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Updated: Feb 22, 2026
09:35
Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain
Published on: May 10, 2017
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Anticonvulsant Therapy in Trigeminal Neuralgia: A Class-Oriented Systematic Review
Miguel Pinto Moreira1, Bruno Daniel Carneiro1,2, Carlos Silva Faria3
1Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal.
Medicines (Basel, Switzerland)
|February 20, 2026
Summary
Anticonvulsants are key for trigeminal neuralgia (TN) pain. Sodium channel blockers are effective but have side effects, while other options offer better tolerability for managing this chronic facial pain.
Area of Science:
- Neurology
- Pharmacology
- Clinical Medicine
Background:
- Trigeminal Neuralgia (TN) is a debilitating chronic neuropathic condition causing severe facial pain.
- Anticonvulsants are the primary pharmacological treatment for TN.
- Comparative evidence on anticonvulsant efficacy and safety by mechanism of action is limited.
Purpose of the Study:
- To systematically review and evaluate the efficacy and safety of anticonvulsants for TN.
- To stratify findings based on the anticonvulsants' mechanisms of action.
Main Methods:
- Systematic literature search of PubMed, Scopus, and Web of Science (PRISMA 2020 guidelines).
- Inclusion of studies on human patients with TN using pharmacological treatments, published in English since 2000.
- Risk of bias assessment using Cochrane RoB 2, ROBINS-I, and ROBINS-E tools.
Main Results:
- Twelve studies met eligibility criteria from 922 initial records.
- Sodium channel inhibitors demonstrated high efficacy but frequent adverse effects (e.g., hyponatremia, CNS symptoms).
- Calcium channel modulators presented a better safety profile; levetiracetam and topiramate showed moderate efficacy and good tolerability. Sodium-channel blockers are effective but less tolerable than alternatives.
Conclusions:
- Drug selection for TN should consider the mechanism of action.
- Tailoring therapy to individual patient characteristics and pain phenotype is crucial for balancing efficacy and tolerability.
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