Journal

Trigeminal Neuralgia : An
overview of Literature with
Emphasis on Medical
Management

Nurul Hildayanti Ilyas, S.Ked

Dewi Nurfadilah, S.Ked

Pembimbing : dr. Hj. Siti Nurhani, Sp. S

Historical Background
• A.D Jujani, an Arab physician First century
• Nicolas Andre in 1756 tic douloureux
• John Fothergill in 1773 Fothergill’s disease
• Pujol, Chapman, & Tiffany 18th & 19th century
Epidemiology
• Middle and old age
• >>> women
• USA 100.000 inhibitants per year is 2,7 for
men dan 5,0 for women
• 1% with multiple sclerosis
Diagnostic criteria
Etio-pathogenesis
• Vascular compression of the trigeminal root
• Damage of the myelin sheath
• Injury to trigeminal nerve
• Unknown
Diagnosis
• Anamnesis
• Physical examination
• MRI
Differential Diagnosis
• TMJ disorder
• Dental disorder
• Vascular migraine
• Cluster headache
• Cracked tooth syndrome
• Post herpetic neuralgia
Treatment
• Medication
• Surgical procedure
• Other : TENS, Acupunture, psychological methods
• Carbamazepine (Tegretol)
Anticonvulsants, Drug of choice for TN,
The mechanism of action may be related to its ability to
block voltage sensitive sodium channels which result in
stabilization of the hyperexcitable trigeminal neural
membranes.
Dosage used may range from 100 mg to 1200 mg per day,
most patients respond to 200 to 800 mg per day in two-three
divided doses
Side effect : drowsiness, dizziness, confusion, vertigo,
nausea, vomiting

• Oxycarbazepine (Trileptal)
Alternative in patients who do not tolerate carbamazepine
Side effect : vertigo, dizziness, ataxia, fatigue
• Baclofen (Lioresal)
A muscle relaxant and antispastic
Initial dose : 5 mg tid for three days, increased to 10 to
20 mg/day every 3 days, max : 50 to 60 mg/day
Side effect : drowsiness, dizziness, weakness, fatigue,
nausea
• Phenytoin (Dilantin)
An antiepileptic agent
Side effect : ataxia, slurred speech, decreased
coordination, nausea
Initial dose : 100 mg twice or thrice daily, max : 800 mg
• Lamotrigine
 A phenyltriazine derivative for the treatment of partial and
generalized tonic clonic seizures
 It acts as a volatage sensitive sodium channel and stabilizes
neural membranes
• Gabapentin (Neurontin)
 An antiepileptic drug
 Dose : 900 mg/day (300 mg/d on day 1, 600 mg/d on day 2, 900
mg/d on day 3), max : 1800 mg/d
 Side effect : dizziness, coordination problems, infections, nausea,
vomiting
• Pregabalin
• Topiramate
• Miscellaneous Drugs
• Surgical Treatment
1) Microvascular decompression
2) Ablative procedures :
 Percutaneous radiofrequency thermal rhizotomy
 Glycerol rhizolysis
 Balloon compression of trigeminal ganglion
3) Gamma knife radiosurgery
4) Other procedures-neurectomy, cryotherapy, and
alcohol injections
Conclusion
TN is a common neuropathic pain characterized by
paroxysmal pain, along the distribution of trigeminal
nerve. Diagnosis is made clinically by characteristic signs
and symptoms. Anticonvulsants form the mainstay of
treatment and surgery is considered when medicinal
therapy fails.
THANK YOU