title: Trigeminal Neuralgia: Toward a Multimodal Approach.
abstract: OBJECTIVE
  Trigeminal neuralgia (TN) is the most common cranial neuralgia in adults, with a slight prevalence in women. Antiepileptic drugs represent the mainstay of the medical treatment, whereas microvascular decompression is the best option in case of neurovascular conflict. Although these treatments showed a good rate of efficacy, they can be contraindicated in some patients and >50% of patients undergoing these treatments will present recurrence of pain in the following months. In this majority of patients, pain becomes chronic and can severely affect their quality of life and cause cognitive disturbances, such as anxiety and depression.
  
  
  METHODS
  The purpose of this study was to review the efficacy and safety of current treatment modalities for TN, as well as to propose a multimodal approach for those patients presenting with a chronic form of TN.
  
  
  RESULTS
  Current treatment modalities have been reviewed. Actual pain evaluation systems and the neuropsychologic features of TN have been analyzed in order to propose an alternative treatment algorithm.
  
  
  CONCLUSIONS
  Chronic pain can also lead to the misperception of patients' own selves leading to enhanced pain perception and altering therapeutic outcomes. Thus, there is the need to define a personalized multimodal approach of treatment, taking into account other available TN therapies and the neuropsychologic aspect of chronic pain.
authors.affiliation: Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy. Electronic address: spina.alfio@hsr.it.
authors.forename: Alfio
authors.initials: A
authors.lastname: Spina
authors.affiliation: Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Mortini
authors.affiliation: Department of Clinical Neuroscience, Specialistic Neurorehabilitation of Neurological, Cognitive and Motor Disorders, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Alemanno
authors.affiliation: Department of Clinical Neuroscience, Specialistic Neurorehabilitation of Neurological, Cognitive and Motor Disorders, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Elise
authors.initials: E
authors.lastname: Houdayer
authors.affiliation: Department of Clinical Neuroscience, Specialistic Neurorehabilitation of Neurological, Cognitive and Motor Disorders, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Iannaccone
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D001007:Anxiety / Q000523:psychology; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D003131:Combined Modality Therapy; D046690:Deep Brain Stimulation / Q000379:methods; D003863:Depression / Q000523:psychology; D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D061145:Microvascular Decompression Surgery / Q000379:methods*; D009465:Neuromuscular Agents / Q000627:therapeutic use; D019635:Neurosurgical Procedures; D011788:Quality of Life; D016634:Radiosurgery / Q000379:methods*; D019051:Rhizotomy / Q000379:methods*; D050781:Transcranial Magnetic Stimulation / Q000379:methods; D014277:Trigeminal Neuralgia / Q000523:psychology / Q000628:therapy*
chemical_list: D000927:Anticonvulsants; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Microvascular decompression; Quality of life; Radiosurgery; Trigeminal neuralgia; Trigeminal neuropathic pain