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Keywords:

  • trigeminal neuralgia;
  • anticonvulsants;
  • carbamazepine;
  • clonazepam;
  • phenytoin;
  • baclofen;
  • valproic, acid;
  • pimozide

SYNOPSIS

Trigeminal neuralgia results from disturbances in the trigeminal root entry zone which generate repetitiveaction potentials. Drugs which relieve the pain of trigeminal neuralgia depress these potentials.Anticonvulsants which exert this or related effects, and which have been demonstrated to be efficacious intrigeminal neuralgia, include carbamazepine, phenytoin, clonazepam, and valproic acid. Baclofen may act byfacilitating segmental inhibition of the trigeminal complex. The mechanism of action of pimozide for treatingtrigeminal neuralgia is not known.Carbamazepine is suggested as the drag of first choice; baclofen or clonazepam could be added ifcarbamazepine monotherapy is ineffective. When these fail, monotherapy with phenytoin, pimozide, or valproicacid would be a reasonable next step.