Trigeminal neuralgia

Trigeminal neuralgia affects 4-5 in every 100,000 people. Read more about the specifics of this condition and what treatments are available abroad.

What is trigeminal neuralgia?

Trigeminal neuralgia is a chronic condition characterized by attacks of severe, excruciating, shooting pain along the course of one or more branches of the trigeminal nerve. The maxillary and mandibular branches of the trigeminal nerve are most commonly affected. Often the cause is sought in another direction - for example, in a dental problem. It is therefore important to know the symptoms of this disease well.

How to recognize the symptoms of trigeminal neuralgia?

There are several main characteristic signs:

• Attack of pain - sudden, shooting, very strong and excruciating pain, sometimes with a feeling of passing electric current. Pain persists usually seconds to minutes, but sometimes it is longer lasting. In most cases, only one half of the face is affected. It is often described as one of the most violent pain experiences.
• Painful tic of the facial musculature - very often the pain attack may be accompanied by a painful contraction of part of the facial musculature.
• Vegetative disorders - it is possible to observe paleness or redness of the face, changes in sweating in the affected half of the face, etc.

What causes trigeminal neuralgia?

Trigeminal neuralgia occurs most often in people over 50 years of age, although it can occur at any age, including infancy. The disorder affectswomen more often than men.

Trigeminal neuralgia can be caused by several different conditions.

- A blood vessel compressing the trigeminal nerve as it exits the brainstem. This compression causes wear or damage to the protective covering around the nerve (the myelin sheath).
- Multiple sclerosis, a disease that causes deterioration of the myelin sheath of the trigeminal nerve.
- Pinching of the nerve by a tumor.
- A tangle of arteries and veins called an arteriovenous malformation.
- Trigeminal nerve damage (perhaps the result of sinus surgery, oral surgery, stroke or facial trauma).

How is the disease diagnosed?

The diagnosis of trigeminal neuralgia is based primarily on the medical history and description of symptoms, along with the results of physical and neurological examinations.

Other diseases that cause pain in the face should be ruled out before diagnosing trigeminal neuralgia. For example, postherpetic neuralgia (nerve pain after a herpes zoster outbreak), cluster headaches, temporomandibular joint disorder that causes pain and dysfunction in the jaw joint and the muscles that control jaw movement.

An MRI may be done to rule out a tumor or multiple sclerosis as the cause of the pain. The examination may possibly reveal the presence and severity of nerve compression by a blood vessel. If doctors suspect that the patient has trigeminal neuralgia, they may prescribe a short course of treatment with certain medications to see if it will help. If so, this means that a positive response to treatment supports the diagnosis.

What is the treatment for trigeminal neuralgia?

People with trigeminal neuralgia need effective medical or surgical treatment to cope with the pain, which at times is truly inhuman.
Treatment options include medications, surgical methods, a gamma knife and complementary approaches.

When is it necessary to perform surgical treatment?

Sometimes medicines fail to relieve the pain or cause side effects. It is also possible that the patient has become resistant to medication over time. Surgical treatment of the problem is then sought.There are several neurosurgical procedures to treat trigeminal neuralgia. Some procedures are performed on an outpatient basis, while others may involve more complex surgery that is performed under general anesthesia and requires a hospital stay.

A rhizotomy (rhizolysis) is a procedure in which nerve fibres are damaged to block pain. Several forms of rhizotomy are available for the treatment of trigeminal neuralgia such as balloon compression, glycerol injection, radiofrequency lesion, stereotactic surgery (gamma knife, cyber knife).

The surgical intervention that is used to treat trigeminal neuralgia is called microvascular decompression.

How does one decide which method to use to treat trigeminal neuralgia?

The doctor decides which method is best for the patient by discussing and presenting all the options to the patient and discussing with the patient all the advantages and disadvantages of the different options. Microvascular decompression is the most invasive surgery but offers the lowest likelihood of pain returning. A small hole is made through the skull and the surgeon places a soft cushion between the nerve and the blood vessel that compresses the nerve.

Microvascular decompression is an inpatient procedure performed under general anesthesia. People usually stay in the hospital for several days after the procedure and usually take several weeks after the procedure to fully recover. Pain relief is permanent in about 50% of people undergoing decompression. In others, the pain returns within 12 to 15 years.

What should people interested in treating trigeminal neuralgia do?

Trigeminal neuralgia is a condition that can be incredibly distressing. The disease has also been called "suicide disease". The pain can be so intense that it can cause the patient's personality to change and lead to complete mental exhaustion and despair. ZIC Medical Karaj can help patients save themselves from this pain by referring them to the best specialists in the world to treat the disease. Patients can approach us and let us know about their specific case