Medication for Trigeminal Neuralgia
The first-line treatment for TN is Medical or Pharmacologic.
Carbamazepine is considered the most proven, first-line treatment for TN( Trigeminal Neuralgia), and it’s been shown to be effective in treating the condition. Carbamazepine should be offered as the initial treatment for patients with TN. Oxcarbazepine has also been shown to be effective for treating patients with TN.
Doctors usually prescribe carbamazepine (Tegretol, Carbatrol, others) for trigeminal neuralgia. Other anticonvulsant drugs that may be used to treat trigeminal neuralgia include oxcarbazepine (Trileptal).
Gabapentin and Pregabalin as an add-on agent for patients already taking carbamazepine or oxcarbazepine.
BOTULINUM TOXIN/ OnabotulinumtoxinA
OnabotulinumtoxinA is a neurotoxin derived from Clostridium botulinum. The mechanism involves inhibition of the release of acetylcholine at the neuromuscular junctions, resulting in reduced muscle contraction, mitigation of peripheral sensitization, and, secondarily, suppression of central sensitization, to relieve pain and twitching
The main problem with treating TN patients with AEDs, even if they are tolerated initially, is that the treatment does not address the vascular compression cause present in 95% of patients, nor the fact that TN is a progressive syndrome.
Therefore the usual result is that, over time, patients require a higher and higher medication dose to achieve the same degree of pain relief, until a point is reached, at which either the medication no longer controls the syndrome or the patient can no longer tolerate the medication side effects.
Surgery for Trigeminal Neuralgia
Surgical interventions are divided into Nonablative (nondestructive) procedures and Ablative (destructive).
Posterior Fossa Exploration / Microvascular decompression (MVD)
Posterior Fossa Exploration: Microvascular Decompression and Partial Sensory Rhizotomy Exploration of the trigeminal root in the posterior fossa is a major operation with a 0.2–0.5% risk for mortality and major morbidity.
By a retrosigmoid posterior fossa approach, in which a blood vessel in contact with the trigeminal nerve is dissected free and prevented from re-impinging on the nerve by placing a Teflon pad between the two structures or by transposing the vessel to a different position.
This operation preserves the anatomical integrity of the trigeminal nerve, as well as its function in most cases. Posterior fossa microsurgery, whether performed by microvascular decompression (MVD) or partial sensory rhizotomy, is the most effective treatment of typical TN and has provided complete pain relief in 73% of patients at 5 years
Peripheral nerve stimulation
Motor cortex stimulation
Lesioning (chemical, thermal, or mechanical destruction of the trigeminal nerve)