■三叉神经痛是一种罕见的疾病,可以通过卡马西平或奥卡西平有效治疗,但这些较老的药物与剂量依赖性和潜在的治疗限制性不良反应有关。第三代抗惊厥药,新的降钙素基因相关肽阻断剂治疗偏头痛,和较老的药物,如氯胺酮和大麻素可能是有前途的佐剂或单一治疗选择。
■新药,他们假定的行动机制,本文讨论了安全性和有效性。缺乏有力的临床证据支持这些药物治疗三叉神经痛。尽管偏头痛和三叉神经痛是不同的,但也考虑了新的偏头痛药物。虽然相似,条件。近年来,尚无具有三叉神经痛特定适应症的新药上市。
■在现实世界的临床实践中,大约一半的三叉神经痛患者服用一种以上的药物进行预防,联合治疗可能是最佳方法。联合治疗可能允许较低剂量的卡马西平或奥卡西平,因此减少了潜在不良事件的数量和严重程度,但必须考虑药代动力学药物-药物相互作用的可能性.三叉神经痛的药物治疗包括急性或流产治疗,通常在医院与长期预防性治疗相比,通常涉及口服药物。
三叉神经痛是一种相对罕见的疾病,通常会影响脸颊周围眼睛下方的面部一侧。三叉神经痛的原因有时是受损的神经或失去部分外保护鞘(髓鞘)的神经。然而,三叉神经痛也可能有其他神经原因。疼痛可以通过触摸触发,压力,或咀嚼,它往往发生在非常痛苦的短暂攻击,然后暂停很少或没有疼痛。三叉神经痛有两种类型的药物治疗:阻止持续发作的药物(通常在急诊室或医院静脉内给药)和长期口服以减少或预防发作的药物。治疗三叉神经痛最有效的两种药物是卡马西平和奥卡西平,实际上是预防癫痫发作的药物。它们有效地减少三叉神经痛的疼痛强度和发作次数,但它们有副作用。事实上,这些副作用非常严重,以至于人们停止服用药物。最近有许多新药上市,可能对三叉神经痛有效,尽管没有专门为此用途开发。最新一代的抗癫痫药物包括艾司卡西平,拉科沙胺,左乙拉西坦,还有瑞替加宾,可能与较老的卡马西平和奥卡西平药物一样有效,副作用较少。临床研究需要在三叉神经痛患者中测试它们,但它们的作用机制表明它们可能效果很好。有一些针对偏头痛开发的新药,可以抑制体内一种叫做CGRP的物质。偏头痛和三叉神经痛有一些相同的症状,但它们是不同的条件,但都涉及太多的CGRP。其他新药包括lasmiditan,匹莫齐特(用于Tourette综合征),替扎尼定(肌肉松弛剂),拉莫三嗪和维索三嗪(抗癫痫药物)也可能是有益的。三叉神经痛患者可能不得不采取联合治疗,使用两种或多种具有不同作用机制的药物。较老的药物如氯胺酮和大麻素也被认为是治疗三叉神经痛的可能的附加剂。
UNASSIGNED: Trigeminal neuralgia is a rare condition that can be effectively treated by carbamazepine or oxcarbazepine but these older drugs are associated with dose-dependent and potentially treatment-limiting adverse effects. Third-generation anticonvulsants, new calcitonin gene-related peptide blockers for migraine, and older drugs such as ketamine and cannabinoids may be promising adjuvants or monotherapeutic options.
UNASSIGNED: The new drugs, their presumed mechanisms of action, safety and efficacy are discussed herein. There is a paucity of robust clinical evidence in support of these drugs for trigeminal neuralgia. New migraine agents are considered as well although migraines and trigeminal neuralgia are distinct, albeit similar, conditions. No new drugs have been released to market in recent years with the specific indication of trigeminal neuralgia.
UNASSIGNED: In real-world clinical practice, about half of trigeminal neuralgia patients take more than one agent for prevention and combination therapy may be the optimal approach. Combination therapy might allow for lower doses of carbamazepine or oxcarbazepine, thus reducing the number and severity of potential adverse events but the potential for pharmacokinetic drug-drug interactions must be considered. Drug therapy for trigeminal neuralgia involves acute or abortive treatments, often administered in hospital versus long-term preventive therapy, usually involving oral agents.
Trigeminal neuralgia is a relatively rare condition that usually affects one side of the face below the eye around the cheekbone. The cause of trigeminal neuralgia is sometimes a damaged nerve or a nerve that has lost part of its outer protective sheath (myelin). However, trigeminal neuralgia may have other neurological causes as well. Pain can be triggered by touch, pressure, or chewing and it tends to occur in very painful brief attacks followed by pauses with little or no pain. There are two types of drug treatment for trigeminal neuralgia: drugs to stop an ongoing attack (which are often administered in an emergency room or hospital intravenously) and drugs that are taken orally over the long term to reduce or prevent attacks.The two most effective drugs for trigeminal neuralgia are carbamazepine and oxcarbazepine, which are actually drugs to prevent seizures. They are effective in reducing the pain intensity and number of attacks of trigeminal neuralgia but they have side effects. In fact, these side effects can be so severe that people stop taking the drugs.Many new drugs have come to market recently that may work for trigeminal neuralgia, although none was specifically developed for this use. The newest generation of anti-seizure medications including eslicarbazepine, lacosamide, levetiracetam, and retigabine, may be just as effective as the older carbamazepine and oxcarbazepine drugs with fewer side effects. Clinical studies are needed to test them in trigeminal neuralgia patients but their mechanisms of action suggest that they might work well.There are some new drugs developed for migraine headache that inhibit a substance in the body called CGRP. Migraine headaches and trigeminal neuralgia have some of the same symptoms but they are different conditions but both involve too much CGRP.Other new drugs include lasmiditan, pimozide (used for Tourette syndrome), tizanidine (muscle relaxant), lamotrigine and vixotrigine (anti-seizure drugs) may also be beneficial. It may be that people with trigeminal neuralgia will have to take combination therapy, the use of two or more drugs with different mechanisms of action. Older drugs like ketamine and cannabinoids are also being considered as possible add-on agents for therapy for trigeminal neuralgia.