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Papers of the Week

Papers: 4 Jan 2020 - 10 Jan 2020

Pharmacology/Drug Development

2020 Jan-Dec

Mol Pain


Trigeminal Neuralgia: an overview from pathophysiology to pharmacological treatments.


de Gambeta E A, Chichorro JG, Zamponi GW
Mol Pain. 2020 Jan-Dec; 16:1744806920901890.
PMID: 31908187.


The trigeminal nerve (V) is the fifth and largest of all cranial nerves and it is responsible for detecting sensory stimuli that arise from the craniofacial area. The nerve is divided into three branches: ophthalmic (V1), maxillary (V2) and mandibular (V3); their cell bodies are located in the trigeminal ganglia (TG) and they make connections with second order neurons in the trigeminal brainstem sensory nuclear complex (VBSNC). Ascending projections via the trigeminothalamic tract transmit information to the thalamus and other brain regions responsible for interpreting sensory information. One of the most common forms of craniofacial pain is trigeminal neuralgia (TN). TN is characterized by sudden, brief and excruciating facial pain attacks in one or more of the V branches, leading to a severe reduction in the quality of life of affected patients. TN etiology can be classified into: idiopathic, classic, and secondary. Classic TN is associated with neurovascular compression in the trigeminal root entry zone, which can lead to demyelination and a dysregulation of voltage gated sodium channel (VGSC) expression in the membrane. These alterations may be responsible for pain attacks in TN patients. The antiepileptic drugs carbamazepine (CBZ) and oxcarbazepine (OXC) are the first-line pharmacological treatment for TN. Their mechanism of action is a modulation of VGSCs, leading to a decrease in neuronal activity. Although CBZ and OXC are the first-line treatment, other drugs may be useful for pain control in TN. Among them, the anticonvulsants gabapentin, pregabalin, lamotrigine and phenytoin, baclofen and botulinum toxin type A can be co-administered with CBZ or OXC for a synergistic approach. New pharmacological alternatives are being explored such as the active metabolite of OXC, eslicarbazepine, and the new Nav1.7 blocker vixotrigine. The pharmacological profiles of these drugs are addressed in this review.