Intervention supported by evidence

There are Cochrane systematic reviews on the use of anticonvulsant drugs in neuropathic pain which include trials of patients with trigeminal neuralgia and there is a separate Cochrane review on nonepi-leptic drugs in the use of trigeminal neuralgia [55-57] as well as a regularly updated online entry in Clinical Evidence [58]. Many of these trials are small, conducted in the era when RCT had less rigorous quality controls. The largest number of RCT have been done on carbamazepine and there is good evidence to show that this drug is highly effective in patients with classic trigeminal neuralgia.

Oxcarbazepine, which is a daughter drug of carbamazepine, has been evaluated in RCT and a small systematic review (all abstracts) comparing it to carbamazepine. It has some improved efficacy over carbamazepine and much better tolerability. Oxcarbazepine has a much lower potential for drug interactions as it does not rely on the liver cytochrome system. A small RCT using gabapentin in combination with five ropivicaine injections on a weekly basis showed this drug to be highly effective [59].

There are no high-quality studies on the use of polypharmacy, as often done in epilepsy.

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