Trigeminal neuralgia (TN) is a highly disabling disorder characterised by very severe, brief and electric shock like recurrent episodes of facial pain. New diagnostic criteria, which subclassify TN on the basis of presence of trigeminal neurovascular conflict or an underlying neurological disorder, should be used as they allow better characterisation of patients and help in decision-making regarding medical and surgical treatments. MR imaging, including high-resolution trigeminal sequences, should be performed as part of the diagnostic work-up. Carbamazepine and oxcarbazepine are drugs of first choice. Lamotrigine, gabapentin, pregabalin, botulinum toxin type A and baclofen can be used either alone or as add-on therapy. Surgery should be considered if the pain is poorly controlled or the medical treatments are poorly tolerated. Trigeminal microvascular decompression is the first-line surgery in patients with trigeminal neurovascular conflict while neuroablative surgical treatments can be offered if MR imaging does not show any neurovascular contact or where patients are considered too frail for microvascular decompression or do not wish to take the risk.

中文翻译：

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三叉神经痛：实用指南

三叉神经痛 (TN) 是一种高度致残的疾病，其特征是非常严重、短暂和电击般的反复发作的面部疼痛。应使用新的诊断标准，根据是否存在三叉神经血管冲突或潜在的神经系统疾病对 TN 进行细分，因为它们可以更好地描述患者特征并有助于做出有关内科和外科治疗的决策。磁共振成像，包括高分辨率三叉神经序列，应作为诊断检查的一部分进行。卡马西平和奥卡西平是首选药物。拉莫三嗪、加巴喷丁、普瑞巴林、A 型肉毒杆菌毒素和巴氯芬可单独使用或作为附加疗法。如果疼痛控制不佳或药物治疗耐受性差，应考虑手术。三叉神经微血管减压术是三叉神经血管冲突患者的一线手术，而如果磁共振成像未显示任何神经血管接触，或者患者被认为太虚弱而无法进行微血管减压术或不愿冒险，则可以提供神经消融手术治疗。