Trigeminal neuralgia.
Sait AshinaCarrie E RobertsonAnan SrikiatkhachornGiulia Di StefanoAnne DonnetMojgan HodaieMark ObermannMarcela Romero-ReyesYoung Seok ParkGiorgio CruccuLars BendtsenPublished in: Nature reviews. Disease primers (2024)
Trigeminal neuralgia (TN) is a facial pain disorder characterized by intense and paroxysmal pain that profoundly affects quality of life and presents complex challenges in diagnosis and treatment. TN can be categorized as classical, secondary and idiopathic. Epidemiological studies show variable incidence rates and an increased prevalence in women and in the elderly, with familial cases suggesting genetic factors. The pathophysiology of TN is multifactorial and involves genetic predisposition, anatomical changes, and neurophysiological factors, leading to hyperexcitable neuronal states, central sensitization and widespread neural plasticity changes. Neurovascular compression of the trigeminal root, which undergoes major morphological changes, and focal demyelination of primary trigeminal afferents are key aetiological factors in TN. Structural and functional brain imaging studies in patients with TN demonstrated abnormalities in brain regions responsible for pain modulation and emotional processing of pain. Treatment of TN involves a multifaceted approach that considers patient-specific factors, including the type of TN, with initial pharmacotherapy followed by surgical options if necessary. First-line pharmacological treatments include carbamazepine and oxcarbazepine. Surgical interventions, including microvascular decompression and percutaneous neuroablative procedures, can be considered at an early stage if pharmacotherapy is not sufficient for pain control or has intolerable adverse effects or contraindications.
Keyphrases
- neuropathic pain
- chronic pain
- pain management
- early stage
- spinal cord injury
- risk factors
- squamous cell carcinoma
- physical activity
- atrial fibrillation
- gene expression
- high resolution
- genome wide
- minimally invasive
- dna methylation
- radiation therapy
- multiple sclerosis
- lymph node
- brain injury
- mass spectrometry
- cerebral ischemia
- blood brain barrier
- subarachnoid hemorrhage
- pregnancy outcomes
- photodynamic therapy
- replacement therapy
- cervical cancer screening