Author:
Di Stefano Giulia,La Cesa Silvia,Truini Andrea,Cruccu Giorgio
Abstract
Abstract
Background
The guidelines on trigeminal neuralgia management that have been agreed and jointly published by the American Academy of Neurology and the European Federation of Neurological Societies recommend carbamazepine (CBZ) and oxcarbazepine (OXC) as the first-choice medical treatments in patients with trigeminal neuralgia (TN). The aim of this retrospective study was to analyze the natural history of classical trigeminal neuralgia in a large cohort of patients, focusing on drug responsiveness, side effects related to CBZ and OXC, and changes in pain characteristics during the course of disease.
Findings
We selected the last 100 consecutive patients with typical TN who began treatment with CBZ and the last 100 with OXC. All had MRI scans and a complete neurophysiological study of trigeminal reflexes. Among them, 22 were excluded on the basis of neuroradiological or neurophysiological investigations, to avoid the inclusion of patients with possible secondary TN. The initial number of responders was 98% with CBZ with a median dose of 600 mg (range 200–1200), and of 94% with OXC, with a median dose of 1200 mg (range 600–1800). In a mean period of 8.6 months, 27% of responders to CBZ incurred in undesired effects to a level that caused interruption of treatment or a dosage reduction to an unsatisfactory level. In a mean period of 13 months, the same occurred to 18% of responders to OXC. Among patients who had a good initial response, only 3 patients with CBZ and 2 with OXC developed late resistance. During the course of disease, paroxysms worsened in intensity in 3% of patients, and paroxysms duration increased in 2%. We did not observe the onset of a clinically manifest sensory deficit at any time in any patient.
Conclusions
Unlike common notion, in our large patient sample the worsening of pain with time and the development of late resistance only occurred in a very small minority of patients. CBZ and OXC were confirmed to be efficacious in a large majority of patients, but the side effects caused withdrawal from treatment in an important percentage of patients. These results suggest the opportunity to develop a better tolerated drug.
Publisher
Springer Science and Business Media LLC
Subject
Anesthesiology and Pain Medicine,Neurology (clinical),General Medicine
Reference25 articles.
1. Merskey H, Bogduk N: Task Force on Taxonomy of the International Association for the Study of Pain: Classification of Chronic Pain. Description of Pain Syndromes and Definitions of Pain Terms. IASP Press, Seattle; 1994:212.
2. Headache Classification Subcommittee of the International Headache Society: The international classification of headache disorders. Cephalalgia 2004, 24(Suppl 1):1–160.
3. Rasmussen P: Facial pain. IV. A prospective study of 1052 patients with a view of: precipitating factor, associated symptoms, objective psychiatric and neurological symptoms. Acta Neurochir (Wien) 1991, 108: 100–109. 10.1007/BF01418516
4. Cruccu G, Iannetti GD, Marx JJ, Thoemke F, Truini A, Fitzek S, Galeotti F, Urban PP, Romaniello A, Stoeter P, Manfredi M, Hopf HC: Brainstem reflex circuits revisited. Brain 2005, 128: 386–394.
5. Herweh C, Kress B, Rasche D, Tronnier V, Tröger J, Sartor K, Stippich C: Loss of anisotropy in trigeminal neuralgia revealed by diffusion tensor imaging. Neurology 2007, 68: 776–778. 10.1212/01.wnl.0000256340.16766.1d
Cited by
123 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献