Oomens M A E-M, Forouzanfar T
Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
Drugs Aging. 2015 Sep;32(9):717-26. doi: 10.1007/s40266-015-0293-6.
Classical trigeminal neuralgia (CTN) is a severe neuropathic pain in the distribution of one or more branches of the trigeminal nerve, which occurs in recurrent episodes, causing deterioration in quality of life, affecting everyday habits and inducing severe disability. The aim of this review is to give an overview of the current literature on pharmaceutical treatment options for CTN in the elderly. The first-line treatment for the management of CTN in adults is an antiepileptic-carbamazepine or oxcarbazepine. There is a lack of research on the use of antiepileptics in the elderly. This is a deficiency, as the use of antiepileptics raises a number of problems due to the polypharmacotherapy common in older patients. This can induce drug interactions due to co-morbidities and changes in pharmacokinetics and pharmacodynamics. Furthermore, the side effects of carbamazepine include central nervous system disturbances, such as a lack of balance, dizziness, somnolence, renal dysfunction and cardiac arrhythmias, which are poorly tolerated by the elderly. Unfortunately, the efficacy and safety of alternative treatment options have not been systematically evaluated. On the basis of the current literature, it is not possible to give an evidence-based recommendation for first-line pharmaceutical management of CTN specifically for the elderly.
经典三叉神经痛（CTN）是一种在三叉神经一个或多个分支分布区域的严重神经性疼痛，呈反复发作，导致生活质量下降，影响日常习惯并引发严重残疾。本综述的目的是概述目前关于老年CTN药物治疗选择的文献。成人CTN管理的一线治疗是抗癫痫药物——卡马西平或奥卡西平。关于老年人使用抗癫痫药物的研究较少。这是一个不足之处，因为由于老年患者常见的多药治疗，使用抗癫痫药物会引发一些问题。这可能由于合并症以及药代动力学和药效学的变化而导致药物相互作用。此外，卡马西平的副作用包括中枢神经系统紊乱，如平衡失调、头晕、嗜睡、肾功能障碍和心律失常，而老年人对这些副作用耐受性较差。不幸的是，替代治疗选择的疗效和安全性尚未得到系统评估。根据目前的文献，无法针对老年CTN的一线药物管理给出基于证据的建议。
