Abstract text (incl. figure legends and references)

QUESTION

Painful Trigeminal Neuropathy (PTN) is an entity which affects the trigeminal nerve axonally and has not yet been well studied. We present our series of the last five years.

METHODS

Observational, descriptive and retrospective study from a database consisting of patients with trigeminal pain followed up in a tertiary hospital for the last five years. We include patients with PTN (ICHD3 criteria: code 13.1.2). We analyzed epidemiological, etiological, clinical and therapeutic variables.

RESULTS

We found 30 patients with PTN (4%) out of 262 patients with trigeminal pain (classic TN: 33%, secondary: 15%, idiopathic: 40%). Women: 67%, mean age of debut: 61.1y [21-92] with an evolution of 3.6y and mean follow-up of 18 months.

Symptoms: right side 48%, left side 31%, bilateral 21%. Affected branches: V1 31%, V2 17%, V3 7%, V1+V2 21%, V2+V3 14%, V1+V2+V3 10%. Burchiel type 2: 94%, Burchiel type 1+2: 7%.

Causes: post-herpetic 28%, post-surgery 24%, post-traumatic 10%, oral infection 3%, idiopathic 34%.

Need for therapy: 90%. Most frequently used drug at start: PGB 38%, GBP 35%, others 27%. Average number of therapies: 2. Monotherapy efficacy: 73%; Polytherapy: 27%. Most effective drug: GBP 30.7% (mean dose: 1212mg/d); CBZ/OXC/ESLI 23%; PGB 19%; AMT 19%; transdermal lidocaine 15%; Duloxetine 8%, LCS 8%, anaesthetic blockade of affected branch 8%.

Most frequent associations: post-herpetic + V1: 100%. Response to transdermal lidocaine in herpetic causes: 50%. Bilateral involvement + idiopathic cause: 100%.

CONCLUSIONS

PTN is an infrequent entity in trigeminal pain (4%) and it is clinically and etiologically heterogeneous. Bilateral affection is associated with an idiopathic cause, and herpetic causes always affect V1. The most effective drug was gabapentin and 50% of post-herpetic cases showed a good response to transdermal lidocaine.