Predicting response to medical and surgical treatment of trigeminal neuralgia

A Spanish study found that older age at diagnosis was associated with a positive response to medical treatment of trigeminal neuralgia. A lower number of previously taken drugs was associated with a good response to microvascular decompression. It seems advisable to not delay surgery when a patient is refractory to medical treatment.

About 30% of patients with trigeminal neuralgia are refractory to pharmacological treatment, which makes them eligible for surgical treatment. The proportion of patients that responds to medical and surgical treatment is variable. This observational and retrospective study aimed to identify prognostic factors and predictors of response to medical and surgical treatment in classical and idiopathic trigeminal neuralgia.

This single-centre study, presented by Dr Joan Miquel Fernández-Vidal (Hospital de la Santa Creu i Sant Pau, Spain) included patients from the Sant Pau Hospital in Barcelona with classical (n=89) and idiopathic (n=104) trigeminal neuralgia. The median age was 64 (range: 22–93) years; 67% were women.

There were 125 patients who received medical treatment. After a follow-up of ≥2 years, 74 (59%) responded to this treatment. Older age seemed to predict a positive outcome (OR 1.04; 95% CI 1.00–1.08; P=0.033). Of 47 patients treated with microvascular decompression, 40 (87%) had a good outcome. A higher number of previously used drugs significantly predicted poor response in this group (OR 0.49; 0.26–0.91; P=0.026). There were 26 patients who were treated with radiofrequency thermocoagulation, 16 of whom (60%) showed a good response. The presence of pain in V2-V3 was associated with a good response in this treatment group (OR 16.2; 1.56-167.7; P=0.02). Finally, 16 patients were treated with balloon compression, of whom 13 (81%) had a good response. No predictors of good response were found in this treatment group.

Limitations of this study were its small sample, retrospective and single-centre design, and the imprecise assessment of response, as validated scales are not used in daily practice.

 

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   1. Fernández-Vidal JM. Predictors of response to medical and surgical treatment in classical and idiopathic trigeminal neuralgia. A27, EHC 2022, 07–10 December, Vienna, Austria.

 

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Posted on 5 January 2023