What are the features of classical trigeminal neuralgia in a prospective series and what is pretrigeminal neuralgia
In a prospective series of 158 patients, the average age of onset was 52.9 years, with 60% being females. TN affects the right side of the face in 56%, left side in 41%, and both sides in 3%.
Pain was reported in the following distributions: V1, 4%; V2, 17%; V3, 19%; V1 + V2, 10%; V2 + V3, 33%; and V1 + V2 + V3, 13%. Thirteen percent had a more dull persistent pain at the onset of the disorder (“pretrigeminal neuralgia”) while 87% had stabbing paroxysmal pain.
The paroxysmal pain was rated on average 10/10 by 58% of the patients. Forty-nine percent of the cohort reported concomitant persistent pain along with the paroxysmal pain.
Forty percent suffered from more than 10 paroxysms of pain per day. Painful awakening at night because of pain attacks at least occasionally was reported by 49%.
Trigger factors were reported by 91% included the following: chewing, 73%; touch, 69%; brushing teeth, 66%; eating, 59%; talking, 58%; and cold wind, 50%. During attacks of pain, 31% experienced ipsilateral autonomic symptoms, most commonly conjunctival tearing or injection.
Of the surgery-naïve patients, 29% had sensory abnormalities on exam, most commonly hypesthesia confined to the painful area of the face. Most patients (63%) had periods of remission, with the average number per year of disease of 0.44 and 37% having months of remission and 63% experiencing years of remission.
