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## Complete Summary

#### GUIDELINE TITLE

Practice parameter: the diagnostic evaluation and treatment of
trigeminal neuralgia (an evidence-based review). Report of the Quality
Standards Subcommittee of the American Academy of Neurology and the
European Federation of Neurological Societies.

#### BIBLIOGRAPHIC SOURCE(S)

Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K,
Nurmikko T, Zakrzewska JM. Practice Parameter: The diagnostic evaluation
and treatment of trigeminal neuralgia (an evidence-based review). Report
of the Quality Standards Subcommittee of the American Academy of
Neurology and the European Federation of Neurological Societies.
Neurology 2008 Oct 7;71(15):1183-90. \[40 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=18716236)

#### GUIDELINE STATUS

This is the current release of the guideline.

### \*\* REGULATORY ALERT \*\*

#### FDA WARNING/REGULATORY ALERT

**Note from the National Guideline Clearinghouse**: This guideline
references a drug(s)/intervention(s) for which important revised
regulatory and/or warning information has been released.

-   [December 12, 2007,
    Carbamazepine](http://www.fda.gov/medwatch/safety/2007/safety07.htm#carbamazepine):
    The U.S. Food and Drug Administration (FDA) has provided
    recommendations for screening that should be performed on specific
    patient populations before starting treatment with carbamazepine.

### COMPLETE SUMMARY CONTENT

 \*\* REGULATORY ALERT \*\*\
 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

-   Trigeminal neuralgia (TN)

-   Classic TN (CTN)

-   Symptomatic TN (STN)

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation\
Screening\
Treatment

#### CLINICAL SPECIALTY

Family Practice\
Internal Medicine\
Neurological Surgery\
Neurology\
Pharmacology

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

-   To perform an evidence-based review of the diagnosis and treatment
    of trigeminal neuralgia (TN) and make evidence-based recommendations

-   To address the following TN diagnostic questions:

    -   How often does routine neuroimaging (computed tomography \[CT\],
        magnetic resonance imaging \[MRI\]) identify a structural cause
        of TN (excluding vascular contact with compression of the fifth
        cranial nerve)?

    -   Which clinical or laboratory features accurately identify
        patients with symptomatic TN (STN)?

    -   For patients with classic TN (CTN), does high-resolution MRI
        accurately identify patients with neurovascular compression?

-   To address the following TN pharmacologic questions:

    -   Which drugs effectively treat CTN?

    -   Which drugs effectively treat STN?

    -   Is there evidence of efficacy of intravenous drugs in acute
        exacerbations of TN?

-   To address the following TN surgical questions:

    -   When should surgery be offered?

    -   Which surgical technique gives the longest pain-free period with
        the fewest complications and good quality of life?

    -   Which surgical techniques should be used in patients with
        multiple sclerosis?

#### TARGET POPULATION

Patients with trigeminal neuralgia

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Diagnosis/Evaluation**

1.  Routine neuroimaging (computed tomography \[CT\], magnetic resonance
    imaging \[MRI\])

2.  Identification of patients with symptomatic trigeminal neuralgia
    (STN) through clinical examination

3.  Electrophysiology studies (measurement of trigeminal reflexes)

4.  Use of high-resolution MRI to identify neurovascular compression
    (considered but not recommended)

**Treatment**

1.  Carbamazepine

2.  Oxcarbazepine

3.  Baclofen

4.  Lamotrigine

5.  Pimozide

6.  Percutaneous procedures on the Gasserian ganglion

7.  Gamma knife surgery

8.  Microvascular decompression

9.  Topical ophthalmic anesthesia (specifically not recommended)

#### MAJOR OUTCOMES CONSIDERED

-   Diagnostic yields of imaging studies

-   Diagnostic accuracy of assessing clinical features for predicting
    risk of symptomatic trigeminal neuralgia (STN)

-   Diagnostic accuracy of measuring trigeminal reflexes and trigeminal
    evoked potentials for identifying patients with STN

-   Sensitivity and specificity of high-resolution magnetic resonance
    imaging (MRI) to identify neurovascular compression

-   Effectiveness of drug treatment for reducing pain

-   Effectiveness of surgery for reducing pain and improving quality of
    life

-   Adverse and side effects of pharmacological therapies

-   Complications of surgery

-   Quality of life

-   Mortality

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

The American Academy of Neurology (AAN) and European Federation of
Neurological Societies (EFNS) assembled a panel of experts who searched
MEDLINE, EMBASE, and the Cochrane library. Searches extended from the
time of database inception to December 2007. All searches used the
following synonyms for TN: trigeminal neuralgia, tic douloureux, facial
pain, or trigeminal neuropathy. The primary search was supplemented by a
secondary search using the bibliography of retrieved articles and
knowledge from the panel. Only full-length original communications were
accepted. [Inclusion criteria were as follows]{.underline}: relevant to
the clinical questions, limited to human subjects, randomized controlled
trials, case control, cohort studies, case series \>6, or meta-analysis.
Abstracts, reviews, and studies with undocumented or unstated mention of
improvement were excluded.

#### NUMBER OF SOURCE DOCUMENTS

47

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Classification of Evidence for Rating of a Screening Article**

**Class I**: A statistical, population-based sample of patients studied
at a uniform point in time (usually early) during the course of the
condition. All patients undergo the intervention of interest. The
outcome, if not objective, is determined in an evaluation that is masked
to the patients\' clinical presentations.

**Class II**: A statistical, non-referral-clinic-based sample of
patients studied at a uniform point in time (usually early) during the
course of the condition. Most patients undergo the intervention of
interest. The outcome, if not objective, is determined in an evaluation
that is masked to the patients\' clinical presentations.

**Class III**: A sample of patients studied during the course of the
condition. Some patients undergo the intervention of interest. The
outcome, if not objective, is determined in an evaluation by someone
other than the treating physician.

**Class IV**: Expert opinion, case reports or any study not meeting
criteria for Class I to III.

**Classification of Evidence for Rating of a Diagnostic Article**

**Class I**: Evidence provided by a prospective study in a broad
spectrum of persons with the suspected condition, using a reference
(gold) standard for case definition, where test is applied in a blinded
evaluation, and enabling the assessment of appropriate tests of
diagnostic accuracy. All patients undergoing the diagnostic test have
the presence or absence of the disease determined.

**Class II**: Evidence provided by a prospective study of a narrow
spectrum of persons with the suspected condition, or a well designed
retrospective study of a broad spectrum of persons with an established
condition (by \"gold standard\") compared to a broad spectrum of
controls, where test is applied in a blinded evaluation, and enabling
the assessment of appropriate tests of diagnostic accuracy.

**Class III**: Evidence provided by a retrospective study where either
persons with the established condition or controls are of a narrow
spectrum, and where the reference standard, if not objective, is applied
by someone other than the person that performed the test.

**Class IV**: Any design where test is not applied in an independent
evaluation OR evidence provided by expert opinion alone or in
descriptive case series (without controls).

**Classification of Evidence for Rating of a Therapeutic Article**

**Class I**: Prospective, randomized, controlled clinical trial with
masked outcome assessment, in a representative population. The following
are required:

a.  Concealed allocation

b.  Primary outcome(s) clearly defined

c.  Exclusion/inclusion criteria clearly defined

d.  Adequate accounting for drop-outs and cross-overs with numbers
    sufficiently low to have minimal potential for bias

e.  Relevant baseline characteristics are presented and substantially
    equivalent among treatment groups or there is appropriate
    statistical adjustment for differences.

**Class II**: Prospective matched group cohort study in a representative
population with masked outcome assessment that meets a-e above OR a
randomized controlled trial in a representative population that lacks
one criteria a-d.

**Class III**: All other controlled trials (including well-defined
natural history controls or patients serving as own controls) in a
representative population, where outcome is independently assessed, or
independently derived by objective outcome measurement.\*

**Class IV**: Evidence from uncontrolled studies, case series, case
reports, or expert opinion.

\*Objective outcome measurement: an outcome measure that is unlikely to
be affected by an observer\'s (patient, treating physician,
investigator) expectation or bias (e.g., blood tests, administrative
outcome data).

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Panel members reviewed abstracts and titles for relevance. Two panel
members reviewed papers meeting inclusion criteria. An additional panel
member arbitrated disagreements. The risk of bias was determined using
the classification of evidence for each study (Classes I--IV; see
\"Rating Scheme for the Strength of the Evidence).

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Other

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

**Classification of Recommendations**

**Level A** = Established as effective, ineffective, or harmful (or
established as useful/predictive or not useful/predictive) for the given
condition in the specified population. (Level A rating requires at least
two consistent Class I studies.)\*\*

**Level B** = Probably effective, ineffective, or harmful (or probably
useful/predictive or not useful/predictive) for the given condition in
the specified population. (Level B rating requires at least one Class I
study or at least two consistent Class II studies.)

**Level C** = Possibly effective, ineffective, or harmful (or possibly
useful/predictive or not useful/predictive) for the given condition in
the specified population. (Level C rating requires at least one Class II
study or two consistent Class III studies.)

**Level U** = Data inadequate or conflicting; given current knowledge,
treatment (test, predictor) is unproven. (Studies not meeting criteria
for Class I--Class III.)

\*\*In exceptional cases, one convincing Class I study may suffice for
an \"A\" recommendation if 1) all criteria are met, 2) the magnitude of
effect is large (relative rate improved outcome \>5 and the lower limit
of the confidence interval is \<2).

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review\
Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

This guideline was approved by the Quality Standards Subcommittee on
February 8, 2008; by the Practice Committee on March 20, 2008; and by
the American Academy of Neurology Board of Directors on June 30, 2008.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Definitions of the classification of screening evidence (Classes I--IV),
classification of therapeutic evidence (Classes I--IV), and strength of
recommendations (A, B, C, U) are provided at the end of the \"Major
Recommendations\" field.

For patients with trigeminal neuralgia (TN), routine imaging may be
considered to identify symptomatic TN (STN) (**Level C**).

The presence of trigeminal sensory deficits or bilateral involvement of
the trigeminal nerves should be considered useful to identify patients
with STN. However, because of poor specificity, the absence of these
features is not useful for excluding STN (**Level B**).

Measuring trigeminal reflexes in a qualified electrophysiologic
laboratory should be considered useful for distinguishing STN from
classic TN (CTN) (**Level B**).

Younger age at onset, involvement of the first division of the
trigeminal nerve, unresponsiveness to treatment, and abnormal trigeminal
evoked potentials should be disregarded as useful for accurately
identifying patients with STN (**Level B**).

To control pain in patients with TN: carbamazepine should be offered
(**Level A**), oxcarbazepine should be considered (**Level B**),
baclofen, lamotrigine, and pimozide may be considered (**Level C**), and
topical ophthalmic anesthesia should not be considered (**Level B**).

For patients with TN refractory to medical therapy: early surgical
therapy may be considered (**Level C**), and percutaneous procedures on
the Gasserian ganglion, gamma knife, and microvascular decompression may
be considered (**Level C**).

**[Definitions]{.underline}**:

**Classification of Evidence for Rating of a Screening Article**

**Class I**: A statistical, population-based sample of patients studied
at a uniform point in time (usually early) during the course of the
condition. All patients undergo the intervention of interest. The
outcome, if not objective, is determined in an evaluation that is masked
to the patients\' clinical presentations.

**Class II**: A statistical, non-referral-clinic-based sample of
patients studied at a uniform point in time (usually early) during the
course of the condition. Most patients undergo the intervention of
interest. The outcome, if not objective, is determined in an evaluation
that is masked to the patients\' clinical presentations.

**Class III**: A sample of patients studied during the course of the
condition. Some patients undergo the intervention of interest. The
outcome, if not objective, is determined in an evaluation by someone
other than the treating physician.

**Class IV**: Expert opinion, case reports or any study not meeting
criteria for Class I to III.

**Classification of Evidence for Rating of a Diagnostic Article**

**Class I**: Evidence provided by a prospective study in a broad
spectrum of persons with the suspected condition, using a reference
(gold) standard for case definition, where test is applied in a blinded
evaluation, and enabling the assessment of appropriate tests of
diagnostic accuracy. All patients undergoing the diagnostic test have
the presence or absence of the disease determined.

**Class II**: Evidence provided by a prospective study of a narrow
spectrum of persons with the suspected condition, or a well designed
retrospective study of a broad spectrum of persons with an established
condition (by \"gold standard\") compared to a broad spectrum of
controls, where test is applied in a blinded evaluation, and enabling
the assessment of appropriate tests of diagnostic accuracy.

**Class III**: Evidence provided by a retrospective study where either
persons with the established condition or controls are of a narrow
spectrum, and where the reference standard, if not objective, is applied
by someone other than the person that performed the test.

**Class IV**: Any design where test is not applied in an independent
evaluation OR evidence provided by expert opinion alone or in
descriptive case series (without controls).

**Classification of Evidence for Rating of a Therapeutic Article**

**Class I**: Prospective, randomized, controlled clinical trial with
masked outcome assessment, in a representative population. The following
are required:

a.  Concealed allocation

b.  Primary outcome(s) clearly defined

c.  Exclusion/inclusion criteria clearly defined

d.  Adequate accounting for drop-outs and cross-overs with numbers
    sufficiently low to have minimal potential for bias

e.  Relevant baseline characteristics are presented and substantially
    equivalent among treatment groups or there is appropriate
    statistical adjustment for differences.

**Class II**: Prospective matched group cohort study in a representative
population with masked outcome assessment that meets a-e above OR a
randomized controlled trial in a representative population that lacks
one criteria a-d.

**Class III**: All other controlled trials (including well-defined
natural history controls or patients serving as own controls) in a
representative population, where outcome is independently assessed, or
independently derived by objective outcome measurement.\*

**Class IV**: Evidence from uncontrolled studies, case series, case
reports, or expert opinion.

\*Objective outcome measurement: an outcome measure that is unlikely to
be affected by an observer\'s (patient, treating physician,
investigator) expectation or bias (e.g., blood tests, administrative
outcome data).

**Classification of Recommendations**

**Level A** = Established as effective, ineffective, or harmful (or
established as useful/predictive or not useful/predictive) for the given
condition in the specified population. (Level A rating requires at least
two consistent Class I studies.)\*\*

**Level B** = Probably effective, ineffective, or harmful (or probably
useful/predictive or not useful/predictive) for the given condition in
the specified population. (Level B rating requires at least one Class I
study or at least two consistent Class II studies.)

**Level C** = Possibly effective, ineffective, or harmful (or possibly
useful/predictive or not useful/predictive) for the given condition in
the specified population. (Level C rating requires at least one Class II
study or two consistent Class III studies.)

**Level U** = Data inadequate or conflicting; given current knowledge,
treatment (test, predictor) is unproven. (Studies not meeting criteria
for Class I--Class III.)

\*\*In exceptional cases, one convincing Class I study may suffice for
an \"A\" recommendation if 1) all criteria are met, 2) the magnitude of
effect is large (relative rate improved outcome \>5 and the lower limit
of the confidence interval is \<2).

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is identified and graded for each
recommendation (see \"Major Recommendations\").

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate diagnostic evaluation and treatment of trigeminal neuralgia

#### POTENTIAL HARMS

-   Carbamazepine is sometimes poorly tolerated and severe adverse
    events have been reported.

-   Sensory loss after percutaneous procedures is present in almost half
    of patients. Less than 6% develop troublesome dysesthesias. The
    incidence of anesthesia dolorosa is around 4%. Postoperatively, 12%
    of patients report a discomfort described as burning, heavy, aching,
    or tiring. Corneal numbness, with the risk of keratitis, occurs in
    4% of patients. Problems with other cranial nerves are uncommon, and
    the major perioperative complication is meningitis, mainly aseptic
    (0.2%). Up to 50% of patients undergoing balloon compression suffer
    temporary and rarely chronic masticatory problems. Mortality is
    extremely low.

-   After gamma knife surgery, studies report sensory complications in
    some patients; complications include facial numbness, troublesome
    sensory loss, and paresthesias. There have been no reports of
    complications unrelated to the trigeminal nerve.

-   The average mortality associated with microvascular decompression is
    0.2%. Up to 4% of patients incur major problems such as
    cerebrospinal fluid leaks, infarcts, or hematomas. Aseptic
    meningitis is the most common complication (occurring in 11% of
    patients). Diplopia is often transient and facial weakness is rare.
    Sensory loss occurs in 7% of patients. The major long-term
    complication is hearing loss which can occur in as many as 10% of
    patients.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

This statement is provided as an educational service of the American
Academy of Neurology. It is based on an assessment of current scientific
and clinical information. It is not intended to include all possible
proper methods of care for a particular neurologic problem or all
legitimate criteria for choosing to use a specific procedure. Neither is
it intended to exclude any reasonable alternative methodologies. The AAN
recognizes that specific patient care decisions are the prerogative of
the patient and the physician caring for the patient, based on all of
the circumstances involved. The clinical context section is made
available in order to place the evidence-based guideline into
perspective with current practice habits and challenges. No formal
practice recommendations should be inferred.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Patient Resources\
Quick Reference Guides/Physician Guides\
Resources\
Slide Presentation\
Staff Training/Competency Material

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K,
Nurmikko T, Zakrzewska JM. Practice Parameter: The diagnostic evaluation
and treatment of trigeminal neuralgia (an evidence-based review). Report
of the Quality Standards Subcommittee of the American Academy of
Neurology and the European Federation of Neurological Societies.
Neurology 2008 Oct 7;71(15):1183-90. \[40 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=18716236)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2008 Oct 7

#### GUIDELINE DEVELOPER(S)

American Academy of Neurology - Medical Specialty Society\
European Federation of Neurological Societies - Medical Specialty
Society

#### SOURCE(S) OF FUNDING

American Academy of Neurology (AAN)

#### GUIDELINE COMMITTEE

Quality Standards Subcommittee

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Primary Authors*: G. Gronseth, MD, FAAN; G. Cruccu, MD; J. Alksne, MD;
C. Argoff, MD; M. Brainin, MD, FESO; K. Burchiel, MD; T. Nurmikko, MD,
PhD; J.M. Zakrzewska, MD, FDSRCS, FFDRCSI

*Quality Standards Subcommittee Members*: Jacqueline French, MD, FAAN
(*Chair*); Charles E. Argoff, MD; Eric Ashman, MD; Stephen Ashwal, MD,
FAAN (*Ex-officio*); Christopher Bever, Jr., MD, MBA, FAAN; John D.
England, MD, FAAN; Gary Franklin, MD, MPH, FAAN (*Ex-officio*); Deborah
Hirtz, MD, FAAN (Ex-officio); Robert G. Holloway, MD, MPH, FAAN; Donald
J. Iverson, MD, FAAN; Steven R. Messé, MD; Leslie A. Morrison, MD; James
C. Stevens, MD, FAAN (*Ex-officio*); David J. Thurman, MD, MPH
(*Ex-officio*); Dean M. Wingerchuk, MD, MSc, FRCP(C); Theresa A.
Zesiewicz, MD, FAAN

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

The American Academy of Neurology (AAN) is committed to producing
independent, critical and truthful clinical practice guidelines (CPGs).
Significant efforts are made to minimize the potential for conflicts of
interest to influence the recommendations of this CPG. To the extent
possible, the AAN keeps separate those who have a financial stake in the
success or failure of the products appraised in the CPGs and the
developers of the guidelines. Conflict of interest forms were obtained
from all authors and reviewed by an oversight committee prior to project
initiation. AAN limits the participation of authors with substantial
conflicts of interest. The AAN forbids commercial participation in, or
funding of, guideline projects. Drafts of the guideline have been
reviewed by at least three AAN committees, a network of neurologists,
*Neurology* peer reviewers and representatives from related fields. The
AAN Guideline Author Conflict of Interest Policy can be viewed at
[www.aan.com](http://www.aan.com/).

The authors report the following conflicts of interest: Dr. Gronseth has
received speaker honoraria from Boeheringer Ingelheim, Pfizer, and
GlaxoSmithKline, and has been compensated by Ortho-McNeil for serving on
a safety monitoring committee; Dr. Cruccu has given lectures for Pfizer
and estimates 5% of his clinical effort is spent on trigeminal reflex
testing; Dr. Alksne estimates 10% of his clinical effort is spent on
surgery for trigeminal neuralgia; Dr. Argoff estimates 25% of his
clinical effort is spent on Medtronic Pump, 25% on trigger point
injections, 20% on epidural steroid injections, and 30% on botulinum
toxin injections; Dr. Brainin has nothing to disclose; Dr. Burchiel
holds equity in Medtronic, Boston Scientific, and Pfizer; Dr. Nurmikko
holds financial interests in Boehringer Ingelheim, Pfizer UK,
Grunenthal, Sanofi Pasteur MSD, and UCB/Scwarz Pharma; Dr. Nurmikko
estimates 10% of his clinical effort is spent on MRI; Dr. Zakrzewska
holds financial interests in UCB Pharma and has received research
support from the Bupa Foundation for decision analysis in trigeminal
neuralgia.

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: A list of American Academy of Neurology (AAN)
guidelines, along with a link to a Portable Document Format (PDF) file
for this guideline, is available at the [AAN Web
site](http://www.aan.com/go/practice/guidelines).

Print copies: Available from the AAN Member Services Center, (800)
879-1960, or from AAN, 1080 Montreal Avenue, St. Paul, MN 55116.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Trigeminal neuralgia. AAN summary of evidence-based guideline for
    clinicians. St. Paul (MN): American Academy of Neurology. 2008. 2 p.
    Available in Portable Document Format (PDF) from the [AAN Web
    site](http://www.aan.com/practice/guideline/index.cfm?fuseaction=home.view&guideline=303).

-   Practice parameter: the diagnostic evaluation and treatment of
    trigeminal neuralgia (an evidence-based review). Slide
    presentation. 2008. 57 p. Available from the [AAN Web
    site](http://www.aan.com/practice/guideline/index.cfm?fuseaction=home.view&guideline=305).

-   Practice parameter: the diagnostic evaluation and treatment of
    trigeminal neuralgia (an evidence-based review). Case study and
    coding. 2008. 3 p. Available from the [AAN Web
    site](http://www.aan.com/practice/guideline/index.cfm?fuseaction=home.view&guideline=302).

-   Practice parameter: the diagnostic evaluation and treatment of
    trigeminal neuralgia (an evidence-based review). Podcast. 2008.
    Available from the [AAN Web
    site](http://www.aan.com/practice/guideline/index.cfm?fuseaction=home.view&guideline=309).

-   AAN guideline development process \[online\]. St. Paul (MN):
    American Academy of Neurology. Available from the [AAN Web
    site](http://www.aan.com/go/practice/guidelines/development).

#### PATIENT RESOURCES

The following is available:

-   Trigeminal neuralgia. AAN summary of evidence-based guideline for
    patients and their families. St. Paul (MN): American Academy of
    Neurology (AAN). 2008. 2 p.

Electronic copies: Available in Portable Document Format (PDF) from the
[AAN Web
site](http://www.aan.com/practice/guideline/index.cfm?fuseaction=home.view&guideline=304).

Please note: This patient information is intended to provide health
professionals with information to share with their patients to help them
better understand their health and their diagnosed disorders. By
providing access to this patient information, it is not the intention of
NGC to provide specific medical advice for particular patients. Rather
we urge patients and their representatives to review this material and
then to consult with a licensed health professional for evaluation of
treatment options suitable for them as well as for diagnosis and answers
to their personal medical questions. This patient information has been
derived and prepared from a guideline for health care professionals
included on NGC by the authors or publishers of that original guideline.
The patient information is not reviewed by NGC to establish whether or
not it accurately reflects the original guideline\'s content.

#### NGC STATUS

This summary was completed by ECRI Institute on September 23, 2008. This
summary was completed by ECRI Institute on November 10, 2008. The
information was verified by the guideline developer on December 11,
2008.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is
copyrighted by the American Academy of Neurology.

### DISCLAIMER

#### NGC DISCLAIMER

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© 1998-2009 National Guideline Clearinghouse

Date Modified: 1/5/2009