Trigeminal neuralgia.

Autor: Ashina S; BIDMC Comprehensive Headache Center, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA. sashina@bidmc.harvard.edu.; BIDMC Comprehensive Headache Center, Department of Anaesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA. sashina@bidmc.harvard.edu.; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. sashina@bidmc.harvard.edu., Robertson CE; Department of Neurology, Mayo Clinic, Rochester, MN, USA., Srikiatkhachorn A; Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand., Di Stefano G; Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy., Donnet A; Department of Evaluation and Treatment of Pain, FHU INOVPAIN, Centre Hospitalier Universitaire de Marseille, Hopital de la Timone, Assistance Publique-Hopitaux de Marseille, Marseille, France., Hodaie M; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontairo, Canada., Obermann M; Department of Neurology, Hospital Weser-Egge, Hoexter, Germany.; Department of Neurology, University Hospital Essen, Essen, Germany., Romero-Reyes M; Department of Pain and Neural Sciences, Brotman Facial Pain Clinic, University of Maryland, School of Dentistry, Baltimore, MD, USA., Park YS; Department of Medical Neuroscience, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.; Department of Neurosurgery, Gamma Knife Icon Center, Chungbuk National University Hospital, Cheongju, Republic of Korea., Cruccu G; Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy., Bendtsen L; Department of Neurology, Mayo Clinic, Rochester, MN, USA.; Department of Neurology, University of Copenhagen, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Glostrup, Copenhagen, Denmark.
Jazyk: angličtina
Zdroj: Nature reviews. Disease primers [Nat Rev Dis Primers] 2024 May 30; Vol. 10 (1), pp. 39. Date of Electronic Publication: 2024 May 30.
DOI: 10.1038/s41572-024-00523-z
Abstrakt: Trigeminal neuralgia (TN) is a facial pain disorder characterized by intense and paroxysmal pain that profoundly affects quality of life and presents complex challenges in diagnosis and treatment. TN can be categorized as classical, secondary and idiopathic. Epidemiological studies show variable incidence rates and an increased prevalence in women and in the elderly, with familial cases suggesting genetic factors. The pathophysiology of TN is multifactorial and involves genetic predisposition, anatomical changes, and neurophysiological factors, leading to hyperexcitable neuronal states, central sensitization and widespread neural plasticity changes. Neurovascular compression of the trigeminal root, which undergoes major morphological changes, and focal demyelination of primary trigeminal afferents are key aetiological factors in TN. Structural and functional brain imaging studies in patients with TN demonstrated abnormalities in brain regions responsible for pain modulation and emotional processing of pain. Treatment of TN involves a multifaceted approach that considers patient-specific factors, including the type of TN, with initial pharmacotherapy followed by surgical options if necessary. First-line pharmacological treatments include carbamazepine and oxcarbazepine. Surgical interventions, including microvascular decompression and percutaneous neuroablative procedures, can be considered at an early stage if pharmacotherapy is not sufficient for pain control or has intolerable adverse effects or contraindications.
(© 2024. Springer Nature Limited.)
Databáze: MEDLINE
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