Management and prognosis

Carbamazepine has been used extensively in the management of TN and with good success. Several meta-analyses are available and generally agree that about 70 percent of patients will benefit from therapeutic doses (100-2400 mg).100[I] The NNT value is accordingly good in the range of 1.8 (1.3-2.2 95 percent confidence interval). However, side effects are frequently observed such as allergic rash, hyponatremia, and numerous drug interactions, so elderly patients in particular must be monitored carefully. A second choice may be oxcarbazepine which also has been documented to be effective in a number of RCT studies.100[I] Other options are lamotrigene, baclofen, and topiramate.103

Surgery may be an option if pharmacological management provides insufficient pain relief. Microvascular decompression provides good pain relief in the majority of the patients over a longer period of time with approximately three-quarters of patients being pain-free three years after surgery.107 A number of other ablative surgical techniques are available but generally do not provide similar long-term pain relief and are associated with significant disturbances in the facial sensory function.

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