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  Trigeminal neuralgia

Trigeminal neuralgia is a condition that causes intense pain in the jaw, lips, nose, eyes, forehead and scalp. This disorder is also called Tic Douloureux. The pain is caused by a neuropathy of the trigeminal nerve. The trigeminal nerve is the fifth cranial nerve is the pathway for sensations of the face to the brain.

Trigeminal neuralgia Neurological disorder
Trigeminal neuralgia


This disease is considered to be an extremely painful condition. The pain has been so uncontrollable and excruciating, that some patients have taken their lives. For this reason, this disease has been called the suicide disease. One in 15,000 people have trigeminal neuralgia and it usually begins in middle age.

Symptoms

The primary symptom of trigeminal neuralgia is sudden painful attacks that feel like stabbing electricity. The attacks can be triggered by common behaviors such as brushing hair or teeth or by changes in temperature especially exposure to colder weather.

Painful attacks vary from patient to patient. Sometimes they occur just once for several seconds or a trigger may cause the pain to occur in episodes throughout the day or as long as several months. Pain that occurs on both sides of the face is experienced by up to 5% of patients. Some patients are able to pinpoint specific areas of the face that are triggers to attacks.

A form of trigeminal neuralgia called atypical trigeminal neuralgia that is similar to the pain in migraines, unending and severe. Other patients describe the pain as burning or pins and needles, rather than a stab. Sometimes the pain is a combination of all three – stabbing pain, burning or migraine like pain.

Diagnosis

A dentist can examine the mouth of an individual suspected of having trigeminal neuralgia. Any problems with the gums or teeth can be examined to determine if they are causing the pain.

A doctor will take a medical history and description of the pain: severity, where on the face it occurs, when it occurs, how long it occurs and how long the pain lasts. The doctor will examine and touch the parts of the face to determine where the pain is occurring. An MRI scan of the head is used to determine other causes of the pain.

Causes

There are three branches of the trigeminal nerve. The nerve is connected to the nervous system deep within the brain. The pain is due to an impairment of the function of the nerve.

The pain is usually the result of contact between a normal vein or artery and the trigeminal nerve, not in the face, but at the base of the brain. The contact put pressure on the nerve as it enters the vein an results in misfiring of the nerve. Physical nerve damage and stress can be the initial trigger of trigeminal neuralgia.

The trigeminal nerve divides into three smaller branches to control signals throughout the face. The first branch is responsible for the eye, upper eyelid and forehead. The second branch controls the sensation of the lower eyelid, cheek, nostril, upper gum and lip. The third branch of the trigeminal nerve is responsible for the jaw, lower lip, gum and some of the muscles used for chewing.

Pain can occur in one branch or all three branches on one side of the face. Other sources of pain can be caused by a tumor, multiple sclerosis, or a stroke.

Triggers can set off pain and may be shaving, teeth brushing, caressing the face, talking, applying makeup, a breeze on the face, smiling, eating or drinking.

Women are more likely affected with trigeminal neuralgia than men. Five percent of patients have a family member with the same disorder, suggesting hereditary factors in some situations.

Treatment

Treatment begins with controlling, blocking or decreasing the pain signals being sent to the brain. Some medications that are used are carbamazepine, phenytoin, and oxycarbazepine. These are classified as anticonvulsant drugs. A muscle relaxant called baclofen is also used.

Some patients build a resistance to drugs and stop responding to the medication. In this case, surgery or a combination of surgery and different medications can be used.

There are seven types of surgical procedures used to treat trigeminal neuralgia. Prognosis depends on the extent of nerve damage required to end the pain. Numbness of the face is a typical side effect.

Alcohol injection is one method, which involves injecting alcohol under the skin where the nerves leave the bones of the face. This procedure may work for weeks or months.

Glycerol injection is another procedure to control the pain of trigeminal neuralgia. The injection is administered at the root of the nerve where it splits into three. The pain is relieved in most people for a period of time. Pain can return along with numbness or tinglin g in the face.

Balloon compression involves inserting a thin catheter (tube) with a balloon on the end near the base of the nerve. When inflated, the balloon will damage the nerve and disrupt or block pain signals. Up to fifty percent of patients experience permanent weakness in the chewing muscles.

Electic current is used to specifically destroy nerve fibers associated with trigeminal neuralgia pain. A needle is threaded through the face to an opening in the scull until it is against the nerve. An electric current is passed through the needle and the hot dip damages the nerve fibers in an effort to block pain signals.

Microvascular decompression is a procedure that relocates or removes blood vessels that are causing the trigeminal pain. The trigeminal nerve and the suspected artery are separated by a small pad. If a vein is the source of the pain, the doctor will remove it.

Partial sensory rhizotomy is a procedure that cuts part of the nerve at the base of the scull. This procedure is commonly successful, but causes facial numbness in almost all patients.

Gamma-knife radiosurgery delivers a high dose of radiation to the root of the nerve. The damage to the nerve reduces or ends the pain. Relief may take several weeks to achieve. This procedure is successful in fifty percent of patients. It is painless and performed without anesthesia.

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