Sensory abnormalities common in trigeminal neuralgia
medwireNews: Findings from a large prospective series show that nearly a third of patients with trigeminal neuralgia (TN) have sensory abnormalities on clinical examination.
TN is very rare. However, Lars Bendtsen (University of Copenhagen, Glostrup, Denmark) and colleagues amassed data on 158 patients who were seen at the Danish Headache Center over the course of 1 year and diagnosed with TN according to the International Classification of Headache Disorders (ICHD) from the International Headache Society.
Recent editions of the ICHD state that TN patients do not have sensory abnormalities at clinical examination, say the researchers. Yet they found that 29% of the 119 patients who had not undergone surgery did so, with hypaesthesia (reduced sense of touch) being the most common, at 17%. In addition, 8% of patients had hyperaesthesia, 3% had allodynia and 2% had hypoalgesia.
Twenty-three percent of patients reported sensory abnormalities such as numbness or prickling, and in almost all (95%) patients the sensory abnormalities occurred only in the area of the face affected by TN.
Among all 158 patients, a similar proportion (31%) had autonomic symptoms, most commonly conjunctival injection or tearing (22%) and a running or blocked nose (16%). Also, 49% of patients had concomitant persistent pain.
The patients were an average age of 62.3 years and had TN lasting 6.4 years. There were more women (60%) than men, and 40% had multiple daily pain attacks. Common triggers included chewing, touch, brushing teeth, talking and cold wind; less common ones were loud noises, emotional stress, strenuous exercise and movement of the ipsilateral arm.
“It proved important to collect a large series of patients fulfilling all core symptoms of TN as well as borderline symptoms in a neurological setting”, write the researchers in Headache.
They say that their findings of frequent sensory and autonomic symptoms, and persistent pain, “offer new insights to the prevailing clinical impression of the clinical characteristics in TN.”
A quarter of the patients had undergone surgery and 37% had undergone invasive dental procedures, having been initially misdiagnosed. Although 89% of patients responded to sodium channel blockers, only 56% kept taking them, with 94% of the patients who stopped doing so because of side effects caused by the high doses required. In addition, 85% of patients who kept taking the drugs also experienced side effects.
“This indicates that there is an unmet need for new medications in TN with better tolerability”, says the team.
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