The Headache Service, Pain Management and Neuromodulation Centre, Guy's and St Thomas' Hospitals NHS Trust, London, UK.
Facial Pain Clinic, Eastman Dental Hospital, London, UK.
Pract Neurol. 2021 Oct;21(5):392-402. doi: 10.1136/practneurol-2020-002782. Epub 2021 Jun 9.
Trigeminal neuralgia (TN) is a highly disabling disorder characterised by very severe, brief and electric shock like recurrent episodes of facial pain. New diagnostic criteria, which subclassify TN on the basis of presence of trigeminal neurovascular conflict or an underlying neurological disorder, should be used as they allow better characterisation of patients and help in decision-making regarding medical and surgical treatments. MR imaging, including high-resolution trigeminal sequences, should be performed as part of the diagnostic work-up. Carbamazepine and oxcarbazepine are drugs of first choice. Lamotrigine, gabapentin, pregabalin, botulinum toxin type A and baclofen can be used either alone or as add-on therapy. Surgery should be considered if the pain is poorly controlled or the medical treatments are poorly tolerated. Trigeminal microvascular decompression is the first-line surgery in patients with trigeminal neurovascular conflict while neuroablative surgical treatments can be offered if MR imaging does not show any neurovascular contact or where patients are considered too frail for microvascular decompression or do not wish to take the risk.
三叉神经痛（TN）是一种高度致残性疾病，其特征为非常剧烈、短暂且类似电击样的反复发作的面部疼痛。新的诊断标准应根据三叉神经与血管的冲突或潜在的神经障碍对 TN 进行分类，因为它们可以更好地对患者进行特征描述，并有助于在药物和手术治疗方面做出决策。磁共振成像（MRI），包括高分辨率三叉神经序列，应作为诊断工作的一部分进行。卡马西平（carbamazepine）和奥卡西平（oxcarbazepine）是首选药物。拉莫三嗪（lamotrigine）、加巴喷丁（gabapentin）、普瑞巴林（pregabalin）、A型肉毒毒素（botulinum toxin type A）和巴氯芬（baclofen）可单独使用或作为附加治疗。如果疼痛控制不佳或药物治疗不耐受，则应考虑手术。对于存在三叉神经与血管冲突的患者，三叉神经微血管减压术是一线手术；如果 MRI 未显示任何神经血管接触，或者患者因身体虚弱不能接受微血管减压术或不愿承担手术风险，则可以提供神经破坏性手术治疗。
