Anti-convulsants: Primary Treatment for TN

Today, Trigeminal Neuralgia is most frequently and effectively treated with anticonvulsant, also known as antiepileptic, drugs. One proposed cause of trigeminal neuralgia is degeneration or damage to facial nerves, causing them to compensate for "mismatched" signals by becoming hypersensitive. Anticonvulsant medications work by regulating incoming and outgoing signals in the nerves, quieting these "distress" signals and the accompanying pain felt by TN patients. Although prescribed less frequently, anticonvulsants may also be used to treat postherpetic neuralgia.

The greatest obstacle to anticonvulsant drugs as treatment for TN is their side effects; these include dizziness, confusion, drowsiness, double vision, nystagmus (eye twitching) and nausea, as well as dramatic changes in blood levels. Anticonvulsants have also been linked to an increased risk of suicidal tendencies, so if you are taking anticonvulsants (especially for the first time), you should be extra aware of any changes in behavior or thought, and notify your doctor immediately. Carbamazepine, the chief anticonvulsant for treating TN, can also trigger a serious reaction is some people (most commonly those of Asian descent). Normally, initial treatment with anticonvulsants involves only one medication, but many patients end up requiring a combination of drugs, or higher dosage if the medications begin to lose effectiveness.

Carbamazepine is, in most cases, the most effective (and most prescribed) drug for treating TN. It is so effective that relief from pain with carbamazepine is often a good indicator that a patient does indeed have TN. Nearly all patients prescribed carbamazepine- usually in the form of Tegretol- complain of side effects, although these fade as the body adjusts to the medication (which, unfortunately, can last as long as the time it takes to increase dosage). More potentially serious side effects that have been linked with carbamazepine that are not dose-related are memory loss, skin rash, and blood problems (found in 2-6% of carbamazepine users). These blood problems include a drop in the number of white blood cells, hyponatremia (low sodium in the blood), and aplastic anemia (the bone marrow stops making blood cells). Oxycarbamazepine (Trileptal) is a new form of Tegretol that may involve fewer side effects, but must be taken in higher doses. Additionally, Gabapentin has fewer side effects than carbamazepine, but is almost as equally effective.

Other alternative medications for carbamazepine include:
Phenytoin (Dilantin, Phenytek)
Gabapentin (Neurontin)
Lamotrigine (Lamictal)
Levateracitam (Keppra)
Pregabalin (Lyrica)
Topirimate (Topamax)
Valproic acid (Depakote)
Clonazepam (Klonopin,Rivatril)

Generally, the above medications are less effective than carbamazepine, and the differences among them are more arbitrary. However, they do have less severe side effects and can be used in combination with each other to strengthen their pain reduction.