Is carbamazepine less effective in the treatment of trigeminal neuralgia when prescribed by oral and maxillofacial surgeons?

Carbamazepine therapy is generally suggested as a first line of treatment for patients with idiopathic trigeminal neuralgia (ITN). This study was intended to investigate patient compliance and effects of carbamazepine in a group of ITN patients referred to oral and maxillofacial surgeons. A total of 19 patients with ITN who were taking carbamazepine as recommended and were unlikely to go into spontaneous remission were analyzed in a retrospective study. The following criteria were used for the assessment: pain-free periods, success, recurrence and failure rate, side effects, and discontinuation of the treatment. Pain relief was recorded in 16 patients with pain-free periods of 1 to 48 mo. Pain recurred in 11 patients within 1 to 30 mo. Side effects were recorded in six patients. The treatment was discontinued in 13 patients for various reasons. At the last visit, the treatment was successful in six patients with pain-free periods of 6 to 48 mo. It is concluded that the carbamazepine treatment of patients with ITN referred to oral and maxillofacial surgeons should not be expected to be successful as generally accepted. Since a relatively high percentage of patients were reluctant to take drugs, a new treatment scheme for patients with ITN referred to an oral and maxillofacial surgeon was suggested.