Non-antiepileptic drugs for trigeminal neuralgia.
Author(s): Yang M, Zhou M, He L, Chen N, Zakrzewska JM.
Affiliation(s): Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue
Xiang, Chengdu, Sichuan, China, 610041.
Publication date & source: 2011, Cochrane Database Syst Rev. , (1):CD004029
BACKGROUND: Non-antiepileptic drugs have been used in the management of
trigeminal neuralgia since the 1970s.
OBJECTIVES: The objective was to systematically review the efficacy and
tolerability of non-antiepileptic drugs for trigeminal neuralgia.
SEARCH STRATEGY: For this updated review we searched the Cochrane Neuromuscular
Disease Group Specialized Register (30 April 2010). We also searched the Cochrane
Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue
2), MEDLINE (January 1966 to April 2010), EMBASE (January 1980 to April 2010),
LILACS (January 1982 to April 2010) and the Chinese Biomedical Retrieval System
(1978 to April 2010). We handsearched 10 Chinese journals.
SELECTION CRITERIA: We searched for double-blind randomized or quasi-randomized
controlled trials in which the active drug was used for at least two weeks.
DATA COLLECTION AND ANALYSIS: Two authors decided which trials fitted the
inclusion criteria and independently graded risk of bias.
MAIN RESULTS: Four trials involving 139 participants were included. The primary
outcome measure in each was pain relief. Three trials with an unclear risk of
bias compared one of the non-antiepileptic drugs tizanidine, tocainide or
pimozide with carbamazepine. In a trial of tizanidine involving 12 participants
(one dropped out due to unrelated disease) one of five treated with tizanidine
and four of six treated with carbamazepine improved, risk ratio 0.30 (95% CI 0.05
to 1.89). Few side effects were noted with tizanidine. In a study involving 12
participants there was an improvement in mean pain scores with tocainide similar
to that with carbamazepine, but significant side effects limited its use. In the
pimozide study more participants improved on pimozide (48/48) than with
carbamazepine (27/48) (risk ratio 1.76, 95% CI 1.37 to 2.26). Up to 83% of
participants reported adverse effects but these did not lead to withdrawal from
the study. A trial with low risk of bias involving 47 participants compared 0.5%
proparacaine hydrochloride eyedrops with placebo but did not show any significant
benefits or side effects.
AUTHORS' CONCLUSIONS: Of the four studies identified, one had low and three an
unclear risk of bias. There is insufficient evidence from randomized controlled
trials to show significant benefit from non-antiepileptic drugs in trigeminal
neuralgia. More research is needed.
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