What is the efficacy of antiepileptic drugs for 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

Most of the literature on medications for trigeminal neuralgia consists of case series, uncontrolled studies with less than a dozen subjects, or small randomized clinical trials, so the apparent efficacy of the drugs requires confirmation through well-designed, large, phase III trials. The controlled data published for lamotrigine and baclofen (BCF) is promising but derives from studies with only 14 and 10 subjects, respectively.

No controlled data exist for the use of phenytoin, clonazepam, sodium valproate, oxcarbazepine, gabapentin, or mexiletine in trigeminal neuralgia; similarly, no controlled data exist for the common practice of adding a second drug when the first fails, except for the addition of lamotrigine to carbamazepine. No head-to-head comparison studies of these agents exists, and only one surgery versus medication study has been published, limited to refractory trigeminal neuralgia, a small (n = 15) trial. Only one Cochran review of medications for trigeminal neuralgia exists, and it looks only at carbamazepine, the traditional favorite. Confusion arises over outcome measures, as some researchers accept only complete relief of pain, whereas others accept partial relief.


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