Trigeminal neuralgia: New classification and diagnostic grading for practice and research

Trigeminal neuralgia (TN) is an exemplary condition of neuropathic facial pain. However, formally classifying TN as neuropathic pain based on the grading system of the International Association for the Study of Pain is complicated by the requirement of objective signs confirming an underlying lesion...

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Main Authors:	Cruccu, Giorgio, Finnerup, Nanna B., Jensen, Troels S., Scholz, Joachim, Sindou, Marc, Svensson, Peter, Treede, Rolf-Detlef, Zakrzewska, Joanna M., Nurmikko, Turo
Format:	Online
Language:	English
Published:	Lippincott Williams & Wilkins 2016
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940067/

id	pubmed-4940067
recordtype	oai_dc
spelling	pubmed-49400672016-07-20 Trigeminal neuralgia: New classification and diagnostic grading for practice and research Cruccu, Giorgio Finnerup, Nanna B. Jensen, Troels S. Scholz, Joachim Sindou, Marc Svensson, Peter Treede, Rolf-Detlef Zakrzewska, Joanna M. Nurmikko, Turo Views & Reviews Trigeminal neuralgia (TN) is an exemplary condition of neuropathic facial pain. However, formally classifying TN as neuropathic pain based on the grading system of the International Association for the Study of Pain is complicated by the requirement of objective signs confirming an underlying lesion or disease of the somatosensory system. The latest version of the International Classification of Headache Disorders created similar difficulties by abandoning the term symptomatic TN for manifestations caused by major neurologic disease, such as tumors or multiple sclerosis. These diagnostic challenges hinder the triage of TN patients for therapy and clinical trials, and hamper the design of treatment guidelines. In response to these shortcomings, we have developed a classification of TN that aligns with the nosology of other neurologic disorders and neuropathic pain. We propose 3 diagnostic categories. Classical TN requires demonstration of morphologic changes in the trigeminal nerve root from vascular compression. Secondary TN is due to an identifiable underlying neurologic disease. TN of unknown etiology is labeled idiopathic. Diagnostic certainty is graded possible when pain paroxysms occur in the distribution of the trigeminal nerve branches. Triggered paroxysms permit the designation of clinically established TN and probable neuropathic pain. Imaging and neurophysiologic tests that establish the etiology of classical or secondary TN determine definite neuropathic pain. Lippincott Williams & Wilkins 2016-07-12 /pmc/articles/PMC4940067/ /pubmed/27306631 http://dx.doi.org/10.1212/WNL.0000000000002840 Text en © 2016 American Academy of Neurology This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Cruccu, Giorgio Finnerup, Nanna B. Jensen, Troels S. Scholz, Joachim Sindou, Marc Svensson, Peter Treede, Rolf-Detlef Zakrzewska, Joanna M. Nurmikko, Turo
spellingShingle	Cruccu, Giorgio Finnerup, Nanna B. Jensen, Troels S. Scholz, Joachim Sindou, Marc Svensson, Peter Treede, Rolf-Detlef Zakrzewska, Joanna M. Nurmikko, Turo Trigeminal neuralgia: New classification and diagnostic grading for practice and research
author_facet	Cruccu, Giorgio Finnerup, Nanna B. Jensen, Troels S. Scholz, Joachim Sindou, Marc Svensson, Peter Treede, Rolf-Detlef Zakrzewska, Joanna M. Nurmikko, Turo
author_sort	Cruccu, Giorgio
title	Trigeminal neuralgia: New classification and diagnostic grading for practice and research
title_short	Trigeminal neuralgia: New classification and diagnostic grading for practice and research
title_full	Trigeminal neuralgia: New classification and diagnostic grading for practice and research
title_fullStr	Trigeminal neuralgia: New classification and diagnostic grading for practice and research
title_full_unstemmed	Trigeminal neuralgia: New classification and diagnostic grading for practice and research
title_sort	trigeminal neuralgia: new classification and diagnostic grading for practice and research
description	Trigeminal neuralgia (TN) is an exemplary condition of neuropathic facial pain. However, formally classifying TN as neuropathic pain based on the grading system of the International Association for the Study of Pain is complicated by the requirement of objective signs confirming an underlying lesion or disease of the somatosensory system. The latest version of the International Classification of Headache Disorders created similar difficulties by abandoning the term symptomatic TN for manifestations caused by major neurologic disease, such as tumors or multiple sclerosis. These diagnostic challenges hinder the triage of TN patients for therapy and clinical trials, and hamper the design of treatment guidelines. In response to these shortcomings, we have developed a classification of TN that aligns with the nosology of other neurologic disorders and neuropathic pain. We propose 3 diagnostic categories. Classical TN requires demonstration of morphologic changes in the trigeminal nerve root from vascular compression. Secondary TN is due to an identifiable underlying neurologic disease. TN of unknown etiology is labeled idiopathic. Diagnostic certainty is graded possible when pain paroxysms occur in the distribution of the trigeminal nerve branches. Triggered paroxysms permit the designation of clinically established TN and probable neuropathic pain. Imaging and neurophysiologic tests that establish the etiology of classical or secondary TN determine definite neuropathic pain.
publisher	Lippincott Williams & Wilkins
publishDate	2016
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940067/
_version_	1613607110099075072

Trigeminal neuralgia: New classification and diagnostic grading for practice and research

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