Treatment Failures in Trigeminal Neuralgia Patients: An Institutional Audit

Abstract

Background: Trigeminal Neuralgia (TN) is a frequent cause of paroxysmal facial pain and headaches in adults. It frequently presents in the fourth and fifth decade of life and affects the 5th cranial nerve. It is usually unilateral and does not disturb sleep. The gold standard drug is Carbamazepine (CBZ) and treatment failure to CBZ could be attributed to intake of drugs or food containing B group vitamins, patients' tolerance to the medication and the use of fake medication. The effectiveness of this drug has been reported but, there is dearth of literature that demonstrates causes of failure of CBZ in the treatment of trigeminal neuralgia.Objective: To determine the causes of treatment failure in Trigeminal neuralgia patients attending the Oral Medicine Clinic of Lagos University Teaching Hospital, Lagos, Nigeria.Materials and Methods: This was a retrospective study of cases of Trigeminal Neuralgia who presented at the Oral Medicine Clinic of the study institution between April 2009 and April 2012. Data were collated from patients' case notes and clinical records. The recorded parameters included patients' bio data, response to treatment and treatment failure. The results were analyzed using Statistical Package for Social Sciences for Windows(version 16).Results: A total number of 32 patients were diagnosed with Trigeminal neuralgia during this period. There were 22 (68.87%) females and 10 (31.2%) males; with female to male ratio of 2.2:1. Age range was 9 to 82years (mean 53.4±13.86). Carbamazepine was the principal drug prescribed. There was treatment failure associated with it due to the use of B group vitamins in 10 patients (31.5%); 5 (15.63%) from tolerance to the drug and 2(6.10%) from fake drugs. Twenty-seven (84.4%) patients went into remission when all the factors leading to failure were addressed; therefore the response rate was good.Conclusion: Carbamazepine was used as the primary drug in the treatment of trigeminal neuralgia and treatment failure was largely due to taking drinks and drugs containing B group vitamins.