Trigeminal Neuralgia
- A neuropathic disorder of the trigeminal nerve that causes episodes of intense pain.
- Also known as Tic Douloureux
- Many cases are associated with vascular compression and subsequent demyelination of the trigeminal nerve, though other causes include compression by a tumor, and multiple sclerosis.
- Classic Trigeminal Neuralgia is a clinical diagnosis that has the following criteria:
- Paroxysmal attacks of pain lasting from a fraction of a second to two minutes that affect one or more divisions of the trigeminal nerve
- Pain has at least one of the following characteristics: intense, sharp, superficial, or stabbing precipitated from trigger areas or by trigger factors
- Attacks are similar in individual patients
- No neurological deficit is clinically evident
- Not attributed to another disorder
- Treatment options include:
- Medical:
- Carbamazepine (most common and drug of choice)
- Gabapentin (lacks evidence in trigeminal neuralgia but widely used for other neuropathic pain)
- Lamotrigine
- Baclofen
- Surgical:
- Microvascular decompression: posterior fossa is explored and the culprit blood vessel is moved off the trigeminal nerve. Typically the nerve is padded with a teflon sheet in order to provide additional protection. 80-90% successful with little or no facial numbness.
- Ablative: Attempts are made to just incapacitate the pain fibers but these techniques can result in facial numbness as other sensory fibers can be damaged. Common methods include:
- Glycerol or alcohol injection
- Radiofrequency rhizotomies
- Stereotactic radiation therapy
- Complete severing of the nerve.
References
- Wikipedia contributors. Trigeminal neuralgia. Wikipedia, The Free Encyclopedia. February 20, 2008, 22:44 UTC. Available at: http://en.wikipedia.org/w/index.php?title=Trigeminal_neuralgia&oldid=192904693. Accessed March 8, 2008
- Luke Bennetto, Nikunj K Patel and Geraint Fuller. Trigeminal neuralgia and its management. BMJ 2007;334;201-205