateral facial pain and is initially treated with antiepileptic medications. For patients not responding or intolerant to medications, surgery is an option. Methods In order to expand understanding of the pain-related burden of illness associated with TN, a cross-sectional survey was conducted of patients at a specialist center that utilizes a multidisciplinary care pathway. Participants provided information regarding their pain experience and treatment history, and completed several patient-reported outcome (PRO) measures. Results Of 129 respondents, 69/128 (54%; 1 missing) reported no pain in the past 4 weeks. However, 84 (65%) respondents were on medications, including 49 (38%) on monotherapy and 35 (27%) on polytherapy. A proportion of patients had discontinued at least one medication in the past, mostly due to lack of efficacy (n = 62, 48%) and side effects (n = 51, 40%). A total of 52 (40%) patients had undergone surgery, of whom 30 had microvascular decompression (MVD). Although surgery, especially MVD, provided satisfactory pain control in many patients, 29% of post-surgical patients reported complications, 19% had pain worsen or stay the same, 48% were still taking pain medications for TN, and 33% reported new and different facial pain. Conclusions In most PRO measures, respondents with current pain interference had poorer scores than those without pain interference. In the Patient Global Impression of Change, 79% expressed improvement since beginning of treatment at this clinic. These results indicate that while the multidisciplinary approach can substantially alleviate the impact of TN, there remains an unmet medical need for additional treatment options.
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Affiliation(s)
| | - Lysbeth Floden
- Clinical Outcomes Solutions, 1820 E. River Rd., Suite 220, Tucson, AZ, 85718, USA
| | | | - Tara Symonds
- Clinical Outcomes Solutions, Unit 68, Basepoint, Shearway Road, Shearway Business Park, Folkestone, Kent, CT19 4RH, UK
| | - Kathryn Giblin
- Formerly Biogen, 225 Binney St, Cambridge, MA, 02142, USA
| | - Chris Hartford
- Clinical Outcomes Solutions, 1820 E. River Rd., Suite 220, Tucson, AZ, 85718, USA
| | - Joanna M Zakrzewska
- Royal National ENT & Eastman Dental Hospitals, 4th Floor Central, 250 Euston Road, London, NW1 2PQ, UK.,UCLH NHS Foundation Trust, Oral theme of the UCL/UCLH NIHR Biomedical Research Centre UK, London, UK
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10
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Bendtsen L, Zakrzewska JM, Heinskou TB, Hodaie M, Leal PRL, Nurmikko T, Obermann M, Cruccu G, Maarbjerg S. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol 2020; 19:784-796. [PMID: 32822636 DOI: 10.1016/s1474-4422(20)30233-7] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Abstract
Trigeminal neuralgia is a very painful neurological condition with severe, stimulus-evoked, short-lasting stabbing pain attacks in the face. The past decade has offered new insights into trigeminal neuralgia symptomatology, pathophysiology, and treatment, leading to a change in the classification of the condition. An accurate diagnosis is crucial because neuroimaging interpretation and clinical management differ among the various forms of facial pain. MRI using specific sequences should be a part of the diagnostic workup to detect a possible neurovascular contact and exclude secondary causes. Demonstration of a neurovascular contact should not be used to confirm a diagnosis but rather to facilitate surgical decision making. Carbamazepine and oxcarbazepine are drugs of first choice for long-term treatment, whereas microvascular decompression is the first-line surgery in medically refractory patients. Advances in neuroimaging techniques and animal models will provide further insight into the causes of trigeminal neuralgia and its pathophysiology. Development of more efficacious treatment options is highly warranted.
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Affiliation(s)
- Lars Bendtsen
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark.
| | - Joanna Maria Zakrzewska
- Pain Management Centre, National Hospital for Neurology and Neurosurgery, London, UK; Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | - Tone Bruvik Heinskou
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Paulo Roberto Lacerda Leal
- Department of Neurosurgery, Faculty of Medicine of Sobral, Federal University of Cearà, Sobral, Brazil; University of Lyon, Lyon, France
| | - Turo Nurmikko
- Neuroscience Research Centre, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany
| | - Giorgio Cruccu
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Stine Maarbjerg
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark
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Nestor MS, Fischer DL, Arnold D, Berman B, Del Rosso JQ. Rethinking the Journal Impact Factor and Publishing in the Digital Age. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2020; 13:12-17. [PMID: 32082465 PMCID: PMC7028381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Clinical and experimental literature search has changed significantly over the past few decades, and with it, the way in which we value information. Today, our need for immediate access to relevant and specific literature, regardless of specialty, has led to a growing demand for open access to publications. The Journal Impact Factor (JIF) has been a long-time standard for representing the quality or "prestige" of a journal, but it appears to be losing its relevance. Here, we define the JIF and deconstruct its validity as a modern measure of a journal's quality, discuss the current models of academic publication, including their advantages and shortcomings, and discuss the benefits and shortcomings of a variety of open-access models, including costs to the author. We have quantified a nonsubscribed physician's access to full articles associated with dermatologic disease and aesthetics cited on PubMed. For some of the most common dermatology conditions, 23.1 percent of citations (ranging from 17.2% for melasma to 31.9% for malignant melanoma) were available as free full articles, and for aesthetic procedures, 18.9 percent of citations (ranging from 11.9% for laser hair removal to 27.9% for botulinum toxin) were available as free full articles. Finally, we discuss existing alternative metrics for measuring journal impact and propose the adoption of a superior publishing model, one that satisfies modern day standards of scholarly knowledge pursuit and dissemination of scholarly publications for dermatology and all of medical science.
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Affiliation(s)
- Mark S Nestor
- Drs. Nestor, Fischer, Arnold, and Berman are with the Center for Clinical and Cosmetic Research in Aventura, Florida
- Drs. Nestor and Berman are with the Department of Dermatology and Cutaneous Surgery, with Dr. Nestor also serving in the Department of Surgery, Division of Plastic Surgery, at the University of Miami Miller School of Medicine in Miami, Florida
- Dr. Del Rosso is with JDR Dermatology Research/Thomas Dermatology in Las Vegas, Nevada and Touro University Nevada in Henderson, Nevada
| | - Daniel L Fischer
- Drs. Nestor, Fischer, Arnold, and Berman are with the Center for Clinical and Cosmetic Research in Aventura, Florida
- Drs. Nestor and Berman are with the Department of Dermatology and Cutaneous Surgery, with Dr. Nestor also serving in the Department of Surgery, Division of Plastic Surgery, at the University of Miami Miller School of Medicine in Miami, Florida
- Dr. Del Rosso is with JDR Dermatology Research/Thomas Dermatology in Las Vegas, Nevada and Touro University Nevada in Henderson, Nevada
| | - David Arnold
- Drs. Nestor, Fischer, Arnold, and Berman are with the Center for Clinical and Cosmetic Research in Aventura, Florida
- Drs. Nestor and Berman are with the Department of Dermatology and Cutaneous Surgery, with Dr. Nestor also serving in the Department of Surgery, Division of Plastic Surgery, at the University of Miami Miller School of Medicine in Miami, Florida
- Dr. Del Rosso is with JDR Dermatology Research/Thomas Dermatology in Las Vegas, Nevada and Touro University Nevada in Henderson, Nevada
| | - Brian Berman
- Drs. Nestor, Fischer, Arnold, and Berman are with the Center for Clinical and Cosmetic Research in Aventura, Florida
- Drs. Nestor and Berman are with the Department of Dermatology and Cutaneous Surgery, with Dr. Nestor also serving in the Department of Surgery, Division of Plastic Surgery, at the University of Miami Miller School of Medicine in Miami, Florida
- Dr. Del Rosso is with JDR Dermatology Research/Thomas Dermatology in Las Vegas, Nevada and Touro University Nevada in Henderson, Nevada
| | - James Q Del Rosso
- Drs. Nestor, Fischer, Arnold, and Berman are with the Center for Clinical and Cosmetic Research in Aventura, Florida
- Drs. Nestor and Berman are with the Department of Dermatology and Cutaneous Surgery, with Dr. Nestor also serving in the Department of Surgery, Division of Plastic Surgery, at the University of Miami Miller School of Medicine in Miami, Florida
- Dr. Del Rosso is with JDR Dermatology Research/Thomas Dermatology in Las Vegas, Nevada and Touro University Nevada in Henderson, Nevada
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Awal D, Amin K, Venda-Nova C, Naqvi A, Zakrzewska J. The specialist management of non-temporomandibular orofacial pain: maxillofacial surgery’s known unknown? Br J Oral Maxillofac Surg 2019; 57:749-754. [DOI: 10.1016/j.bjoms.2019.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 06/21/2019] [Indexed: 11/26/2022]
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Abstract
Trigeminal neuralgia is one of the most severe facial pains that patients can experience. This unpredictable, episodic pain, mostly unilateral in the distribution of the trigeminal nerve, results in recurrent shooting pain lasting for seconds to minutes. It is light touch provoked and therefore prevents patients from eating and touching their face, and so has a significant impact on quality of life. Patients often consult a dentist because it usually presents like dental pain. Dentists need to avoid irreversible dental treatment. Response to carbamazepine is good but tolerability is poor. Surgical options are available and are generally successful. Patients can gain further information from a patient support group, such as Trigeminal Neuralgia Association UK. CPD/Clinical Relevance: Although rare, trigeminal neuralgia patients often present to dentists who therefore need to recognize it as a non-dental cause of pain in order to avoid irreversible dental treatment.
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Affiliation(s)
- Joanna M Zakrzewska
- Professor and Consultant in Facial Pain, Eastman Dental Hospital, 256 Gray's Inn Road, London WC1X 8LD, Pain Management Centre, National Hospital for Neurology and Neurosurgery, 25 Cleveland Street, London W1T 4AJ and UCLH NHS Foundation Trust, UK
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Huang B, Yao M, Liu Q, Chen Y, Ni H, Li Z, Xie K, Fei Y, Li L. Personalized needle modification for CT-guided percutaneous infrazygomatic radiofrequency ablation of the maxillary nerve through the foramen rotundum in order to treat V2 trigeminal neuralgia. J Pain Res 2019; 12:2321-2329. [PMID: 31440076 PMCID: PMC6666371 DOI: 10.2147/jpr.s207297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/08/2019] [Indexed: 11/24/2022] Open
Abstract
Background: The computed tomography (CT)-guided radiofrequency ablation (RFA) of the maxillary nerve (V2) via foramen rotundum (FR) approach has been reported to offer the highest rates of pain relief in V2 trigeminal neuralgia (TN). However, the access to FR may be obstructed by the greater wing of the sphenoid bone. Objectives: We report on an optimized CT-guided percutaneous infrazygomatic of maxillary nerve through the foramen rotundum (FR) to treat V2 trigeminal neuralgia (TN) using personalized RFA needles based on patient’s individual CT-image parameters. Patients and methods: 176 patients with isolated V2 TN were included. If the entry of the percutaneous needle into the FR canal was blocked by the greater wing of the sphenoid bone, straight RFA needles was bent at the tip with an angle α (the angle between the straight line from the external opening of FR to the skin entry point and the long axis of the FR canal). The maxillary nerve RFA was performed after confirmation with electrophysiological tests. Pain relief in the V2 territory and TN recurrence rate were followed for up to 60 months. Results: Fifty-two patients (29.55%) required needle bending. The maxillary nerve thermal RFA resulted in analgesia in the V2 territory without affecting the V1 or V3 zone. TN recurrence rate at 6, 12, 24, 36, 48 and 60 months was 2.55%, 7.64%, 17.20%, 24.41%, 30.28% and 33.77%, respectively. Conclusion: The personalized needle modification technique for maxillary nerve RFA through FR is safe and effective to treat V2 TN.
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Affiliation(s)
- Bing Huang
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Ming Yao
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Qianying Liu
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Yajing Chen
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Huadong Ni
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Zhang Li
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Keyue Xie
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Yong Fei
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Langping Li
- Department of Anesthesiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, People's Republic of China
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Trigeminal neuralgia: Comparison of characteristics and impact in patients with or without multiple sclerosis. Mult Scler Relat Disord 2019; 34:41-46. [PMID: 31228715 DOI: 10.1016/j.msard.2019.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/25/2019] [Accepted: 06/16/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The commonest secondary cause for trigeminal neuralgia (TN) is multiple sclerosis (MS) and little is known about this group of patients in terms of their presentation and treatments. We compared patients with TN and MS (pwTNMS) with a cohort of patients with primary TN, who had been referred to the same specialist unit, both in terms of characteristics and impact on quality of life at the time of their first assessment. METHODS Using a prospective patient database we extracted key clinical data and results from psychometrically tested questionnaires of 26 pwTNMS and compared them to an age and gender-matched set of 68 patients with primary TN. RESULTS Our findings suggest that pwTNMS exhibit a more severe clinical phenotype than primary TN. Prior to referral, pwTNMS are more likely to have used more healthcare services and undergone more neurosurgical interventions. Strikingly, pwTNMS exhibit reduced lengths and duration of remission periods and fewer identifiable triggers. Furthermore, pwTNMS report significant impact on quality of life comparable to those in primary TN, scoring highly in measures of anxiety, depression, and catastrophizing, but also report greater sleep disturbance, and overall interference in activities of daily living. CONCLUSIONS pwTNMS have a more intractable TN, one which may necessitate a more complex approach to treatment, earlier referral to secondary care and an extensive assessment of mental health. Quality of life in pwTNMS is severely affected by both their MS and their TN, suggesting management should occur in specialist centres with access to a multidisciplinary team.
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Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, Eide PK, Leal PRL, Maarbjerg S, May A, Nurmikko T, Obermann M, Jensen TS, Cruccu G. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol 2019; 26:831-849. [DOI: 10.1111/ene.13950] [Citation(s) in RCA: 191] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/08/2019] [Indexed: 12/19/2022]
Affiliation(s)
- L. Bendtsen
- Department of Neurology Faculty of Health and Medical Sciences Danish Headache Center Rigshospitalet‐Glostrup University of Copenhagen Glostrup Denmark
| | - J. M. Zakrzewska
- Pain Management Centre National Hospital for Neurology and Neurosurgery London UK
- Eastman Dental Hospital UCLH NHS Foundation Trust London UK
| | - J. Abbott
- Trigeminal Neuralgia Association UK Oxted Surrey UK
| | | | - G. Di Stefano
- Department of Human Neuroscience Sapienza University Rome Italy
| | - A. Donnet
- Headache and Pain Department CHU La Timone APHM Marseille France
| | - P. K. Eide
- Department of Neurosurgery Oslo University Hospital‐Rikshospitalet Oslo Norway
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
| | - P. R. L. Leal
- Department of Neurosurgery Faculty of Medicine of Sobral Federal University of Ceará Sobral Brazil
- University of Lyon 1 Lyon France
| | - S. Maarbjerg
- Department of Neurology Faculty of Health and Medical Sciences Danish Headache Center Rigshospitalet‐Glostrup University of Copenhagen Glostrup Denmark
| | - A. May
- Department of Systems Neuroscience Universitäts‐Krankenhaus Eppendorf Hamburg Germany
| | - T. Nurmikko
- Neuroscience Research Centre Walton Centre NHS Foundation Trust Liverpool UK
| | - M. Obermann
- Center for Neurology Asklepios Hospitals Schildautal Seesen Germany
| | - T. S. Jensen
- Department of Neurology and Danish Pain Research Center Aarhus University Hospital University of Aarhus Aarhus C Denmark
| | - G. Cruccu
- Department of Human Neuroscience Sapienza University Rome Italy
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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. [PMID: 30832577 PMCID: PMC6734423 DOI: 10.1186/s10194-019-0973-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/18/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Prognosis of medically treated trigeminal neuralgia patients is assumed to be poor, but the evidence is lacking. Thus, prospective real-life studies of medical management of trigeminal neuralgia are warranted. METHODS This was an observational study. Patients were consecutively enrolled in a structured management program at a specialist centre for facial pain. Optimisation of medical treatment, physiotherapy, psychotherapy, and advice from trained nurses, were parts of the program. Medically intractable patients were referred for neurosurgery. Data-collection was prospective using standardised schemes and patient surveys. The aim was to describe the two-year outcome of medical treatment at the specialist centre. The primary outcome was a 50% reduction in the overall burden of pain according to a Numerical Rating Scale (NRS) after two years. RESULTS A total of 186 primary TN patients were enrolled in the program of which 103 patients remained medically managed and completed the two-year follow-up. Fifty patients were treated surgically within the first two years of follow-up. Half of the medically managed patients (53 (51%)), had more than a 50% reduction in the overall burden of pain over the two-year period. The overall burden of pain on NRS decreased from mean 5.34 to 3.00, p < 0.01. There was no significant association between primary outcome and sex, depression and/or anxiety, concomitant persistent pain, or neurovascular contact with morphological changes of the trigeminal nerve. CONCLUSIONS Patients with trigeminal neuralgia improve over a two-year period when enrolled in a structured medical management program. Optimisation of drug treatment, continuous advice and education and support by the multidisciplinary team, referral of the medically intractable patients for surgery or the natural history of the disease, can be some of the reasons for the improvement. The favourable prognosis provides hope and optimism for medically managed TN patients. TRIAL REGISTRATION Current study was observational, and patients were offered standard clinical care and laboratory workups according to current American Academy of Neurology and European Federation of Neurological Societies treatment guidelines. The study has been registered at ClincalTrials.gov. ID: NCT03838393 .
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Abstract
Patients with idiopathic trigeminal neuralgia (TN) were categorised into 3 subtypes (n = 225). Group 1 (n = 155, 68.9%) had TN without concomitant pain, group 2 (n = 32, 14.2%) had TN with intermittent concomitant pain, and group 3 (n = 39, 16.9%) had TN with autonomic symptoms. We tested 2 hypotheses: (1) that different pain profiles would be associated with the different groups; (2) that the severe pain associated with TN would impact negatively on activities of daily living and thereby result in disability as defined by the World Health Organisation. A different pain profile was found across the groups. We obtained unequivocal evidence that TN causes disability with up to 45% of patients being absent from usual daily activities 15 days or more in the past 6 months. On the Hospital Anxiety and Depression Scale, 35.7% patients had mild-to-severe depression and over 50% were anxious. The Pain Catastrophizing Scale showed that 78% of patients had considerable negative thoughts with scores >20 and a mean score of 36.4. Prior to referral, only 54% had been prescribed carbamazepine while opioids had been prescribed in 14.6% of the patients. Prior to referral, over 80% had already been to 1 specialist centre which had not provided appropriate management. Patients with TN report varied characteristics but all result in some degree of psychosocial disability especially before adequate therapy is attained.
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Chen YW, Chuang SK. Botulinum Toxin A Might Be an Alternative or Adjunct Therapy for the Treatment of Trigeminal and Postherpetic Neuralgia. J Evid Based Dent Pract 2017; 17:259-261. [PMID: 28865822 DOI: 10.1016/j.jebdp.2017.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION The efficacy of botulinum toxin for the treatment of trigeminal and postherpetic neuralgia: A systematic review with meta-analyses. Shackleton T, Ram S, Black M, Ryder J, Clark GT, Enciso R. Oral Surg Oral Med Oral Pathol Oral Radiol 2016;122(1):61-71. SOURCE OF FUNDING Information not available TYPE OF STUDY/DESIGN: Systematic review and meta-analysis.
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Morra ME, Elgebaly A, Elmaraezy A, Khalil AM, Altibi AMA, Vu TLH, Mostafa MR, Huy NT, Hirayama K. 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. [PMID: 27377706 PMCID: PMC4932020 DOI: 10.1186/s10194-016-0651-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/17/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several different interventions have been examined to alleviate pain and reduce frequency of trigeminal neuralgia (TN) paroxysms. However, some patients continue to have persistent or recurrent painful attacks. Using a systematic review and meta-analysis approach, we aimed to synthesize evidence from published randomized controlled trials (RCTs) regarding safety and efficacy of botulinum toxin type A (BTX-A) as a possible emerging choice of treatment for TN. METHODS We conducted an electronic search in 10 databases/electronic search engines to access relevant publications. All articles in all languages reporting RCTs on the efficacy and safety of BTX-A in the treatment of TN were included for systematic review and meta-analysis. RESULTS A total of four RCTs (n = 178) were identified for final meta-analysis. The overall effect favored BTX-A versus placebo in terms of proportion of responders (risk ratio RR = 2.87, 95 % confidence interval CI [1.76, 4.69], p <0.0001) with no significant detected heterogeneity (p = 0.31; I(2) = 4 %). Paroxysms frequency per day was significantly lower for BTX-A group (mean difference MD = -29.79, 95 % CI [-38.50,-21.08], p <0.00001) with no significant heterogeneity (p = 0.21; I(2) = 36 %). CONCLUSION Despite limited data, our results suggest that BTX-A may be an effective and safe treatment option for patients with TN. Further larger and well-designed RCTs are encouraged to translate these findings into better clinical outcome and better quality of life for TN patients.
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Affiliation(s)
| | - Ahmed Elgebaly
- Faculty of Medicine, Al Azhar University, Cairo, 11884, Egypt
| | - Ahmed Elmaraezy
- Faculty of Medicine, Al Azhar University, Cairo, 11884, Egypt
| | - Adham M Khalil
- Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | | | - Tran Le-Huy Vu
- University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | | | - Nguyen Tien Huy
- Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan. .,Center for Molecular Bio-Medicine, University of Medicine and Pharmacy, 217 Hong Bang, District 5, Ho Chi Minh City, Ho Chi Minh, 70000, Viet Nam.
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
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Du S, Ma X, Li X, Yuan H. Ophthalmic branch radiofrequency thermocoagulation for atypical trigeminal neuralgia:a case report. SPRINGERPLUS 2015; 4:813. [PMID: 26722633 PMCID: PMC4690819 DOI: 10.1186/s40064-015-1624-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 12/15/2015] [Indexed: 01/03/2023]
Abstract
Background Trigeminal neuralgia is an intense neuralgia involving facial areas supplied by trigeminal nerve. The pain is characterized by sudden onset, short persistence, sharp or lancinating. Trigeminal neuralgia commonly affects frontal areas, infraorbital or paranasal areas, mandibular areas and teeth. While Trigeminal neuralgia affecting merely the upper eyelid is rare. Here we report a case of atypical Trigeminal neuralgia confined to the upper eyelid. The patient was pain free during the follow-up period of 6 months after unusual ophthalmic branch radiofrequency thermocoagulation. Case presentation A 55-year-old female patient was diagnosed as primary trigeminal neuralgia involving the right upper eyelid. As the pain could not be controlled by drug therapy, peripheral nerve branch radiofrequency thermocoagulation was recommended. A combination of infratrochlear, supratrochlear and lacrimal radiofrequency thermocoagulation was implemented in this case. The point where the bridge of the nose abuts the supraorbital ridge and the point slightly above the lateral canthus along outer border of the orbit were selected respectively as the puncture sites. After positive diagnostic test, radiofrequency thermocoagulation of the above-mentioned nerve branches was performed respectively. The patient was pain free immediately after the treatment and during the follow-up period of 6 months. Discussion Trigeminal neuralgia is a common severe and chronic facial neuralgia which requires accurate diagnosis and effective therapy. With typical clinical symptoms, normal neurological signs, normal CT and MRI findings, the patient was diagnosed as classic trigeminal neuralgia. As the patient was drug resistant, some invasive treatments were considered. Peripheral branch neurolysis was chosen for its minimal invasiveness, convenience, low risk and not affecting further invasive treatments. According to the anatomic data and the diagnostic test results, infratrochlear, supratrochlear and lacrimal nerve were responsible, therefore, an unusual combination of infratrochlear, supratrochlear, and lacrimal radiofrequency thermocoagulation was implemented for this patient. Conclusions Radiofrequency thermocoagulation is an effective treatment option for trigeminal neuralgia. Peripheral branch radiofrequency thermocoagulation for trigeminal neuralgia should be considered preferentially due to its minimal invasiveness and convenience. Furthermore, as the sensory innervation of the upper eyelid is complex, the knowledge of peripheral distribution of trigeminal nerve is essential.
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Affiliation(s)
- Shibin Du
- Department of Anesthesiology and Pain Management, Xijing Hospital, Fourth Military Medical University, 710032 Xian, China
| | - Xiaoliang Ma
- Department of Anesthesiology and Pain Management, Xijing Hospital, Fourth Military Medical University, 710032 Xian, China
| | - Xiaoqin Li
- Department of Anesthesiology and Pain Management, Xijing Hospital, Fourth Military Medical University, 710032 Xian, China
| | - Hongjie Yuan
- Department of Anesthesiology and Pain Management, Xijing Hospital, Fourth Military Medical University, 710032 Xian, China
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