Medical management of refractory trigeminal neuralgia

PURPOSE OF REVIEW: First- and second-line medical and surgical therapies for trigeminal neuralgia (TN) may have limited efficacy or tolerability in some individuals. In addition, even when these therapies are initially successful, efficacy frequently wanes over time. This narrative review presents medication options for intractable trigeminal neuralgia with a focus on new and upcoming therapies. RECENT FINDINGS: Lacosamide, eslicarbazepine, and botulinum toxin are increasingly used for intractable TN, with recent studies demonstrating efficacy. Basimglurant and vixotrigine (BIIB074) are investigational agents currently or recently studied for treatment of TN. Intravenous (i.v.) sodium channel blockers, i.v. magnesium, multiple formulations of lidocaine, and sumatriptan can be used for acute treatment of intractable TN. SUMMARY: Multiple medical therapies exist for treatment of intractable TN, with newer options demonstrating efficacy in recent studies. Investigational agents are currently being studied as potential future options for management of intractable TN.