16th European Headache Congress

Prof.

Chair

Multidisciplinary approach to trigeminal neuralgia

Invited speaker

Invited lecture

Trigeminal neuralgia

How to diagnose trigeminal neuralgia

Invited Lecture (online)

Effectiveness and safety of surgical treatment of classic and Idiopathic trigeminal neuralgia

Abstract text (incl. figure legends and references) QUESTION Surgical treatment of trigeminal neuralgia (TN) is indicated in refractory cases. Different percutaneous and invasive techniques can be performed. This study aims to analyze the effectiveness and safety of these procedures. METHODS A retrospective observational single-center study of patients with classic or idiopathic refractory TN (failure to 3 different groups of drugs). Clinical, diagnostic-therapeutic, and clinical evolution data were collected. RESULTS We included 70 patients (60% female), with a median age at diagnosis of 56 [23-82], 48(69%) had classic TN. The mean number of previous drugs used was 4.24 (SD±2.25). 47 patients (67%) were treated with microvascular decompression (MVD), being effective in 87% (52% total, 35% partial) and achieving medication withdrawal in 15. 11 (23.4%) presented complications; major, yet reversible, in 3 cases. In 42 (60%) percutaneous techniques were used. 26 (37.1%) underwent radiofrequency thermocoagulation (1.77 times per patient on average) with a response rate of 60% (12% total, 48% partial), complications appeared in 7 (17.4%), 3 of which were major and persistent. 16 (34.8%) underwent balloon compression (1.25 times per patient) with 84% effectiveness (56% total, 25% partial), 4 (25%) minor complications were registered, 75% of which were persistent. In 17 patients (24%) both techniques were used (47% DCMV as the first option). 2 gangliolysis, 1 stereotactic radiosurgery, and 1 implantation of cortex stimulation device were performed, with no subsequent complications. CONCLUSIONS Surgical techniques are effective in patients with refractory TN, allowing to reduce medication use. The technique that offers the best results is MVD. Complications may appear in up to a quarter of patients, regardless of the technique used, being more frequent and persistent, contrary to expectations, in percutaneous procedures.

Multidisciplinary clinical assessments

Abstract lecture

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.

Oro-facial and temporomandibular disorders

Predictors of response to medical and surgical treatment in classical and idiopathic trigeminal neuralgia

Abstract text (incl. figure legends and references) Question The proportion of patients that respond to medical and surgical treatment in trigeminal neuralgia (TN) is variable. We aimed to identify potential predictors of response to medical and surgical treatment in classical and idiopathic trigeminal neuralgia. Methods We conducted an observational, retrospective, and unicenter study in adults with classical or idiopathic TN. We analyzed the relationship between several epidemiologic, anatomic, and clinical characteristics and outcomes with the use of the chi-square or Fisher's exact test for categorical variables and with ANOVA for continuous variables. P-value ≤0.05 was considered significant. All reported P-values are two-sided. Results A total of 193 patients (67% women) were included, with a median age at the first visit of 64 [22-93] years. Medical treatment response for ≥2 years was present in 59% of patients. Older age at the first visit (66 vs 58, p&lt;0.01) and the presence of hypertension (47% vs 26%, p=0.03) were associated with response to medical treatment. No significant differences were found in terms of gender, affected branch, type of TN, or other comorbidities. The effectiveness of microvascular decompression was 87%. A more significant number of previous drugs (3.7 vs 6.7, p=0.03) was associated with no response. No differences were found regarding other variables. The effectiveness with thermocoagulation was 60%. V2 involvement (75% vs 17%, p=0.01) and pain in V2-V3 branches (91% vs 40%, p=0.01) were associated with effectiveness, while single branch involvement (27% vs 87%, p&lt;0.01) to no response. The effectiveness of mechanical compression was 84%. No response predictors were found. Conclusions Advanced age and hypertension were associated with a sustained response to medical treatment. A greater number of drugs before microvascular decompression was associated with a worse response. The involvement of branches V2 and V2-V3 was associated with effectiveness with thermocoagulation.

Strauss 2-3

SciSe 10

Scientific session

SciSe 10
Trigeminal neuralgia

Appointment

Chair

Programme

SciSe 10Trigeminal neuralgia

Appointment

Chair

Programme

SciSe 10
Trigeminal neuralgia