Jorns T P, Zakrzewska J M
Barts and the London, Queen Mary's School of Medicine and Dentistry, London, UK.
Br J Neurosurg. 2007 Jun;21(3):253-61. doi: 10.1080/02688690701219175.
Classical trigeminal neuralgia (TN) is a rare neuropathic pain with distinct diagnostic criteria. The aim of this review is to provide recommendations for medical management based on current evidence and provide some pointers on the conduct of future trials. A review of the literature identified four systematic reviews, of which one was a meta-analysis and 18 randomized controlled trials (RCT) on medical management of trigeminal neuralgia. The evidence suggests that carbamazepine is still the first line drug for medical management, but this should be changed to oxcarbazepine if there is poor efficacy and an unacceptable side effect profile. Combination of carbamazepine with lamotrigine or baclofen is the second line treatment when monotherapy fails, but the evidence is weak. An early neurosurgical opinion should be sought when a patient has a neurovascular contact of the trigeminal nerve, poor efficacy and tolerability of drug treatment and no remission periods. Many of the new antiepileptic drugs need to be evaluated in RCTs with innovative designs and robust outcome measures.
经典三叉神经痛（TN）是一种具有独特诊断标准的罕见神经性疼痛。本综述的目的是基于当前证据为药物治疗提供建议，并为未来试验的开展提供一些指导。对文献的回顾确定了四项系统评价，其中一项是荟萃分析，以及18项关于三叉神经痛药物治疗的随机对照试验（RCT）。证据表明，卡马西平仍是药物治疗的一线药物，但如果疗效不佳且副作用难以接受，则应改为奥卡西平。当单药治疗失败时，卡马西平与拉莫三嗪或巴氯芬联合使用是二线治疗，但证据不足。当患者存在三叉神经的神经血管接触、药物治疗疗效和耐受性差且无缓解期时，应尽早寻求神经外科意见。许多新型抗癫痫药物需要在具有创新设计和可靠结局指标的随机对照试验中进行评估。
