Title: The Painful Twitch - Trigeminal Neuralgia<br/>Author: WanTsu Wendy Chang<br/><a href='http://umem.org/profiles/faculty/1322/'>[Click to email author]</a><hr/><ul>
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<span style="font-size:14px;">Trigeminal neuralgia is diagnosed by:</span>
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<span style="font-size:14px;">Pain in 1 or more divisions of the trigeminal nerve</span></li>
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<span style="font-size:14px;">Paroxysms of pain that are sudden, intense, usually few seconds in duration</span></li>
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<span style="font-size:14px;">Pain triggered by innocuous stimuli in the trigeminal nerve territory (91-99% patients)</span></li>
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<span style="font-size:14px;"><em>24-49% of patients experience continuous or long-lasting pain</em></span></li>
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<span style="font-size:14px;">Exam may reveal forceful contraction of the facial muscles during a paroxysm (tic convulsif)</span></li>
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<span style="font-size:14px;">Causes include:</span>
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<span style="font-size:14px;">Intracranial vascular compression of the trigeminal nerve root (most common)</span></li>
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<span style="font-size:14px;">Multiple sclerosis, cerebellopontine angle tumor</span></li>
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<span style="font-size:14px;">Idiopathic (10% of cases)</span></li>
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<span style="font-size:14px;">Carbamazepine and oxcarbazepine are first-line treatments</span>
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<span style="font-size:14px;">They may be poorly tolerated due to side effects including dizziness, diplopia, ataxia, CNS depression, and hyponatremia</span></li>
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<span style="font-size:14px;">They also have limited efficacy on continuous pain</span></li>
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<span style="font-size:14px;">Acute exacerbations may warrant admission for hydration, acute pain control, and titration of antiepileptic drugs</span>
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<span style="font-size:14px;">Botulinum toxin A was recently added as a treatment option</span></li>
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<span style="font-size:14px;"><u>Bottom Line</u>: New onset trigeminal neuralgia needs workup for its etiology. Carbamazepine and oxcarbazepine can be effective for symptom management though continuous or long-lasting pain exacerbations are difficult to treat.</span></p>
<fieldset><legend>References</legend>
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Cruccu G, Di Stefano G, Truini A. Trigeminal neuralgia. <em>N Engl J Med</em>. 2020;383(8):754-62.</li>
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Bendtsen L, Zakrzewska JM, Heinskou TB, <em>et al</em>. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. <em>Lancet Neurol</em>. 2020;19(9):784-96.</li>
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