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Trigeminal neuralgia: New classification and diagnostic grading for practice and research.

Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, Treede RD, Zakrzewska JM, Nurmikko T - Neurology (2016)

Bottom Line: Trigeminal neuralgia (TN) is an exemplary condition of neuropathic facial pain.Secondary TN is due to an identifiable underlying neurologic disease.TN of unknown etiology is labeled idiopathic.

View Article: PubMed Central - PubMed

Affiliation: From the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain (G.C., N.B.F., T.S.J., J.S., R.-D.T., T.N.), Washington, DC; Scientific Panel Pain of the European Academy of Neurology (G.C., T.S.J., T.N.), Vienna, Austria; Department of Neurology and Psychiatry (G.C.), Sapienza University, Rome, Italy; Danish Pain Research Centre, Department of Clinical Medicine (N.B.F., T.S.J.), and Section of Orofacial Pain and Jaw Function, Department of Dentistry (P.S.), Aarhus University, Denmark; Departments of Anesthesiology and Pharmacology (J.S.), Columbia University Medical Center, New York, NY; Department of Neurosurgery (M.S.), Hôpital Neurologique "Pierre Wertheimer," University of Lyon 1, Lyon, France; Center for Biomedicine and Medical Technology Mannheim (CBTM) (R.-D.T.), Heidelberg University, Mannheim, Germany; Facial Pain Unit, University College London Hospitals NHS Foundation Trust (J.M.Z.); and Pain Relief (T.N.), Neuroscience Research Centre, The Walton Centre NHS Foundation Trust, Liverpool, UK.

No MeSH data available.


Related in: MedlinePlus

New classification and diagnostic grading system for trigeminal neuralgia (TN)aTN is typically a unilateral condition. Few patients develop TN on both sides of the face over the course of a disease, e.g., in multiple sclerosis, but they virtually never present with simultaneous bilateral pain. bThe pain strictly follows the distribution of the trigeminal nerve branches. It does not extend to the posterior third of the scalp, the posterior part of the external ear, or the angle of the mandible (figure 2). cParoxysmal pain is the main complaint, but it may be accompanied by continuous pain. dTrigger maneuvers include innocuous mechanical stimuli, facial or oral movements, or complex activities such as shaving or applying make-up. Confined trigger zones and a common combination with brisk muscle contractions (tics) help distinguish triggered TN from allodynia in other conditions of neuropathic pain. Trigger maneuvers may be tested by the examiner. eMRI readily identifies major neurologic diseases, such as tumors of the cerebellopontine angle or multiple sclerosis. Other investigations may include the neurophysiologic recording of trigeminal reflexes and trigeminal evoked potentials, which become necessary in patients who cannot undergo MRI. fAdvanced MRI techniques are capable of demonstrating neurovascular compression with morphologic changes of the trigeminal nerve root.
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Figure 1: New classification and diagnostic grading system for trigeminal neuralgia (TN)aTN is typically a unilateral condition. Few patients develop TN on both sides of the face over the course of a disease, e.g., in multiple sclerosis, but they virtually never present with simultaneous bilateral pain. bThe pain strictly follows the distribution of the trigeminal nerve branches. It does not extend to the posterior third of the scalp, the posterior part of the external ear, or the angle of the mandible (figure 2). cParoxysmal pain is the main complaint, but it may be accompanied by continuous pain. dTrigger maneuvers include innocuous mechanical stimuli, facial or oral movements, or complex activities such as shaving or applying make-up. Confined trigger zones and a common combination with brisk muscle contractions (tics) help distinguish triggered TN from allodynia in other conditions of neuropathic pain. Trigger maneuvers may be tested by the examiner. eMRI readily identifies major neurologic diseases, such as tumors of the cerebellopontine angle or multiple sclerosis. Other investigations may include the neurophysiologic recording of trigeminal reflexes and trigeminal evoked potentials, which become necessary in patients who cannot undergo MRI. fAdvanced MRI techniques are capable of demonstrating neurovascular compression with morphologic changes of the trigeminal nerve root.

Mentions: The minimum requirements for possible TN are pain distribution within the facial or intraoral territory of the trigeminal nerve and a paroxysmal character of pain (figure 1). The examining physician must ascertain that the pain does not extend to the posterior third of the scalp, the back of the ear, or the angle of the mandible, as these territories are innervated by cervical nerves (figure 2). The territory of the mandibular division of the trigeminal nerve reaches to the cranium; a patient with TN in the mandibular branch of the trigeminal nerve may therefore describe pain both in the lower lip and the temple. If the neuralgia involves 2 trigeminal divisions, they should be contiguous; a combination of the maxillary and mandibular divisions is most frequent. TN in the ophthalmic division or the tongue tends to be considered an indication of TN secondary to a major neurologic disease. However, this interpretation has not been adequately scrutinized.4,5 It is further important to note that both the affected division of the trigeminal nerve and the side of the face may change over the course of the disease.6–8


Trigeminal neuralgia: New classification and diagnostic grading for practice and research.

Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, Treede RD, Zakrzewska JM, Nurmikko T - Neurology (2016)

New classification and diagnostic grading system for trigeminal neuralgia (TN)aTN is typically a unilateral condition. Few patients develop TN on both sides of the face over the course of a disease, e.g., in multiple sclerosis, but they virtually never present with simultaneous bilateral pain. bThe pain strictly follows the distribution of the trigeminal nerve branches. It does not extend to the posterior third of the scalp, the posterior part of the external ear, or the angle of the mandible (figure 2). cParoxysmal pain is the main complaint, but it may be accompanied by continuous pain. dTrigger maneuvers include innocuous mechanical stimuli, facial or oral movements, or complex activities such as shaving or applying make-up. Confined trigger zones and a common combination with brisk muscle contractions (tics) help distinguish triggered TN from allodynia in other conditions of neuropathic pain. Trigger maneuvers may be tested by the examiner. eMRI readily identifies major neurologic diseases, such as tumors of the cerebellopontine angle or multiple sclerosis. Other investigations may include the neurophysiologic recording of trigeminal reflexes and trigeminal evoked potentials, which become necessary in patients who cannot undergo MRI. fAdvanced MRI techniques are capable of demonstrating neurovascular compression with morphologic changes of the trigeminal nerve root.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940067&req=5

Figure 1: New classification and diagnostic grading system for trigeminal neuralgia (TN)aTN is typically a unilateral condition. Few patients develop TN on both sides of the face over the course of a disease, e.g., in multiple sclerosis, but they virtually never present with simultaneous bilateral pain. bThe pain strictly follows the distribution of the trigeminal nerve branches. It does not extend to the posterior third of the scalp, the posterior part of the external ear, or the angle of the mandible (figure 2). cParoxysmal pain is the main complaint, but it may be accompanied by continuous pain. dTrigger maneuvers include innocuous mechanical stimuli, facial or oral movements, or complex activities such as shaving or applying make-up. Confined trigger zones and a common combination with brisk muscle contractions (tics) help distinguish triggered TN from allodynia in other conditions of neuropathic pain. Trigger maneuvers may be tested by the examiner. eMRI readily identifies major neurologic diseases, such as tumors of the cerebellopontine angle or multiple sclerosis. Other investigations may include the neurophysiologic recording of trigeminal reflexes and trigeminal evoked potentials, which become necessary in patients who cannot undergo MRI. fAdvanced MRI techniques are capable of demonstrating neurovascular compression with morphologic changes of the trigeminal nerve root.
Mentions: The minimum requirements for possible TN are pain distribution within the facial or intraoral territory of the trigeminal nerve and a paroxysmal character of pain (figure 1). The examining physician must ascertain that the pain does not extend to the posterior third of the scalp, the back of the ear, or the angle of the mandible, as these territories are innervated by cervical nerves (figure 2). The territory of the mandibular division of the trigeminal nerve reaches to the cranium; a patient with TN in the mandibular branch of the trigeminal nerve may therefore describe pain both in the lower lip and the temple. If the neuralgia involves 2 trigeminal divisions, they should be contiguous; a combination of the maxillary and mandibular divisions is most frequent. TN in the ophthalmic division or the tongue tends to be considered an indication of TN secondary to a major neurologic disease. However, this interpretation has not been adequately scrutinized.4,5 It is further important to note that both the affected division of the trigeminal nerve and the side of the face may change over the course of the disease.6–8

Bottom Line: Trigeminal neuralgia (TN) is an exemplary condition of neuropathic facial pain.Secondary TN is due to an identifiable underlying neurologic disease.TN of unknown etiology is labeled idiopathic.

View Article: PubMed Central - PubMed

Affiliation: From the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain (G.C., N.B.F., T.S.J., J.S., R.-D.T., T.N.), Washington, DC; Scientific Panel Pain of the European Academy of Neurology (G.C., T.S.J., T.N.), Vienna, Austria; Department of Neurology and Psychiatry (G.C.), Sapienza University, Rome, Italy; Danish Pain Research Centre, Department of Clinical Medicine (N.B.F., T.S.J.), and Section of Orofacial Pain and Jaw Function, Department of Dentistry (P.S.), Aarhus University, Denmark; Departments of Anesthesiology and Pharmacology (J.S.), Columbia University Medical Center, New York, NY; Department of Neurosurgery (M.S.), Hôpital Neurologique "Pierre Wertheimer," University of Lyon 1, Lyon, France; Center for Biomedicine and Medical Technology Mannheim (CBTM) (R.-D.T.), Heidelberg University, Mannheim, Germany; Facial Pain Unit, University College London Hospitals NHS Foundation Trust (J.M.Z.); and Pain Relief (T.N.), Neuroscience Research Centre, The Walton Centre NHS Foundation Trust, Liverpool, UK.

No MeSH data available.


Related in: MedlinePlus