What is the role of antiepileptic drugs in the treatment of trigeminal neuralgia (TN)?

Updated: Jul 11, 2019
  • Author: Manish K Singh, MD; Chief Editor: Robert A Egan, MD  more...
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Answer

Antiepileptic drugs (AEDs) work well for trigeminal neuralgia (TN) and have been known to do so since a study was completed with phenytoin (PHE) in 1942 (Bergouignan) and another with carbamazepine (CBZ) in 1962 (Blom). [27] With 3 placebo-controlled crossover studies validating its efficacy in trigeminal neuralgia, providing relief by roughly 75% versus only 25% in the placebo arms (Killian, Nicol, Campbell), carbamazepine is the best studied drug for this disorder and the only one with US Food and Drug Administration (FDA) approval in this setting.

Since the carbamazepine studies, however, newer second- and third-generation AEDs have expanded the choice of AED in trigeminal neuralgia, having demonstrated their efficacy in a variety of neuropathic pain syndromes, including trigeminal neuralgia, as well as in painful diabetic polyneuropathy and postherpetic neuralgia.

Other anticonvulsant agents possibly useful in the treatment of this disorder include sodium valproate and clonazepam (Klonopin). Clonazepam has moderate efficacy but is not recommended because of a low level of evidence and its adverse effects (eg, sedation) and dependence. The National Institutes of Health (NIH) currently is sponsoring studies of topiramate.

Also see Antiepileptic Drugs.


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