title: Refractory trigeminal neuralgia. Non-surgical treatment options.
abstract: The guidelines on trigeminal neuralgia management published by the American Academy of Neurology (AAN) and the European Federation of Neurological Societies (EFNS) recommended that patients unresponsive to carbamazepine or oxcarbazepine be offered the surgical option. However, because some patients may not be willing to resort to surgery, we searched the literature for treatment in refractory trigeminal neuralgia. We found other oral treatments, intranasal spray, subcutaneous injections, various kinds of peripheral nerve blocks and injections of botulinum toxin. On the basis of the available evidence we suggest that no oral treatment other than carbamazepine or oxcarbazepine is useful. Among the other options, there is increasingly strong evidence that botulinum toxin injections are efficacious and may be offered before surgery or to those unwilling to undergo surgery.
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University, Viale Università 30, 00185, Rome, Italy. cruccu@uniroma1.it
authors.forename: Giorgio
authors.initials: G
authors.lastname: Cruccu
authors.forename: Andrea
authors.initials: A
authors.lastname: Truini
mesh_terms: D001905:Botulinum Toxins / Q000627:therapeutic use; D002220:Carbamazepine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018592:Cross-Over Studies; D004311:Double-Blind Method; D006801:Humans; D000078330:Oxcarbazepine; D016032:Randomized Controlled Trials as Topic; D014277:Trigeminal Neuralgia / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*
chemical_list: D002220:Carbamazepine; D001905:Botulinum Toxins; D000078330:Oxcarbazepine