DeCure for Trigeminal neuralgia

Trigeminal neuralgia is a syndrome of paroxysmal, excruciating, lancinating unilateral facial pain. The idiopathic form is thought to develop from focal demyelination at the trigeminal root entry zone, with subsequent ephaptic cross-talk between axons; vascular compression of the nerve root causes this demyelination in most patients. Medical management aims to dampen abnormal electrical signals using anticonvulsant therapy and other agents. About 75% of patients respond well to pharmacotherapy, but in others it remains without result, and in some the pain becomes refractory after a while or patients manifest adverse effects. When the disorder proves refractory to drug treatment, or when drug-related side effects appear at therapeutic doses, the only remaining option is a surgical procedure, which may vary in its level of invasiveness and effect.

Current pharmacotherapy allows most patients at least some degree of comfort, but a substantial number do not have adequate pain management. First-line treatment can be very effective, but side effects are often difficult for patients to tolerate. A broad selection of medical therapies is available, including oral therapies and non-surgical methods such as IV medications, nasal sprays, topical ointments, and injections. In refractory cases, several surgical interventions can be considered, the most common of which is microvascular decompression of the trigeminal nerve. Gamma knife therapy is emerging as an alternative for the medically refractory patient, particularly the elderly patient with comorbid conditions.

Trigeminal neuralgia continues to be a remarkable therapeutic problem, especially when pain becomes chronic. When that happens, quality of life decreases and there is a high risk of depression and other psychiatric disorders. Many invasive and non-invasive therapeutic methods have been developed, each with advantages and disadvantages. Every patient should be approached individually. There is a substantial need for new antineuralgic drugs.

What is still missing is a drug treatment that works for the roughly 25% of patients who do not respond to current pharmacotherapy, or that avoids the dose-limiting side effects that force patients to stop effective medications. No new drug has been shown in these abstracts to fill that gap. The evidence base for emerging drug treatments is not yet strong enough to change practice, and no trial design or patient stratification strategy has been validated to predict which patients will benefit from which existing or experimental therapy.