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MS trigeminal neuralgia — SCE Neurology MCQ

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HardMSMS trigeminal neuralgiaSCE Neurology

A patient with MS has brief electric-shock facial pain triggered by touch, with a demyelinating plaque at the trigeminal root-entry zone. Which medicine is the usual initial treatment?

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Correct answer: C — Carbamazepine with safety counselling and monitoring

The best answer is “Carbamazepine with safety counselling and monitoring”. The phenotype is trigeminal neuralgia secondary to MS. Carbamazepine is the usual initial medicine, with oxcarbazepine or specialist procedures considered when efficacy, interactions or adverse effects limit treatment. The alternatives “Propranolol for a presumed tremor-related facial pain syndrome”, “Levodopa for demyelination at the trigeminal root-entry zone”, “Pyridostigmine for episodic facial pain triggered by touch”, “Acetazolamide for brief electric-shock facial pain” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/