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  • Intervention - Treatments - Percutaneous destructive neurosurgical techniques (radiofrequency thermocoagulation, glycerol rhizolysis, or balloon compression) - Trigeminal neuralgia
    search date 2010 57 which identified no RCTs comparing percutaneous destructive neurosurgical techniques radiofrequency thermocoagulation glycerol rhizolysis or balloon compression versus placebo no treatment or versus other treatments covered in this review Top Comment As Clinical Evidence was unable to perform a second appraisal of results retrieved by the contributor s search we may have missed studies that could affect our overall assessment of this intervention Clinical guide One of the systematic reviews search date 2003 54 identified nine observational studies mainly case series 2077 people comparing percutaneous destructive neurosurgical techniques to the Gasserian ganglion and or pre ganglionic nerve route versus stereotactic radiosurgery It suggested that radiofrequency thermocoagulation may offer higher rates of complete pain relief than glycerol rhizolysis and stereotactic radiosurgery a non percutaneous destructive neurosurgical technique but it is also associated with the highest rate of complications RCTs comparing the effects of percutaneous destructive neurosurgical techniques with no treatment have not been undertaken and are unlikely to be in future because of ethical considerations We did identify one small prospective comparative cohort observational study comparing radiofrequency thermocoagulation with glycerol rhizolysis 67 This low quality evidence study of 79 people with relatively short median follow ups of 24 to 36 months for each technique showed better pain control results for radiofrequency thermocoagulation compared with glycerol rhizolysis 85 v 59 P 0 05 based on raw data but this difference lost significance when life table analysis was applied P 0 51 One of the systematic reviews search date 2010 57 identified a small RCT comparing pulsed radiofrequency thermocoagulation versus conventional radiofrequency thermocoagulation 68 Everyone in the pulsed radiofrequency thermocoagulation treatment group dropped out and needed conventional radiofrequency thermocoagulation Furthermore everyone in the pulsed radiofrequency thermocoagulation group required additional carbamazepine and or gabapentin compared with one person in the conventional

    Original URL path: http://www.clinicalevidence.org/x/systematic-review/1207/intervention/sr-1207-i17.html (2016-02-01)
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  • Intervention - Treatments - Lamotrigine - Trigeminal neuralgia
    see table We found insufficient evidence to judge the effectiveness of lamotrigine in people with trigeminal neuralgia Lamotrigine is often used in people who cannot tolerate carbamazepine but the dose must be increased slowly to avoid rashes thus making it unsuitable for acute use Top Benefits and harms Lamotrigine versus placebo We found one systematic review search date 2011 35 which identified one small double blind crossover RCT comparing lamotrigine versus placebo in people receiving carbamazepine or phenytoin 36 Pain relief Lamotrigine compared with placebo We don t know whether adding lamotrigine is more effective than adding placebo to current treatment at increasing the proportion of people improved improvement not further defined after 2 weeks of treatment very low quality evidence Ref type Population Outcome Interventions Results and statistical analysis Effect size for ORs and RRs Favours Symptom improvement 36 RCT Crossover design 14 people with refractory trigeminal neuralgia using either carbamazepine or phenytoin In review 35 Proportion of people improved 2 weeks of treatment 10 13 77 with addition of lamotrigine 8 14 57 with addition of placebo Other comment Results after crossover Significance not assessed Psychological distress No data from the following reference on this outcome 36 35 Ability to perform normal activities No data from the following reference on this outcome 36 35 Adverse effects Ref type Population Outcome Interventions Results and statistical analysis Effect size for ORs and RRs Favours Adverse effects 36 RCT Crossover design 14 people with refractory trigeminal neuralgia using either carbamazepine or phenytoin In review 35 Total number of people reporting adverse effects 7 13 54 with addition of lamotrigine 7 14 50 with addition of placebo Other comment Adverse effects with lamotrigine included dizziness constipation nausea and drowsiness Lamotrigine may also cause serious skin rash and allergic reactions particularly if the

    Original URL path: http://www.clinicalevidence.org/x/systematic-review/1207/intervention/sr-1207-i5.html (2016-02-01)
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  • Intervention - Treatments - Gabapentin - Trigeminal neuralgia
    Trigeminal neuralgia Message Please wait Notes Remove Edit Notes Please do not record person identifiable clinical or staff information and other sensitive information in this field Update Cancel Remove Notes Please do not record person identifiable clinical or staff information and other sensitive information in this field Save Cancel Treatments Gabapentin In this section Key points Benefits and Harms Comment Top Key points For GRADE evaluation of interventions for Trigeminal neuralgia see table We found no evidence comparing gabapentin versus placebo no treatment or other treatments covered in this review in people with trigeminal neuralgia Gabapentin does have support for use in treating other neuropathic pain conditions particularly multiple sclerosis Top Benefits and harms Gabapentin We found no systematic review or good quality RCTs on the effects of gabapentin compared with placebo no treatment or other listed interventions in the review in people with trigeminal neuralgia For further information on harms of gabapentin see harms of anti epileptic drugs under Epilepsy Top Comment As Clinical Evidence was unable to perform a second appraisal of results retrieved by the contributor s search we may have missed studies that could affect our overall assessment of this intervention Clinical guide Although gabapentin has

    Original URL path: http://www.clinicalevidence.org/x/systematic-review/1207/intervention/sr-1207-i8.html (2016-02-01)
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  • - BMJ Clinical Evidence - Glossary
    in close contact with the nerve are moved out of the way with the aim of avoiding nerve damage and hence preserving function This procedure requires general anaesthetic It is the only neurosurgical procedure designed to spare the trigeminal nerve from damage and to directly address the cause of trigeminal neuralgia in most cases rather than just relieve the symptom of pain Results of this procedure vary the most from

    Original URL path: http://www.clinicalevidence.org/x/systematic-review/1207/glossary/sr-1207-g1.html (2016-02-01)
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  • - BMJ Clinical Evidence - Glossary
    that involves using a focused beam of ionising radiation to selectively damage the small unmyelinated and small myelinated pain fibres of the trigeminal nerve while ideally sparing the rest of the nerve fibres While several technologies purport similar results CyberKnife radiosurgery and other LINAC MLC based radiosurgery technologies the predominant and proven technology for this non invasive neurosurgical technique is the Gamma Knife View all glossaries Follow us on Blogs

    Original URL path: http://www.clinicalevidence.org/x/systematic-review/1207/glossary/sr-1207-g2.html (2016-02-01)
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  • - BMJ Clinical Evidence - Glossary
    skin of the cheek and that cause partial destruction ablation of the trigeminal nerve by selectively targeting damage to the small unmyelinated and small myelinated pain fibres of the trigeminal nerve while ideally sparing the rest of the nerve fibres e g radiofrequency thermocoagulation glycerol rhizolysis and balloon compression Also known as percutaneous ablative surgical procedures View all glossaries Follow us on Blogs Podcasts Twitter Facebook RSS Email YouTube Google

    Original URL path: http://www.clinicalevidence.org/x/systematic-review/1207/glossary/sr-1207-g3.html (2016-02-01)
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  • - BMJ Clinical Evidence - Glossary
    viscous alcohol called glycerol to damage the Gasserian ganglion and or pre ganglionic nerve route The procedure stops the transmission of pain signals to the brain by causing selective chemical damage to the small unmyelinated and small myelinated pain fibres of the trigeminal nerve while ideally sparing the rest of the nerve fibres This minimally invasive procedure is also known as percutaneous retrogasserian glycerol rhizolysis View all glossaries Follow us

    Original URL path: http://www.clinicalevidence.org/x/systematic-review/1207/glossary/sr-1207-g4.html (2016-02-01)
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  • - BMJ Clinical Evidence - Glossary
    ganglionic nerve route The procedure involves using a balloon to press the nerve against bony tissue which causes mechanical nerve destruction partial nerve damage and is designed to stop the transmission of pain signals to the brain by selectively damaging the small unmyelinated and small myelinated pain fibres of the trigeminal nerve while ideally sparing the rest of the nerve fibres This minimally invasive procedure is also known as microcompression

    Original URL path: http://www.clinicalevidence.org/x/systematic-review/1207/glossary/sr-1207-g5.html (2016-02-01)
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