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суббота, 6 сентября 2008 г.

Невралгия тройничного нерва

Новые рекомендации Американской академии неврологии будут опубликованы в номере от 7 октября 2008 года журнала Neurology.
TN is a common cause of facial pain, the authors write, with an annual incidence of 4 to 5 in 100,000. The International Association for the Study of Pain defines TN as sudden, usually unilateral, severe, brief, stabbing, recurrent episodes of pain in the distribution of the trigeminal nerve.
* For patients with TN, routine imaging should be done to identify those patients with symptomatic TN (STN) — that is, TN arising from some other structural abnormality (level C).
* The presence of trigeminal sensory deficits should be considered useful to identify those with STN, they note, but because of poor specificity, the absence of these features cannot rule out STN (level B).
* Measuring trigeminal reflexes in a qualified electrophysiologic laboratory should be considered useful for distinguishing STN from classic TN (CTN), a designation that includes all cases without an established etiology (level B).
* Younger age at onset, involvement of the first division of the trigeminal nerve, unresponsiveness to treatment, and abnormal trigeminal-evoked potentials should be disregarded in identifying those with STN (level B).
* To control pain in TN, carbamazepine should be offered (level A), and oxcarbazepine should be considered (level B). Although the evidence for carbamazepine is stronger, they note, oxcarbazepine may pose fewer safety concerns. Baclofen or lamotrigine may be considered (level C). Topical ophthalmic anesthesia should not be considered (level B).
* For patients refractory to medical therapy, early surgical therapy may be considered (level C), they note. "Some TN experts believe patients with TN failing to respond to first-line therapy are unlikely to respond to alternative medications and suggest early surgical referral," the authors write. Percutaneous procedures on the Gasserian ganglion, gamma knife, and microvascular decompression may be considered (level C).
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