A Simple Guide to Trigeminal Neuralgia

A Simple Guide to Trigeminal Neuralgia
-----------------------------------------------

What is Trigeminal Neuralgia?
--------------------------------------

Trigeminal Neuralgia is the sudden ,lightning-like paroxysms of pain which occurs in the distribution of one or more branches of the trigeminal nerve usually on one side of the face.

It is a rare codition affecting more women than men.

It is more common at the age of 60 years and above.

What are the causes of Trigeminal Neuralgia?
----------------------------------------------------

Trigeminal Neuralgia has no known cause,
but may be due to :
1.compression of the trigeminal nerve by tumors or vascular anomalies(eg aneurysm)

2.Trauma- injury to the trigeminal nerve

3.Tumours- compressing the trigeminal nerve

4.Infections-meningeal inflammation of the trigeminal nerve

5.Temporomandibular Joint Syndrome - inflammation in the temporomandibular joint may compress or cause inflammation in the trigeminal nerve.

6.Multiple sclerosis-an area of demyelination from multiple sclerosis may be the cause- more common in younger patient.

What are the symptoms and signs of Trigeminal Neuralgia?
---------------------------------------------------------------

Symptoms:
-----------
1.Pain is brief, lightning-like, paroxysmal with usually severe.

There may be recurrent stabs of pain or spontaneous exacerbations of pain.

It can last from a few seconds to 1-2 minutes and is followed by a refractory period(no pain).

Sometimes the pain occurs in clusters to the extent that the patient complains that it lasts for hours.

Usually the maxillary branch is most commonly involved ,followed by the mandibular, and then the ophthalamic.

Pain is unilateral (rarely bilateral).

Pain may occur several times a day.

It rarely occurs at night.

There are certain triggers which can spark off an attack:
-----------------------------------------------------------

Light touch at the trigger zone such as the lips is the most provocative.

Other triggers are
1.shaving,
2.face washing,
3.chewing
4.talking
5.brushing teeth
6.sneezing

Pain causes brief muscle spasm of the facial muscles, inducing the tic.

Signs:
---------
Physical examination findings are normal.

A normal neurologic examination is part of the diagnosis of idiopathic Trigeminal Neuralgia.

A careful examination of the cranial nerves must be done, including the corneal reflex.

Any abnormality in the neurological examination suggests that the trigeminal neuralguia is secondary to other illnesses.

What are the investigations required in Trigeminal Neuralgia?
----------------------------------------------------------------

1.Blood for infections such as meningitis,

2.MRI of brain to exclude an uncommon mass lesion or aberrant vessel compressing the nerve roots.

What is the treatment of Trigeminal Neuralgia?
-----------------------------------------------------

Medications:
----------------
1.Carbamazepine is the most effective medical treatment.

2.Baclofen (Lioresal)
Most often used after therapy with carbamazepine has been initiated.
A combination of carbamazepine and Baclofen often relieve pain in many patient.

3.Other anticonvulsant such as phenytoin, oxcarbazepine, clonazepam, lamotrigine, valproic acid, and gabapentin.

4.Muscle relaxants
These agents are also useful in the treatment of Trigeminal Neuralgia.

They can depress the sensitivity of the nerve and relax the muscle.

Mental and physical sluggishness and dizziness occur with use of most anticonvulsant and muscle relaxants.

Surgery
-------------
1.Percutaneous radiofrequency ablation of a portion of the trigeminal ganglion
is the method of choice.

2.anesthetic blocks of the trigeminal ganglion.

3.decompression of trigeminal root entry of impinging vascular structures.

4.Surgical division of the affected branch of the nerve.

What is the prognosis of Trigeminal Neuralgia?
------------------------------------------------------

80% of patients respond well to carbamazepine but recurrences and exacerbations are common.

Surgery is usually effective but may leave permanent neurological deficit.

Trigeminal Neuralgia is not life threatening.