Trigeminal neuralgia: Difference between revisions
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==Clinical Findings== | == Clinical Findings == | ||
*Paroxysms of severe unilateral pain in trigeminal nerve distribution lasting only seconds | |||
*Normal neuro exam | *Paroxysms of severe unilateral pain in trigeminal nerve distribution lasting only seconds | ||
*Normal neuro exam | |||
*No pain between paroxysms | *No pain between paroxysms | ||
==Treatment== | == Treatment == | ||
*Carbamazepine | |||
Phenytoin 250 mg IV to abort an acute attack | |||
*Relief lasts from four hours to three days | |||
* Fosphenytoin seems to work similarly15 | |||
Carbamazepine | |||
*First-line agent with 75% success rate initially | |||
*Proposed Mechanism: Decreases the response of neurons to peripheral stimulation | |||
*Started at 100 mg one to two times per day | |||
*Increase by 100-200 mg every 3 days | |||
*Usual maintenance dose is 400-800 mg (rare > 1500 mg) | |||
*Pain relief occurs within several hours to days (94% within 48<br>hours) | |||
*Target serum concentration is 24-43 μmol/L | |||
**If unsuccessful, phenytoin 200-400 mg/day is used in combination | |||
*Other agents: Baclofen, Clonazepam, Valproic acid, Lamotrigine, Gabapentin, Oxcarbazepine, Topiramate | |||
*Posterior fossa microvascular decompressive surgery | |||
**Approximately 50% of patients will require surgery | |||
Successful in 70% of patients16 | |||
== Source == | |||
Tintinalli | |||
Tintinalli | |||
J Pain Symptom Manage 2001; 21(6):506-510. | |||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 01:01, 1 September 2012
Clinical Findings
- Paroxysms of severe unilateral pain in trigeminal nerve distribution lasting only seconds
- Normal neuro exam
- No pain between paroxysms
Treatment
Phenytoin 250 mg IV to abort an acute attack
- Relief lasts from four hours to three days
- Fosphenytoin seems to work similarly15
Carbamazepine
- First-line agent with 75% success rate initially
- Proposed Mechanism: Decreases the response of neurons to peripheral stimulation
- Started at 100 mg one to two times per day
- Increase by 100-200 mg every 3 days
- Usual maintenance dose is 400-800 mg (rare > 1500 mg)
- Pain relief occurs within several hours to days (94% within 48
hours) - Target serum concentration is 24-43 μmol/L
- If unsuccessful, phenytoin 200-400 mg/day is used in combination
- Other agents: Baclofen, Clonazepam, Valproic acid, Lamotrigine, Gabapentin, Oxcarbazepine, Topiramate
- Posterior fossa microvascular decompressive surgery
- Approximately 50% of patients will require surgery
Successful in 70% of patients16
Source
Tintinalli
J Pain Symptom Manage 2001; 21(6):506-510.