Trigeminal neuralgia.

IF 76.9 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Sait Ashina, Carrie E Robertson, Anan Srikiatkhachorn, Giulia Di Stefano, Anne Donnet, Mojgan Hodaie, Mark Obermann, Marcela Romero-Reyes, Young Seok Park, Giorgio Cruccu, Lars Bendtsen
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引用次数: 0

Abstract

Trigeminal neuralgia (TN) is a facial pain disorder characterized by intense and paroxysmal pain that profoundly affects quality of life and presents complex challenges in diagnosis and treatment. TN can be categorized as classical, secondary and idiopathic. Epidemiological studies show variable incidence rates and an increased prevalence in women and in the elderly, with familial cases suggesting genetic factors. The pathophysiology of TN is multifactorial and involves genetic predisposition, anatomical changes, and neurophysiological factors, leading to hyperexcitable neuronal states, central sensitization and widespread neural plasticity changes. Neurovascular compression of the trigeminal root, which undergoes major morphological changes, and focal demyelination of primary trigeminal afferents are key aetiological factors in TN. Structural and functional brain imaging studies in patients with TN demonstrated abnormalities in brain regions responsible for pain modulation and emotional processing of pain. Treatment of TN involves a multifaceted approach that considers patient-specific factors, including the type of TN, with initial pharmacotherapy followed by surgical options if necessary. First-line pharmacological treatments include carbamazepine and oxcarbazepine. Surgical interventions, including microvascular decompression and percutaneous neuroablative procedures, can be considered at an early stage if pharmacotherapy is not sufficient for pain control or has intolerable adverse effects or contraindications.

Abstract Image

三叉神经痛
三叉神经痛(TN)是一种面部疼痛疾病,以剧烈和阵发性疼痛为特征,严重影响生活质量,给诊断和治疗带来了复杂的挑战。TN 可分为典型性、继发性和特发性。流行病学研究表明,TN 的发病率不一,女性和老年人的发病率较高,家族病例提示有遗传因素。TN 的病理生理学是多因素的,涉及遗传易感性、解剖学变化和神经生理学因素,导致神经元过度兴奋状态、中枢敏化和广泛的神经可塑性变化。三叉神经根受到神经血管压迫,形态发生重大变化,三叉神经初级传入发生局灶性脱髓鞘,这些都是 TN 的主要致病因素。对TN患者进行的脑结构和功能成像研究显示,负责疼痛调节和疼痛情绪处理的脑区存在异常。TN 的治疗需要考虑患者的具体因素(包括 TN 的类型),采取多管齐下的方法,首先进行药物治疗,然后在必要时选择手术治疗。一线药物治疗包括卡马西平和奥卡西平。如果药物治疗不足以控制疼痛,或存在无法忍受的不良反应或禁忌症,可在早期阶段考虑手术干预,包括微血管减压术和经皮神经烧蚀术。
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来源期刊
Nature Reviews Disease Primers
Nature Reviews Disease Primers Medicine-General Medicine
CiteScore
76.70
自引率
0.20%
发文量
75
期刊介绍: Nature Reviews Disease Primers, a part of the Nature Reviews journal portfolio, features sections on epidemiology, mechanisms, diagnosis, management, and patient quality of life. The editorial team commissions top researchers — comprising basic scientists and clinical researchers — to write the Primers, which are designed for use by early career researchers, medical students and principal investigators. Each Primer concludes with an Outlook section, highlighting future research directions. Covered medical specialties include Cardiology, Dermatology, Ear, Nose and Throat, Emergency Medicine, Endocrinology, Gastroenterology, Genetic Conditions, Gynaecology and Obstetrics, Hepatology, Haematology, Infectious Diseases, Maxillofacial and Oral Medicine, Nephrology, Neurology, Nutrition, Oncology, Ophthalmology, Orthopaedics, Psychiatry, Respiratory Medicine, Rheumatology, Sleep Medicine, and Urology.
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