Clinical Considerations of Trigeminal Neuralgia

삼차신경통 진단 및 치료의 중요 고려사항

  • Jeon, Young-Mi (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Tae, Il-Ho (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Choi, Jong-Hoon (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Ahn, Hyung-Joon (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Shim, Woo-Hyun (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Kwon, Jeong-Seung (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry)
  • 전영미 (연세대학교 치과대학 구강내과학교실) ;
  • 태일호 (연세대학교 치과대학 구강내과학교실) ;
  • 최종훈 (연세대학교 치과대학 구강내과학교실) ;
  • 안형준 (연세대학교 치과대학 구강내과학교실) ;
  • 심우현 (연세대학교 치과대학 구강내과학교실) ;
  • 권정승 (연세대학교 치과대학 구강내과학교실)
  • Published : 2007.12.30

Abstract

Trigeminal neuralgia is defined as "a sudden, usually unilateral, brief stabbing recurrent pain in the distribution of one or more branches of the fifth cranial nerve" by the International Association for the Study of Pain(IASP). Trigeminal neuralgia is classified as an idiopathic trigeminal neuralgia with no apparent cause and a symptomatic trigeminal neuralgia which is caused by a structural lesion such as brain tumor. Over 80% of the tumors are meningioma, acoustic neuroma, and epidermoid tumors. Symptomatic trigeminal neuralgia can not be excluded even if old-aged patient does not have abnormal neurologic sign and symptom, and good response to pharmacotherapy. Therefore, initial examinations such as MRI or CT are essential to exclude symptomatic trigeminal neuralgia. When compared with CT, MRI, especially gadolinium enhanced MRI, has an increased sensitivity in the detection of intracranial lesions. The most effective medical treatment of trigeminal neuralgia is carbamazepine. The most common side effects of carbamazepine include drowsiness, dizziness, unsteadiness, nausea, anorexia. Hepatotoxicity, bone marrow depression are the most feared side effect of carbamazepine therapy but occurs rarely. It require periodic complete blood cell counts as well as hepatic and renal function tests. It has been recommended that complete blood cell counts is done every 2 weeks for the first 2months and then quaterly thereafter. Oxcarbazepine can be used if neutropenia occurs.

References

  1. Bagheri SC, Farhidvash F, Perciaccante VJ. Diagnosis and treatment of patients with trigeminal neuralgia. J Am Dent Assoc 2004;135:1713-1717 https://doi.org/10.14219/jada.archive.2004.0124
  2. Scrivani SJ, Mathews ES, Maciewicz RJ. Trigeminal neuralgia. Oral Surg Iral Med Oral Pathol Oral Radiol Endod 2005;100:527-538 https://doi.org/10.1016/j.tripleo.2005.06.004
  3. Eller JL, Raslan AM, Burchiel KJ. Trigeminal neuralgia: definition and classification. Neurosurg Focus 2005;18:E3
  4. Canavero S, Bonicalzi V. Drug therapy of trigeminal neuralgia. Expert Rev Neurother 2006;6:429-440 https://doi.org/10.1586/14737175.6.3.429
  5. Zakrzewska JM, Patsalos PN. Oxcarbazepine: a new drug in the management of intractable trigeminal neuralgia. J Neurol Neurosurg Psychiatry 1989;52: 472-476 https://doi.org/10.1136/jnnp.52.4.472
  6. Blom S. Trigeminal neuralgia: its treatment with a new anticonvulsant drug(G32883). Lancet 1962;1: 839-840
  7. Jorns TP, Zakrzewska JM. Evidence-based approach to the medical management fo trigeminal neuralgia. Br J Neurosurg 2007;21:253-261 https://doi.org/10.1080/02688690701219175
  8. Cheng TM, Cascino TL, Onofrio BM. Comprehensive study of diagnosis and treatment of trigeminal neuralgia secondary to tumors. Neurology 1993;43: 2298-2302 https://doi.org/10.1212/WNL.43.11.2298
  9. Puca A, Maglio M, Vari R, tamburrini G, Tancredi A. Evaluation of fifth nerve dysfunction in 136 patients with middle and posterior cranial fossae tumors. Eur Neurol 1995;35:33-37 https://doi.org/10.1159/000117086
  10. Matsuka Y, Fort ET, Merrill RL. Trigeminal neuralgia due to an acoustic neuroma in the cerebellopontine angle. J Orofac Pain 2000;14:147-151
  11. Okeson JP. Orofacial Pain. Guidelines for Assessment, Diagnosis, and Management. 1996, The American Academy of Orofacial Pain, pp.45-52
  12. Truini A, Galeotti F, Cruccu G. New insight into trigeminal neuralgia. J Headache Pain 2005;6:237-239 https://doi.org/10.1007/s10194-005-0195-9
  13. Yang J, Simonson TM, Ruprecht A, Meng D, Vincent SD, Yuh WTC. Magnetic resonance imaging used to assess patients with trigeminal neuralgia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 81:343-350 https://doi.org/10.1016/S1079-2104(96)80335-0
  14. Zakrzewska JM. Diagnosis and differential diagnosis of trigeminal neuralgia. Clin J Pain 2002;18:14-21 https://doi.org/10.1097/00002508-200201000-00003
  15. Barker FG 2nd, Jannetta PJ, Babu RP, Pomonis S, Bissonette DJ, Jho HD. Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors. J Neurosurg 1996;84:818-825 https://doi.org/10.3171/jns.1996.84.5.0818
  16. Okeson JP. Bell`s Orofacial Pains. 6th ed., Chicago, 2005, Quintessence Publishing Co, pp.451-457
  17. Lewis MA, Sanker V, De Laat A, Benoliel R. Management of neuropathic orofacial pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(supple):1-24 https://doi.org/10.1016/j.tripleo.2006.11.016
  18. Nomura T, Ikezaki K, Matsushima T, Fukui M. Trigeminal neuralgia: differentiation between intracranial mass lesions and ordinary vascular compression as causative lesions. Neurosurg Rev 1994;17:51-57 https://doi.org/10.1007/BF00309988
  19. Lye RH, Ramsden RT, Stack JP, Gillespie JE. Trigeminal nerve tumor: comparison of CT and MRI. J Neurosurg 1987;67:124-127 https://doi.org/10.3171/jns.1987.67.1.0124
  20. Hutchins LG, Harnsberger HR, Hardin CW, Dillon WP, Smoker WR, Osborn AG. The radiologic assessment of trigeminal neuropathy. Am J Roentgenol 1989;153:1275-1282 https://doi.org/10.2214/ajr.153.6.1275
  21. Sevick RJ, Dillon WP, Engstrom J, Bergman WG, Harnsberger HR. Trigeminal neuropathy: Gd-DTPA enhanced MR imaging. J Comput Assist Tomogr 1991;15:605-611 https://doi.org/10.1097/00004728-199107000-00015