Management of trigeminal neuralgia: A multi-centre case study in general practice

Area of Science:

• Neurology
• Epidemiology
• Primary Care Medicine

Background:

• Trigeminal neuralgia (TN) diagnosis and management in primary care often lack adherence to guidelines.
• Up-to-date UK prevalence data for TN is scarce.
• Primary care physicians are frequently the first point of contact for patients with TN symptoms.

Purpose of the Study:

• To estimate the prevalence of trigeminal neuralgia (TN) in the UK.
• To audit the diagnosis and management of TN in primary care settings.
• To assess adherence to diagnostic criteria and treatment guidelines for TN.

Main Methods:

• A retrospective review of patient records from five UK general practitioner (GP) practices (total population 55,842) between 2019 and 2020.
• Identification of patients coded with trigeminal neuralgia (TN) or facial pain (FP) using EMIS and SystmOne systems.
• Analysis of diagnostic basis, primary care management, and secondary care referral patterns.

Main Results:

• A prevalence of 22.3 per 10,000 was estimated for TN.
• Only seven patients met all diagnostic criteria, with two confirmed for TN.
• Carbamazepine was prescribed to 58.8% of TN patients, and 38.2% were referred to specialists.

Conclusions:

• The actual prevalence of TN might be higher than previously reported.
• Omission of key diagnostic criteria is common, potentially leading to misdiagnosis or delayed diagnosis.
• Referral rates for TN patients are low, despite the recommendation for imaging consideration.