Thursday, October 30, 2014

Definition

Also called trigeminal neuralgia, this is a neurologic condition of the trigeminal facial nerve, characterized by paroxysms (sudden outburst) of flashing, stabbing pain radiating along the course of a branch of the nerve from the angle of the jaw.

Description

Trigeminal neuralgia is the most frequent of all neuralgias and results from dysfunction of the fifth, or trigeminal, cranial nerve. It is often caused by degeneration of the nerve or by pressure on it.

Any of the three branches of the nerve may be affected. Neuralgia of the first branch results in pain around the eyes and over the forehead; of the second branch, pain in the upper lip, nose, and cheek; of the third branch, pain on the side of the tongue and the lower lip.

Causes

The cause is unknown, but the disorder occurs most frequently in middle and later life.

It affects women more frequently than men.

Symptoms

The pain may be a tearing, darting, or sharp cutting sensation that occurs in a portion of the face, typically on one side. An attack may last for seconds or a few minutes, and its intensity may make one contract the facial muscles, hence the term tic. Episodes may recur for days or weeks or months.

Often, there are trigger zones - spots on the face or certain movements - that precipitate the pain. These may include smiling, talking, chewing, brushing one's teeth, or blowing the nose. Although the pain may be incapacitating, it is not life-threatening. Attacks come and go variably, but periods of remission may grow shorter as one ages.

Because it is easy to mistake the pain for a toothache, people suffering from trigeminal neuralgia often consult a dentist. The result in many cases is inappropriate and often irreversible treatment, including tooth extraction, splints to readjust the jaw position, and root canal surgery.

Diagnosis

Diagnosis is based on the symptoms typically.

In a young patient with trigeminal neuralgia, multiple sclerosis is suspected even if there are no other neurologic signs.

Treatment

In general, attempts to control the pain of trigeminal neuralgia begin with medications such as phenytoin or carbamazepine. Baclofen may also be helpful.

If drug treatments fail to control the discomfort, nerve blocks or surgical procedures to reduce the sensitivity of the nerve are an option. An operation to free the nerve from the blood vessel or tumor compressing it also can eliminate the pain permanently. However, this is a major neurosurgical procedure with several potential complications.

Gamma radiotherapy to the trigeminal root is a noninvasive method that may be successful. Symptomatic relief may also be obtained from radiofrequency rhizotomy, another noninvasive treatment.

Questions

Are there any tests that need to be done to determine the cause of the symptoms?

What treatment do you recommend?

How successful is it?

Will you be prescribing any medications? What are the side effects?

How successful is the medication in controlling the pain?

What noninvasive treatments are available?