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World Neurosurg. 2017 Jul;103:220-230. doi: 10.1016/j.wneu.2017.03.126. Epub 2017 Apr 2.

Trigeminal Neuralgia: Toward a Multimodal Approach.

Author information

1
Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy. Electronic address: spina.alfio@hsr.it.
2
Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
3
Department of Clinical Neuroscience, Specialistic Neurorehabilitation of Neurological, Cognitive and Motor Disorders, San Raffaele Scientific Institute, Milan, Italy.

Abstract

OBJECTIVES:

Trigeminal neuralgia (TN) is the most common cranial neuralgia in adults, with a slight prevalence in women. Antiepileptic drugs represent the mainstay of the medical treatment, whereas microvascular decompression is the best option in case of neurovascular conflict. Although these treatments showed a good rate of efficacy, they can be contraindicated in some patients and >50% of patients undergoing these treatments will present recurrence of pain in the following months. In this majority of patients, pain becomes chronic and can severely affect their quality of life and cause cognitive disturbances, such as anxiety and depression.

METHODS:

The purpose of this study was to review the efficacy and safety of current treatment modalities for TN, as well as to propose a multimodal approach for those patients presenting with a chronic form of TN.

RESULTS:

Current treatment modalities have been reviewed. Actual pain evaluation systems and the neuropsychologic features of TN have been analyzed in order to propose an alternative treatment algorithm.

DISCUSSION:

Chronic pain can also lead to the misperception of patients' own selves leading to enhanced pain perception and altering therapeutic outcomes. Thus, there is the need to define a personalized multimodal approach of treatment, taking into account other available TN therapies and the neuropsychologic aspect of chronic pain.

KEYWORDS:

Microvascular decompression; Quality of life; Radiosurgery; Trigeminal neuralgia; Trigeminal neuropathic pain

PMID:
28377244
DOI:
10.1016/j.wneu.2017.03.126
[Indexed for MEDLINE]

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