Effectiveness and tolerance of real-world medical treatment in classical and idiopathic trigeminal neuralgia. A series of 193 patients.

Abstract text (incl. figure legends and references)

Question

Medical treatment recommendations in trigeminal neuralgia (TN) are based on few clinical trials with small samples and expert recommendations. Our aim is to describe the long-term effectiveness and tolerability of medical treatment in classical and idiopathic trigeminal neuralgia in real-world conditions.

Methods

We performed an observational study in which all patients with classical and idiopathic TN seen in our center were retrospectively collected.

Results

We included 193 patients (67% women), with a median age at diagnosis of 59 years [15-93], and a median follow-up of 3 years. 64% had classic TN. The median number of drugs used was 3.23 (SD ±2.26).

Of the 125 patients followed ≥2 years, 74 (59%) achieved sustained control. 66 (53%) with carbamazepine and derivatives, and 23 (18%) with gabapentinoids. 17 (25%) responded to the first drug used, and 19 (15%) responded to combined treatment.

Of the 66 patients followed ≥5 years, 28 (42%) achieved sustained control. 23 with carbamazepine and derivatives, and 7 with gabapentinoids. 17 (25%) responded to the first drug used, and 6 (9%) responded to combined treatment.

A total of 130 patients were treated with carbamazepine, 103 (54%) as first choice. A response was obtained in 44 (35%). 54 (42%) reported adverse effects.

Conclusions

Despite the increasing therapeutic offer of neuromodulators, carbamazepine is still the drug of choice, and with better effectiveness data. However, adverse effects are an important limitation. In a high percentage of patients with medical treatment we do not achieve a correct long-term control of TN.