Trigeminal neuralgia: historical notes and current concepts.
BACKGROUND
Trigeminal neuralgia is a syndrome of paroxysmal excruciating, lancinating unilateral facial pain.


RESULTS
There are several clinical features that are characteristic of trigeminal neuralgia, but there may be red flags that should suggest alternative diagnoses. There is convincing evidence that the idiopathic form develops from focal demyelination at the trigeminal root entry zone with subsequent ephaptic cross-talk between axons. Vascular compression of the nerve root causes this demyelination in most patients. Medical management of this condition, using anticonvulsant therapy and other agents, aims to dampen the abnormal electrical signals and to ameliorate symptoms. In refractory cases, a number of surgical interventions can be considered, the most common of which is microvascular decompression of the trigeminal nerve. Gamma knife therapy is emerging as an alternative treatment for the patient with medically refractive trigeminal neuralgia, particularly in the elderly patient with comorbid conditions.


CONCLUSIONS
Knowledge of the proper diagnosis and management of trigeminal neuralgia is essential to the successful management of these patients.
Prasad
Sashank
S
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. sashank.prasad@uphs.upenn.edu
Galetta
Steven
S
D049671:History, 18th Century; D049672:History, 19th Century; D049674:History, 21st Century; D006801:Humans; D016634:Radiosurgery / Q000379:methods; D014276:Trigeminal Nerve / Q000473:pathology / Q000601:surgery / Q000648:ultrastructure; D014277:Trigeminal Neuralgia / Q000266:history* / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy