What are the guideline sources, guidelines and references for Trigeminal neuralgia ?
Guideline sources The following summarized guidelines for the evaluation and management of trigeminal neuralgia are prepared by our editorial team based on guidelines from the European Academy of Neurology (EAN 2019). 1 Guidelines 1. Screening and diagnosis Etiology: recognize that idiopathic trigeminal neuralgia is moderately associated with neuromuscular compression without morphological changes, whereas classical trigeminal neuralgia is highly associated with neuromuscular compression with morphological changes. A 2. Diagnostic investigations Physical examination: do not use clinical characteristics to exclude secondary trigeminal neuralgia. D Magnetic resonance imaging: Use MRI as part of the work-up in patients with trigeminal neuralgia. B https://web.pathway.md/diseases/reclWwDTOcCLIDYOJ 1/3 6/24/23, 4:08 PM Trigeminal neuralgia Pathway g p p p g Obtain MRI in all patients with trigeminal neuralgia to exclude secondary causes. Use a combination of three high-resolution sequences - 3D T2-weighted, 3D time-of-flight MRA and 3D T1-weighted gadolinium - to aid the detection of a possible neurovascular compression. Blind the neuroradiologist to the side of pain. Describe whether a vessel contact causes morphological changes of the nerve. B 3. Medical management General principles: Attempt medical management before offering surgery for trigeminal neuralgia. B Treat patients with secondary trigeminal neuralgia similar to patients with primary trigeminal neuralgia. B Management of acute exacerbations: consider IV fosphenytoin and lidocaine in acute exacerbations of pain. C First-line therapy: Initiate one of the following medications as first-line therapy for long-term treatment in patients with trigeminal neuralgia: carbamazepine B oxcarbazepine B Second-line therapy: Consider one of the following medications either as monotherapy or as add-on therapy for long-term treatment in patients with trigeminal neuralgia: lamotrigine C gabapentin C 4. Nonpharmacologic interventions Psychological support and referral: offer psychological and nursing support to patients with trigeminal neuralgia. Refer to national support groups where these are present. B 5. Therapeutic procedures Botulinum toxin injections: consider botulinum toxin type A injections as add-on therapy for medium-term treatment in patients with trigeminal neuralgia. C 6. Surgical interventions Surgical interventions: offer surgery for patients with trigeminal neuralgia after medical management. Offer surgery for patients with trigeminal neuralgia if the pain is not sufficiently controlled medically or if medical treatment is poorly tolerated and inform of the possibility at an early stage. B https://web.pathway.md/diseases/reclWwDTOcCLIDYOJ 2/3 6/24/23, 4:08 PM Trigeminal neuralgia Pathway Show 2 more References 1. Bendtsen L, Zakrzewska JM, Abbott J et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019 Jun;26 6 831 849. Open 2. N Attal, G Cruccu, R Baron et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010 Sep;17 9 1113-e88. Open https://web.pathway.md/diseases/reclWwDTOcCLIDYOJ 3/3