Trigeminal Neuralgia
Overview

Trigeminal neuralgia is a condition of the nerves that causes sharp pains to shoot through the face. The pain is short and frequent and forms from the trigeminal nerve, which is one of the largest nerves in the head and is responsible for sending messages of pain, pressure, touch, and temperature to the brain.

 

Trigeminal neuralgia is most commonly a result from a blood vessel putting pressure on the trigemnial nerve. When the blood vessel pulses with each heartbeat it rubs against the nerve and slowly wears away the membrane around the nerve root. In about 5% of patients there is a tumor that puts pressure on the nerve, which causes the pain.

 

The condition is 33% more likely to develop in women than in men and can happen at any age. The attacks of pain most commonly take place in the fall and spring.

Symptoms

The pain can be distributed through the various parts of the face, from the cheeks, forehead, scalp, jaw, to the eyes, the ears, the nose and the lips. This pain can be excruciating and in some patients can also be followed by a facial spasm.

 

Any activity that involves using the facial muscles can trigger an intense bout of pain and can occur at any time in the day for as short as only a quick second or as long as a few minutes. Simple everyday activities that most people take for granted, such as brushing one’s teeth, applying make up, chewing, and shaving can aggravate the disorder. Even uncontrolled things like a loud noise, or a breeze of cold air can set off the pain. Typically the events of pain happen in cycles and can last weeks or even months at a time. A patient with this disorder can have extreme anxiety anticipating the next time the pain occurs which can be so troublesome that it can lead to depression and even malnutrition, which can result in death. Trigeminal Neuralgia considered to be one o the most painful conditions known to man, and this is why it has been nicknamed the “Suicide Disease.”

 

It is not uncommon for a patient to have the pain can go away for a few weeks, or months and in some cases go into remission for years. This relief of symptoms can make it difficult to determine how effective any particular treatment is.

 

More often than not, only one of the trigeminal nerves is affected and the pain is located on only one side of the face. In only 10% of patients are both nerves disturbed which can bring about pain on both sides.

Diagnosis

A study of the patient’s medical history with be conducted, followed by a complete neurological examination. Once this is done, imaging studies will be ordered and an MRI of the patient’s head is analyzed. The MRI is used to mostly identify if the symptoms are a result from a tumor or multiple sclerosis (MS), a neurological disease. When the MRI is taken a contrasting agent is often injected into the patient to enhance the image and better visualize a tumor if it exists.

Treatment

There are a number of ways in which a patient with Trigeminal Neuralgia can be treated. The first option is to use medication to treat the symptoms and to try and control the pain. The most common medication is Tegretol, which can be effective for most patients with mild pain. One of the drawbacks to Tegretol is that it can cause many side effects including, forgetfulness, confusion, drowsiness, and nausea.
It is recommended that this drug administered initially in low doses and then gradually increased when needed. When this drug is first administered A more severe side effect that Tegretol has is that is can cause problems with a patient’s bone marrow and lower one’s white blood cell count, which helps to fight off infection. When a patient is on this medication he or she must be under close medical supervision and get their blood tested regularly.

 

Other forms of treatment include surgery, of which there are several options but the most effective is gamma knife radiosurgery. With the procedure there is no incision and a large number of radiation beams are directed exactly at the trigeminal nerve, where it leaves the brain. This procedure is ideal for most patients as there is no worry for those on anticoagulants, little chance for numbness in the face afterwards, and there is no sedation needed, as the patient is released after only a fraction of a day.

 

Other types of surgeries involve causing damage to the trigeminal nerve to try and disrupt the flow of information from the nerve to the brain. In these procedures the outcome desired is that the brain does not receive pain signals from the nerve. However, these procedures are not always effective and can leave the nerve permanently damaged causing numbness in the face.

 

Another type of surgery called microvascular decompression involves opening the skull and finding the blood vessel that putting pressure against the nerve. Once found, the blood vessel is pushed away from the trigeminal nerve and a small piece of material such as Teflon is put in between the nerve and blood vessel. Although effective in most cases, this procedure has a number of risks including, infection and swelling of the brain, numbness of the face and also pain.

Prognosis

For most patients their pain gets more intense and more frequent, the longer they have trigeminal neuralgia. Treatment with medication is the usually the first option, and over the time that they use the medication, their dose needs to increase in order to best control the pain. When the dosage of medication can no longer increase, surgery is required.

 

The best form of surgery is gamma knife radiosurgery. There is less complication with this type of surgery and there are strong, positive results for 85% - 90% of patients who receive this procedure. Pain is relieved in as little as a day, and sometimes as long as four weeks after the procedure. In some cases, less than 10% pain may reoccur within three years.

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