TRIGEMINAL NEURALGIA - CLINICAL MANIFESTATIONS OF FIRST DIVISION INVOLVEMENT

A series of 19 patients with what originally had been diagnosed as a f irst division (V-1) trigeminal neuralgia was collected. The inclusion criteria were savers, rather shortlasting pain attacks within the V, a rea, combined with trigger mechanisms. There were 10 women and 9 men, and the mean age of onset was 57.8 years. Fifteen of 16 with adequate information on attack duration had paroxysms of a ''few seconds''' dur ation or less, whereas 10 patients had paroxysms lasting less than or equal to 2 seconds. In an exceptional case, only ''more long-lasting'' attacks (greater than 30 seconds' duration) were experienced. In rega rd to autonomic phenomena, lacrimation was most frequently present (in a total of 8 patients; 3 rather regularly, 5 more irregularly). The c ombination of lacrimation, conjunctival injection, and rhinorrhea was present in only 2 (of 19), and in neither of them in a major way. Typi cally, autonomic phenomena occurred during the later stages of disease and during particularly severe and long-lasting attacks. Seven of 14 with adequate information also had nocturnal attacks. Initially, a mor e or less complete carbamazepine effect was reported by 10 of 13 patie nts. Precipitation mechanisms were the same as with second and third d ivision tie. but ware mainly located within the V, area, particularly initially. A comparison with SUNCT syndrome has been made. SUNCT is a predominantly male disorder, with only exceptional attacks of less tha n or equal to 10 seconds' duration, and generally with attacks of 15 s econds or longer. Autonomic symptoms and signs are more pronounced tha n in V, tie. Carbamazepine generally provides minor, if any, benefit i n SUNCT. The present work strongly indicates that the two disorders ar e essentially different.