Trigeminal Neuralgia
Ronald Brisman, M.D.

Dementia Trigeminal Neuralgia

Dementia Trigeminal Neuralgia

What is dementia?

Dementia is characterized by impaired cognitive (intellectual) brain function such as memory, language, judgment, concentration and the ability to carry out familiar tasks (dressing, planning or balancing a checkbook).

back to top

Can trigeminal neuralgia cause dementia?

Trigeminal neuralgia does not cause dementia. However, medicines especially carbamazepine (Tegretol) that are given to relieve the pain of trigeminal neuralgia can impair cognitive function, sometimes very severely.

back to top

Have some patients with trigeminal neuralgia developed dementia as a result of medicines given to treat trigeminal neuralgia?

Yes. I (Ronald Brisman, M.D.) have treated two patients who had major cognitive impairment (dementia) and trigeminal neuralgia that was causing severe face pain that persisted even though they were taking carbamazepine. They had both lost the ability to speak, recall even the simplest events, dress, and feed or bathe themselves. Once they were successfully relieved of their trigeminal neuralgia by a minimally invasive procedure, they were able to stop carbamazepine and their severe cognitive impairment disappeared. Both of them were able to resume their usual, high powered executive occupation.

back to top

Are there any reports in the medical literature of progressive and severe dementia resulting from medicines given to treat trigeminal neuralgia?

Yes. There is a report in the medical literature http://www.neurology.org/content/65/4/650.full of a patient with trigeminal neuralgia in whom carbamazepine caused encephalopathy (brain disorder) with severe, progressive cognitive impairment characteristic of Creutzfeldt-Jakob disease (CJD) that was reversed when carbamazepine was stopped. This patient exhibited rapidly progressive dementia, parkinsonism (slowing of movement, tremor, rigidity or stiffness and balance problems), generalized myoclonus (quick, involuntary jerking movements), electroencephalograph and spinal fluid abnormalities characteristic of CJD.

back to top

Are there lesser degrees of neurologic impairment that may be caused by medicines used to treat trigeminal neuralgia?

Yes. As noted by the above authors, carbamazepine may induce many neurologic adverse reactions including somnolence, tremor, incoordination, nystagmus (fast, uncontrollable eye movements) and worsening of preexisting epileptic conditions, which may occur alone or in various combination, after minimal overdose or even doses within therapeutic range.

back to top

What medicine used to treat trigeminal neuralgia is most likely to cause cognitive impairment?

Tegretol (carbamazepine) is the drug most likely to cause cognitive impairment. But impairment may occur from many of the medicines used to treat trigeminal neuralgia, such as oxcarbazepine (Trileptal), gabapentin (Neurontin) and pregabalin (Lyrica), especially at higher doses.

back to top

Is the cognitive impairment caused by carbamazepine (Tegretol) reversed when Tegretol is stopped?

Usually, the cognitive impairment caused by Tegretol and other medicines is quickly reversed when Tegretol (or other medicine) is stopped.

back to top

Do most people who take Tegretol have cognitive impairment?

Most people can take carbamazepine (or other medicines to treat trigeminal neuralgia), especially at small or modest doses, without overt impairment in cognitive function. But some people may have other factors that decrease cognitive reserve such as advanced age, cerebrovascular disease, multiple sclerosis or other degenerative disease of the nervous system, and the addition of carbamazepine (or other medicines) may tip them over into cognitive dysfunction that significantly affects their daily lives.

back to top

What is the best way to relieve the pain of trigeminal neuralgia in someone who cannot tolerate Tegretol?

Although sometimes it may be possible to relieve their face pain with another medication, patients who cannot tolerate Tegretol are often better off when they have a neurosurgical procedure that eliminates their pain and allows them to reduce or stop all their trigeminal neuralgia-relieving medicines, many of which can cause some deterioration in cognitive function. A minimally invasive procedure such as Gamma Knife radiosurgery or needle rhizotomy (radiofrequency and/or glycerol) can usually be sufficient to eliminate bothersome side effects of medicines.

back to top
Website Builder