Trigeminal neuralgia

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Overview

Trigeminal neuralgia, also known as the tick Douloureax, is a condition involving pain deep facial nerve similar to electroshock, most often located in the lower face and jaw. However, symptoms can occur anywhere near the nose, ears, eyes and lips. Many experts believe that trigeminal neuralgia is one of the most painful human conditions.

Neuralgia is severe pain along a nerve. Pain arising from a change in neurological structure or function caused by irritation or nerve damage. The condition affects women more often than men and is more likely to occur in people aged over 50 years.


Contents

1. Overview
2. What is the trigeminal nerve?
3. Symptoms
4. Causes
5. How does trigeminal neuralgia progresses?
6. Are there any complications?
7. When to seek medical assistance
8. Examinations and investigations
9. Treatment modalities
10. Alternative medicine
11. Support and assistance


What is the trigeminal nerve?

Trigeminal nerve (fifth cranial nerve) is one of the main nerves of the face. There is a nerve each side of the face. It crosses the skull from the brain to the front of the ear.

The name, “trigeminal nerve “, comes from that is divided into three main branches. Each branch is divided into several small nerves. Nerves in the first branch go to the scalp, forehead and around eyes. Nerves in the second branch spread around the cheek area. Nerves in the third branch cover the jaw.

Branches of the trigeminal nerve controls the sensations of touch and pain at the brain level at the face, from mouth to teeth, muscles used for chewing, producing saliva and tears.


Symptoms

Symptoms of trigeminal neuralgia can be:

- occasional twinges caused of pain bearable
- episodes of severe pain, pain feels like an electric shock
- crisis of spontaneous pain triggered or not of certain things or situations, such as on the face, chewing, speaking and brushing teeth
- bouts of pain that lasts a few seconds
- pain in areas controlled by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips or eyes and forehead
- pain affecting half a point in front
- pain focused local or more widespread, according to a model
- attacks that deepens over time


Causes

Trigeminal neuralgia occurs due to a disturbing of the trigeminal nerve function. Usually, the problem is contact between a normal blood vessel (an artery or vein) and the trigeminal nerve from the brain. This contact pressure on nerves and cause malfunctions.

Trigeminal neuralgia can occur as a result of the aging process or may be associated with multiple sclerosis or a disorder affecting the myelin sheath that protects some nerve. In restricted cases, trigeminal neuralgia can be triggered by a tumor compressing the trigeminal nerve. However, in some cases, the cause can’t be detected.


How does trigeminal neuralgia progresses?

The first painful crisis occurs without warning and for no apparent reason. Pain occurs intermittently and can take shorter or longer periods of time. Its frequency range can vary a lot (from a painful crisis to a hundred crisis per day).

The first episode can persist for days, weeks or months and then the pain can stop for a while. Painful episodes become more frequent and will increase as you age.


Are there any complications?

Pain itself can be severe and stressful. If not treated, the patient may suffer from depression or anxiety. Some people avoid wash his teeth for fear of triggering pain, can lose weight and teeth hygiene is poor. However, in cases where the cause is pressure on a blood vessel, there are no complications affecting the trigeminal nerve itself or to affect the brain.

In a small number of cases trigeminal neuralgia occurs as a result of conditions and may be accompanied by other symptoms or specific condition problems.


When to seek medical assistance

If you have facial pain that persists or is recurrent, that does not improve from the use of analgesics, consult your doctor. It is important to consult your doctor in the shortest time possible to prevent development of severe complications. Trigeminal neuralgia can be always controlled and treated adequately with medication.


Examinations and investigations

The doctor will try to detect if facial pain or headaches can be caused by:

- atypical neuralgia
- myofascial pain
- facial pain, temporomandibular
- in cluster headache
- local diseases of the sinuses, throat, jaw and head bones.

Physical examination of the head will help to diagnose other causes of painful syndrome. Physical findings in people with trigeminal neuralgia are normal.

Patient’s doctor should do a complete neurological examination to determine the presence or absence of other conditions such as multiple sclerosis, which may be associated with nerve pain syndromes (such as trigeminal neuralgia’s case). The investigations that may be requested by the physician are: CT or MRI scan of the head, for people that are suspected of suffering from related conditions such as brain tumors or neurological skull.


Treatment modalities

Usually, treatment of trigeminal neuralgia uses drugs and many people feel the need for additional treatment. However, is possible that some of those suffering from this disorder do not respond to drug therapy or to present unpleasant side effects. In their case will be taken into account injections or surgery.

1. Medications – Medications that minimizes or blocks pain signals sent to the brain is most commonly recommended initial treatment for trigeminal neuralgia.

Anticonvulsants – Carbamazepine is the drug that is prescribed most often to treat trigeminal neuralgia. Other anticonvulsant drugs used to treat trigeminal neuralgia include lamotrigine, oxcarbazepine and gabapentin. If your anticonvulsant begin to lose efficiency, the doctor may increase the dose or he can replace it. Side effects may include dizziness, confusion, drowsiness, double vision and nausea.

Antispasmodics – Agencies musculoskeletal relaxants such as baclofen can be used alone or in combination with carbamazepine and phenytoin.

Side effects can include confusion, nausea and drowsiness.

Injections with alcohol – alcohol injections can relieve numb areas of the face pain temporarily. The doctor will inject alcohol in the face where occurs the trigeminal nerve pain. Pain relief is not permanent, so that may be necessary to repeat injections or other procedure to choose differently in the future. Side effects may include injection site infections, bleeding and damage to neighboring nerves.

2. Surgery – The goal of surgery for trigeminal neuralgia is to either remove the compression exerted by a blood vessel on the trigeminal nerve, or to treat trigeminal nerve damage and to remove the dysfunction of it. Nerve damage often causes temporary or permanent numbness and facial pain and, irrespective of the surgical procedure, the pain may return months or years later.

Surgical options for trigeminal neuralgia are:

- Gamma Knife Radiosurgery – procedure involves providing a high and concentrated radiation dose, to the trigeminal nerve root. Because efficacy and safety of surgery compared with other surgical options for treating trigeminal neuralgia, the procedure can be widely used and can be instituted more quickly than other surgical procedures. Gamma Knife Radiosurgery uses radiation to destroy the trigeminal nerve and reduce or eliminate pain.

Improvement occurs gradually and may take several weeks until the pain will disappear. The procedure is painless, requires no anesthesia and is successful for most patients. One important aspect is that it can be repeated if pain recurs. Side effects occur in less than 5% of people that support this surgery and can include loss of facial sensation duration.

- Microvascular decompression – The procedure involves repositioning or removal of blood vessels that are in contact with the trigeminal root. During surgery, the doctor makes an incision behind the ear, on the side where the pain occurs.

Then, through a small hole in the skull, part of the brain is lifted to expose the trigeminal nerve. Any artery in contact with nerve root will be repositioned and the surgeon will then insert a buffer between the nerve and artery. If a vein compresses the nerve, the doctor will remove it. Surgery is successful in most cases, but involves some risks too.

You must learn that it may decrease hearing, to show weakness, facial numbness, double vision, stroke and even death. Most of those who supported this procedure have not shown then facial numbness. If the nerve isn’t compressed by any artery or vein, the surgeon could section a part of the nerve. This is called rhizotomy.

- Injection of glycerol – During this procedure, the doctor will insert a needle into the face and the opening of the skull. The needle will be guided in Meckel cavity, a small bag with cerebrospinal fluid that surrounds the trigeminal nerve ganglion – where the trigeminal nerve which divides into three branches – and part of the root. Then they will inject a small amount of sterile glycerol. The procedure will be done under ultrasound guidance.

After three or four hours glycerol affects the trigeminal nerve and blocks local pain signals. Initially, the procedure relieves pain for most people. Some people manifest later recurrent pain, numbness and tingling or facial numbness experience.

- Balloon compression – During this technique, the doctor will insert a needle that has a central channel, through the face of the patient into an opening from the base of the skull. Inside the needle will be inserted a catheter that will have a balloon on the end.

The balloon is inflated with enough pressure to damage the nerve and block pain signals. Balloon compression successfully controls pain in most people, at least for a while. Most people who support this procedure sometimes experience face numbness, temporary or permanent weakness of the muscles used for chewing.

- electrical current (radiofrequency thermal selective rhizotomy) is a procedure that selectively destroys nerve fibers associated with pain. The patient will be sedated and the doctor will insert a needle that has a central channel through an opening in front to the base of the skull. Once the needle is positioned, through this it will be introduced an electrode, to the nerve root. When the patient wakes up from anesthesia, he will indicate to the doctor where and how he feels tingling caused by impulses from the top electrode.

If the doctor locates the nerves involved in pain, the patient will be sedated again. Electrode will be heated until nerve fibers are damaged. Almost all persons subject to rhizotomy will fell some facial numbness after the procedure.

- Cutting the nerve – A procedure called partial trigeminal rhizotomy involves cutting a portion of the trigeminal nerve to the brain. Through an incision behind the ear, the doctor makes an incision into the skull to reach the nerve problem. In order to remove the nerve from the source, facial numbness will be permanent.


Alternative medicine

There were quite a few efficacy clinical studies on the alternative treatments for trigeminal neuralgia. However, some people have managed to improve the condition symptoms with these treatments. Always ask permission doctor before trying an alternative treatment because it can interact with other drugs.

The complementary and alternative treatments for trigeminal neuralgia include:

- acupuncture
- biofeedback
- therapy with vitamins
- nutritional therapy
- electrical stimulation of nerves.


Support and assistance

Living with trigeminal nerve neuralgia can be difficult. The disorder can affect the patient’s interaction with his friends, family, workplace productivity and quality of life in general. You can find understanding and encouragement in a group support. Group members often share related experiences including the latest treatments.

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