J Oral Med Pain.  2023 Jun;48(2):56-68. 10.14476/jomp.2023.48.2.56.

Treatment Utilization Patterns and Long-term Prognosis of Trigeminal Neuralgia: Insights from a Nationwide Study

• Park JE
• Kim HK
• Kim ME

• KMID: 2552141
• DOI: http://doi.org/10.14476/jomp.2023.48.2.56

Abstract

Purpose
This nationwide retrospective study aimed to examine treatment utilization patterns, including pharmacological and surgical interventions, and evaluate the long-term prognosis of trigeminal neuralgia (TN). This study also aimed to provide accurate epidemiologic information on TN.
Methods
Claims data from the Health Insurance Review and Assessment Service (HIRA) in Korea from 2007 to 2018 was utilized. Incidence rates, healthcare utilization, remission periods, and treatment durations of TN. Furthermore, pharmacological and surgical treatment patterns were also evaluated.
Results
A total of 28,669 patients were included, with an annual crude incidence rate of 7.0 per 100,000 persons. Findings showed that incidence increased with age, peaking in the 60s. Patients utilized about two healthcare institutions, with neurology having the highest visit rate among the specialties. Remission duration decreased initially but stabilized with repeated episodes. Approximately half of the patients initially received analgesics. For monotherapy, carbamazepine (CBZ, 49.3%) and gabapentin (46.9%) were the most frequently prescribed drugs. Among those patients receiving CBZ monotherapy, the mean (standard deviation) daily dose was 333.2 (167.8) mg, with a slight increase over time. Surgery was performed in 12.7% of the study population, with the ganglion procedure as the most frequent and repeated. Microvascular decompression had low reoperation rates, and fewer patients resumed medication.
Conclusions
Korean patients with TN exhibited similar demographics and epidemiologic features as those from other countries. The stable decrease in remission duration and insignificant increase in CBZ dosage over time suggests a favorable prognosis for TN. However, deviations from the international guidelines, such as the use of ineffective medications and early surgery decisions, were observed. Further education for clinicians is necessary to improve understanding and treatment of TN.

Keyword

Epidemiology; Insurance claim review; Prognosis; Therapeutics; Trigeminal neuralgia