{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T23:20:37Z","timestamp":1769469637810,"version":"3.49.0"},"reference-count":45,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicines"],"abstract":"<jats:p>Background\/Objectives: Trigeminal Neuralgia (TN) is a chronic neuropathic condition characterized by sudden, severe facial pain. Anticonvulsants are the cornerstone of pharmacological management, yet comparative evidence based on pharmacological class remains scarce. This systematic review aimed to evaluate the efficacy and safety of anticonvulsants in TN, stratified by their mechanism of action. Methods: A systematic search in PubMed, Scopus and Web of Science was conducted following PRISMA 2020 guidelines. Studies employing a pharmacological approach including human patients with TN, published in English since 2000, were included. Risk of bias was assessed using the Cochrane RoB 2, the ROBINS-I and the ROBINS-E tools, according to the study design. Results: Out of 922 initial records, 12 studies met the eligibility criteria. Sodium channel inhibitors showed high efficacy but frequent adverse effects, particularly hyponatremia and central nervous system symptoms. Calcium channel modulators offered a more favorable safety profile. Combination therapies showed benefits, levetiracetam and topiramate were moderately effective and well tolerated. Although the evidence has limitations, anticonvulsants continue to be the primary treatment for TN. Sodium-channel blockers demonstrate strong efficacy, whereas alternative agents generally provide superior tolerability. Conclusions: These findings support selecting drugs according to their underlying mechanisms of action. Equally important is tailoring therapy to pain phenotype and patient characteristics, balancing mechanism with tolerability and efficacy.<\/jats:p>","DOI":"10.3390\/medicines13010003","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T12:41:16Z","timestamp":1769431276000},"page":"3","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anticonvulsant Therapy in Trigeminal Neuralgia: A Class-Oriented Systematic Review"],"prefix":"10.3390","volume":"13","author":[{"given":"Miguel","family":"Pinto Moreira","sequence":"first","affiliation":[{"name":"Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3434-2247","authenticated-orcid":false,"given":"Bruno Daniel","family":"Carneiro","sequence":"additional","affiliation":[{"name":"Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal"},{"name":"Rheumatology Service, Unidade Local de Sa\u00fade do Alto Minho, Hospital Conde de Bertiandos, 4990-078 Ponte de Lima, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8470-152X","authenticated-orcid":false,"given":"Carlos Silva","family":"Faria","sequence":"additional","affiliation":[{"name":"Department of Surgery and Physiology, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2119-4479","authenticated-orcid":false,"given":"Daniel Humberto","family":"Pozza","sequence":"additional","affiliation":[{"name":"Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal"},{"name":"Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-135 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1326-780X","authenticated-orcid":false,"given":"Sara","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Department of Surgery and Physiology, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal"},{"name":"Anesthesiology Department, S\u00e3o Jo\u00e3o University Hospital Centre, 4200-135 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1097\/01.JAA.0000511034.41821.df","article-title":"Trigeminal neuralgia","volume":"30","author":"Gietzen","year":"2017","journal-title":"JAAPA"},{"key":"ref_2","first-page":"32","article-title":"Trigeminal neuralgia: Therapeutic strategies to restore quality of life","volume":"38","year":"2024","journal-title":"J. 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