Trigeminal neuralgia. Pathophysiology and treatment

Area of Science:

• Neurology
• Neurosurgery
• Pain Medicine

Background:

• Trigeminal neuralgia (TN), or tic douloureux, is characterized by paroxysmal, severe facial pain.
• Often idiopathic, TN is increasingly attributed to neurovascular conflict involving the trigeminal nerve root.
• Potential underlying causes include multiple sclerosis, tumors, or lesions impinging on the trigeminal nerve pathway.

Purpose of the Study:

• To review the current understanding of trigeminal neuralgia pathophysiology.
• To discuss available therapeutic options, including pharmacological and surgical interventions.
• To propose guidelines for managing trigeminal neuralgia.

Main Methods:

• Review of existing literature on trigeminal neuralgia.
• Analysis of neuroimaging data supporting the neurovascular conflict hypothesis.
• Evaluation of the efficacy and side effects of current treatments.

Main Results:

• The neurovascular conflict hypothesis, where an artery compresses the trigeminal nerve root, is the prevailing theory.
• This compression can cause localized demyelination and ectopic neuronal discharges, leading to pain.
• Antiepileptic drugs offer relief, aligning with the neurovascular conflict theory.

Conclusions:

• Trigeminal neuralgia is often caused by an artery compressing the trigeminal nerve root, leading to demyelination.
• While effective drugs exist, many patients experience inadequate relief or significant side effects.
• Surgical options are available, and guidelines are proposed for treatment selection.