Trigeminal Neuralgia

Trigeminal Neuralgia

Trigeminal neuralgia or tic douloureux is a chronic condition characterized by excruciating paroxysms of pain in the areas supplied by the trigeminal nerve, viz. cheeks, lips, gums and chin. Initially the pain may be mild and last for a few seconds but it gradually could progress into frequent bouts of unbearable pain. Trigeminal neuralgia is among the most painful disorders affecting humans usually above the age of 50 and especially women.

The trigeminal nerve is the 5th cranial nerve and carries sensations from the face to the brain. The nerve further divides into three branches that supply different parts of the face. Trigeminal neuralgia occurs when the function of the trigeminal nerve is disrupted due to pressure either by an artery or vein. It can also occur due to aging or disorders like multiple sclerosis that damage the myelin sheath protecting the nerves. Pain in trigeminal neuralgia is caused by stimulation of certain areas supplied by the nerve, which are called ‘trigger zones’. These include the cheeks, lips, gums and teeth. The stimuli could be anything like brushing the teeth, chewing on a hard substance or any kind of injury.

Pain is the hallmark symptom of trigeminal neuralgia. It is present in only one side of the face and seldom lasts more than a few seconds or a minute or two, but is so intense that the patient wines, hence the name ‘tic’.

Pain can be mild or excruciating and is usually sharp and stabbing like an electric shock. Pain is usually felt on the lips, cheeks, gums and chin. In rare cases, it is also felt around the eyes. Paroxysms of pain recur frequently, both during day and night for several weeks at a time. An attack of pain is followed by a dull ache and tenderness of the affected area.

Trigeminal neuralgia diagnosis is based strictly on the symptoms of the disorder. The type, location and triggers of pain need to be thoroughly described. Other causes of facial pain like diseases of the jaw, teeth and sinus should be ruled out.

A neurological examination is done by touching the affected parts and conducting reflex tests. In some cases, an MRI scan of the brain may be done to find out if a tumor is causing the trigeminal neuralgia.

A majority of cases of trigeminal neuralgia only require medical treatment. Surgical treatment and other therapies are required for patients who do not respond to or have side effects with medications.

Trigeminal Neuralgia Medical treatment

Medications for trigeminal neuralgia reduce or block the pain signals sent to the brain. The most commonly prescribed drugs are anticonvulsant drugs like Carbamazepine. A low dose is started initially and then scaled up until a dose is reached that stops the pain. Along with these anti-spasmodic drugs are given to relax the muscles.

Studies reveal that carbamazepine is effective only initially and that too only in 75% of cases. One third of the people cannot tolerate the drug well in the dose required to alleviate pain. In such cases, surgical therapy should be offered.

Trigeminal Neuralgia Surgical treatment

Open surgery

This involves microvascular decompression in which the nerve root of the trigeminal nerve is exposed, the blood vessel that is compressing the nerve is identified and gently moved away from the point of compression.

Percutaneous procedures

  • Radiofrequency rhizotomy uses electrocoagulation to destroy the part of the nerve that causes pain.
  • Balloon compression temporarily compresses the nerve and damages the pain causing fibres, thereby relieving pain.
  • Glycerol rhizotomy selectively damages the nerve by injecting glycerol at the point where the nerve divides, which interferes with the transmission of pain to the brain.

Stereotactic radiosurgery delivers a single concentrated dose of ionizing radiation to a precise target at the root of the trigeminal nerve, which interrupts the transmission of pain to the brain.

The Centre for Neurosciences at Kokilaben Dhirubhai Ambani Hospital, Indore is home to the best trigeminal neuralgia doctors in Indore. They are supported by experienced staff and technicians who can implement the best trigeminal neuralgia treatment. The main aim of trigeminal neuralgia treatment is pain relief and this is done using the most advanced technology and procedures.