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Non-antiepileptic drugs for trigeminal neuralgia

  • Review
  • Intervention

Authors


Abstract

Background

Non-antiepileptic drugs have been used in trigeminal neuralgia management since the 1970s.

Objectives

The objective was to review systematically the efficacy of non-antiepileptic drugs for trigeminal neuralgia.

Search strategy

We searched the Cochrane Neuromuscular Disease Group Register, MEDLINE, EMBASE, and LILACS (all to August 2005) and the Chinese Biomedical Retrieval System, the database of the Chinese Cochrane Center (The Cochrane Library, Issue 1 2005), conference paper databases and checked bibliographies. We handsearched ten Chinese journals.

Selection criteria

We searched for randomized or quasi-randomized controlled trials.

Data collection and analysis

Two authors decided which trials fitted the inclusion criteria and graded methodological quality independently.

Main results

Nine trials of different non-antiepileptic drugs involving 223 participants were included. Each trial investigated one non-antiepileptic drug. Two trials tested baclofen. In one, more people gained 50% reduction from baseline than with placebo (relative risk 15.00, 95% CI 0.97 to 231.84, P value = 0.05). In the other, slightly more participants on baclofen had a 75% reduction in attacks on the 10th day compared with carbamazepine (relative risk 2.38, 95% CI 0.83 to 6.85, P value = 0.11). One trial showed no significant difference in reduction in average daily frequency of attacks with L-Baclofen compared with racemic baclofen. Tizanidine was investigated in two trials. In one, the proportion of people with reduction in the average number of paroxysms per day increased with tizanidine compared with placebo (relative risk 8.00, 95% CI 1.21 to 52.69, P value = 0.03). In the other, one of five participants improved in visual analog scale score with tizanidine and four of six with carbamazepine (relative risk 0.30, 95% CI 0.05 to 1.89, P value = 0.20). One study showed that the improvement in mean values of pain scores with tocainide was similar to that of carbamazepine. In one study more participants improved during the pimozide than the carbamazepine period (relative risk 1.78, 95% CI 1.39 to 2.28). In one study, proparacaine hydrochloride 0.5% instillation into the eyes was not significantly different from placebo (relative risk 1.06, 95% CI 0.37 to 2.99, P value = 0.92). In another, there was moderate or marked improvement in seven of nine participants treated with clomipramine and three of nine with amitriptyline after a 12-week treatment (RR 2.33, 95% CI 0.87 to 6.27).

Authors' conclusions

There is insufficient evidence from randomized controlled trials to show significant benefit from non-antiepileptic drugs in trigeminal neuralgia. More research is needed.

Plain language summary

Drugs, other than those used for epilepsy, for treating trigeminal neuralgia

Trigeminal neuralgia is a condition that affects the trigeminal nerve, the nerve which provides the sensory innervation of the skin on the face. It causes a sudden, severe stabbing facial pain near the nose, lips, cheek, eyes or ear. The incidence of trigeminal neuralgia is three to five new cases per 100,000 people each year. Non-antiepileptic drugs, such as baclofen and tocainide have been used to treat trigeminal neuralgia since the 1970s.

We found nine randomized controlled trials of different non-antiepileptic drugs, involving 223 people in total. This review found insufficient evidence to show significant benefit from non-antiepileptic drugs in treating trigeminal neuralgia. Side effects of these drugs were relatively common and serious ones restricted their clinical use.

The overall methodological quality of the trials included in the review was poor. Further well-designed randomized controlled trials are needed to establish whether non-antiepileptic drugs are beneficial in trigeminal neuralgia.

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