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Year : 2021  |  Volume : 69  |  Issue : 7  |  Page : 199--205

Medical Management of Trigeminal Neuralgia

1 Department of Neurology, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India
2 Associate Consultant Neurologist , Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India

Correspondence Address:
Dr. Satish V Khadilkar
Dean's Office, First Floor, Bombay Hospital, 12 New Marine Lines, Mumbai - 400 020, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.315996

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Background: Trigeminal neuralgia (TN) is a painful condition, often leading to poor quality of life. Objective: The aim of this review was to discuss the various treatment modalities for the medical management of TN. Materials and Methods: We reviewed the available literature on TN in clinical databases including PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews, with a specific focus on the pharmacological treatment and newer drugs under development for the treatment of TN. Results: Carbamazepine (CBZ) is the gold standard of treatment for TN. The first-line drugs for the treatment of TN are CBZ and oxcarbazepine (OXC). A proportion of cases (30%) are initially resistant to the first-line drugs. Alternative drugs need to be considered if the first-line drugs are not well tolerated or become ineffective with prolonged therapy. The second-line drugs comprise lamotrigine, baclofen, gabapentin, and pregabalin used as monotherapy or in combination with CBZ/OXC. Botulinum toxin A may be a promising presurgical option. Newer drug like vixotrigine has shown good results in phase two randomized control trials. About 50% of cases develop treatment resistance to oral drugs over the subsequent years of therapy and require surgical options. Conclusion: The first-line drugs for the treatment of TN (irrespective of the age group or type) are CBZ and OXC. Combination therapy with second-line or other drugs may become necessary with poor response to CBZ/OXC, or if adverse events occur. Patients should be offered surgical options if there is poor response or tolerance to the medical therapy.


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