AEDs for Trigeminal Neuralgia Can Lead to Worse Cognitive, Motor Performance

The purpose of this study was to investigate why patients treated with antiepileptic drugs experience cognitive impairment and difficulty with activities of daily living.

First-line treatment of trigeminal neuralgia pain with antiepileptic drugs (AEDs) usually confers initial pain relief, but the efficacy of AEDs often diminishes with time, according to study results in the Journal of Headache and Pain. The study results also showed that many patients treated with AEDs report impairments in cognition and activities of daily living (ADL) during treatment.

In the study, researchers from the United Kingdom and Norway administered a battery of sensorimotor and cognitive tasks to 43 patients with trigeminal neuralgia and 41 age-matched control participants.

Sensorimotor tasks included those related to ADL and motor abilities (steering, aiming, and tracking) whereas cognitive tasks tested simple phonological working memory, complex phonological working memory, visuospatial working memory, processing speed, and inhibition.

Patients in this study ascribed cognitive and motor deficits to their medications. Compared with control participants, patients with trigeminal neuralgia performed significantly worse at tracking a moving object (P <.01). In the aiming task, patients with trigeminal neuralgia had a significantly longer mean movement time compared with control participants (1.33 vs 1.24 seconds, respectively; P <.05).

For the backward digit recall task, patients with trigeminal neuralgia had a significantly longer reaction time compared with control participants (P <.001). In the Corsi block tapping test, which tests short-term memory, patients with trigeminal neuralgia had a significantly longer processing speed (3.69 vs 3.14 seconds, respectively; P <.001). Patients with trigeminal neuralgia also had longer reaction times in the forward digit recall test (P <.001).

A limitation of this study was the lack of assessment as to whether the AEDs were responsible for the worse cognitive and motor performance scores or whether other factors were at play.

According to their findings, the researchers suggested clinicians should consider alternative therapies to manage trigeminal neuralgia pain “in the form of surgery or non-AED pharmacological interventions that come with fewer side effects.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Coats RO, Crossley KL, Conlin N, et al. Cognitive and sensorimotor function in participants being treated for trigeminal neuralgia pain. J Headache Pain. 2020;21(1):91.