TRIGEMINAL NEURALGIA

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Neurosurgery , Radiotherapy

Also known as Tic douloureux

ABOUT THE DISEASE

Trigeminal neuralgia (TN), is a form of neuropathic pain (pain associated with nerve injury or lesion) that affects the trigeminal or 5th cranial nerve.

It is broadly divided into two types- Typical or "classic" form (called "Type 1" or TN1) causes extreme, sporadic, sudden burning or electric shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episode. These attacks can occur in quick succession. The “atypical” form of the disorder (called "Type 2" or TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than Type 1. Both forms of pain may occur in the same person, or simultaneously and can hamper normal activity. These cycles of pain may occur for a few days or weeks, and then stop for days, weeks or even years before returning.

The trigeminal nerve is one of 12 pairs of nerves attached to the brain. The nerve has three branches that conduct sensations of touch and pain from the upper, middle, and lower portions of the face, eyes, sinuses and the oral cavity, to the brain. More than one nerve branch can be affected by the disorder. When both sides of the face are affected simultaneously it is known as bilateral TN.

SYMPTOMS

• Very painful, sharp electric-like spasms that usually last a few seconds or minutes, but can become constant
• Pain is usually only on one side of the face, often around the eye, cheek, and lower part of the face
• The pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind.
• Bouts of pain rarely occur at night, during sleep
• In some cases numbness or tingling of the face in the days leading up to an attack.

CAUSES

Trigeminal neuralgia is associated with a variety of conditions that can damage the trigeminal nerve such as:
- A blood vessel that grows too close and presses on the nerve, wearing away the nerve`s protective coating (called myelin).
- A tumor putting extra pressure on the nerve
- Multiple sclerosis, a disease that causes deterioration of the trigeminal nerve’s myelin sheath.
- Injury to the trigeminal nerve (may be due to sinus surgery, oral surgery, stroke, or facial trauma)
- A tangle of arteries and veins called an arteriovenous malformation

In many cases, a cause of the nerve damage cannot be found.

Can occur at any age, but is more common in people older than 50 years of age and is more prevalent in females than males. It is also found to be passed down the families.

DIAGNOSIS

- Medical history
- Blood tests
- MRI of the head
- Trigeminal reflex testing

TREATMENT METHODS

Treatment plans include medicines, surgery, and complementary approaches.

Medications

- Anticonvulsant medicines
- Tricyclic antidepressants
- Muscle relaxants

Since TN is a progressive disorder that often becomes resistant to medication over time, individuals often seek surgical treatment.

Surgery

Depending upon the patient`s condition, the area affected and associated problems, there can be different options like:

• Balloon compression works by injuring the insulation on nerves that are involved with the sensation of light touch on the face. Pain relief usually lasts one to two years.

• Glycerol injection damages the insulation of trigeminal nerve fibers. This form of rhizotomy is likely to result in recurrence of pain within a year to two years. However, the procedure can be repeated multiple times.

• Radiofrequency ablation - Using electric current, the procedure can be repeated until the desired amount of sensory loss is obtained.

• Stereotactic radiosurgery (Gamma Knife, Cyber Knife) uses computer imaging to direct highly focused beams of radiation at the site where the trigeminal nerve exits the brain stem.

• Microvascular decompression (MVD) is the most invasive of all surgeries for TN, but also offers the lowest probability that pain will return.

• Neurectomy (also called partial nerve section), which involves cutting part of the nerve, may be performed near the entrance point of the nerve at the brain stem during an attempted microvascular decompression if no vessel is found to be pressing on the trigeminal nerve.

Complementary approaches

Techniques such as low-impact exercise, yoga, creative visualization, aroma therapy, or meditation may be useful in combination with drug therapy. Other options include acupuncture, upper cervical chiropractic, biofeedback, vitamin therapy, botulinum toxin injection, etc.