Trigeminal neuralgia: New classification and diagnostic grading for practice and research.
Trigeminal neuralgia: New classification and diagnostic grading for practice and research.
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DOI：
10.1212/wnl.0000000000002840
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发表时间：
2016-07-12
期刊：
影响因子：
9.9
通讯作者：
Nurmikko T
中科院分区：
文献类型：
--
作者：
Cruccu G;Finnerup NB;Jensen TS;Scholz J;Sindou M;Svensson P;Treede RD;Zakrzewska JM;Nurmikko T
三叉神经痛（TN）是神经性面部疼痛的示例性病症。然而，根据国际疼痛研究协会的分级系统将TN正式分类为神经性疼痛，由于需要客观体征确认躯体感觉系统的潜在病变或疾病而变得复杂。最新版的国际头痛疾病分类也造成了类似的困难，因为它放弃了症状性TN一词，不再将其用于主要神经系统疾病（如肿瘤或多发性硬化症）引起的表现。这些诊断挑战阻碍了TN患者的治疗和临床试验的分类，并阻碍了治疗指南的设计。针对这些缺点，我们开发了一种与其他神经系统疾病和神经性疼痛的疾病分类学相一致的TN分类。我们提出了三个诊断类别。传统的三叉神经根切断术需要显示血管压迫三叉神经根的形态学改变。继发性TN是由于可识别的潜在神经系统疾病。病因不明的TN被标记为特发性。当疼痛发作发生在三叉神经分支的分布时，诊断确定性被分级为可能。触发性发作允许指定临床上确定的TN和可能的神经性疼痛。确定经典或继发性TN病因的影像学和神经生理学检查可确定神经病理性疼痛。
Trigeminal neuralgia (TN) is an exemplary condition of neuropathic facial pain. However, formally classifying TN as neuropathic pain based on the grading system of the International Association for the Study of Pain is complicated by the requirement of objective signs confirming an underlying lesion or disease of the somatosensory system. The latest version of the International Classification of Headache Disorders created similar difficulties by abandoning the term symptomatic TN for manifestations caused by major neurologic disease, such as tumors or multiple sclerosis. These diagnostic challenges hinder the triage of TN patients for therapy and clinical trials, and hamper the design of treatment guidelines. In response to these shortcomings, we have developed a classification of TN that aligns with the nosology of other neurologic disorders and neuropathic pain. We propose 3 diagnostic categories. Classical TN requires demonstration of morphologic changes in the trigeminal nerve root from vascular compression. Secondary TN is due to an identifiable underlying neurologic disease. TN of unknown etiology is labeled idiopathic. Diagnostic certainty is graded possible when pain paroxysms occur in the distribution of the trigeminal nerve branches. Triggered paroxysms permit the designation of clinically established TN and probable neuropathic pain. Imaging and neurophysiologic tests that establish the etiology of classical or secondary TN determine definite neuropathic pain.