Trigeminal neuralgia

Question 1

Definition of trigeminal neuralgia (1)

Answer 1

‘- a sudden, unilateral, severe, brief stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial
nerve’ IASP

Question 2

Incidence of trigeminal neuralgia (7)

Answer 2

 Point prevalence 0.001
 Incidence approx 3-5 per 100,000 of
the population
 Women >men
 Age 50 years plus
 Unilateral
 Idiopathic
 Secondary

Question 3

Presentation of trigeminal neuralgia (5)

Answer 3

 Unilateral, sharp shooting pain; severity
10/10
-lightening
-knife being twisted
-electric shock
 Triggered –eating, talking, washing
 Paroxysms
 Day > night
 Remission

Question 4

Associations with trigeminal neuralgia (3)

Answer 4

 Depression
 Suicidal
 Isolated

Question 5

Pathophysiology of trigeminal neuralgia (1)

Answer 5

Local demyelination of the trigeminal root

Question 6

Management of trigeminal neuralgia (2)

Answer 6

Medical

Surgical

Question 7

Management of trigeminal neuralgia - surgery (4)

Answer 7

• microvascular decompression
• ganglion procedures
• stereotactic radiosurgery
• cryoanalgesia

Question 8

Management of trigeminal neuralgia - medication (6)

Answer 8

Sodium channel blockers
 Carbamazepine
 Oxcarbazepine
 Lamotrigine
Gabapentin/Pregabalin
Baclofen
Valproate

Question 9

Trigeminal neuralgia - management: carbamazepine (Tegretol) dosage and side effects (6)

Answer 9

Dosage
-twice daily (carbamazepine retard)
-increase dose gradually
Side effects
-rash 8%
-ataxia and somnolence
-dyscrasia (rare)
-drug interactions - warfarin etc.

Question 10

Surgical management of trigeminal neuralgia (4)

Answer 10

Microvascular decompression
Ganglion procedures
Stereotactic radiosurgery
Cryoanalgesia

Question 11

Microvascular decompressions - management of trigeminal neuralgia (2)

Answer 11

> 80% complete pain relief - often life long

Morbidity - CSF leaks, meningitis, cranial nerve deficits

Question 12

Ganglion procedure - management of trigeminal neuralgia (5)

Answer 12

The needle is inserted through foramen ovale into the ganglion
-compression balloon
-glycerol injection
-thermocoagulation
General anaesthesia
Sensory deficit

Question 13

Cryoanalgesia - management of trigeminal neuralgia (3)

Answer 13

Recovery and recurrence of the pain
Fibrosis
Sensory deficit

Question 14

Stereotactic radiosurgery audit (4)

Answer 14

Delay in pain relief
Failure of treatment
20-30% of patients get some paraesthesia
Recurrence of pain