Trigeminal neuralgia

Trigeminal neuralgia is a neuropathic disorder of the trigeminal nerve that causes episodes of intense pain in the eyes, lips, nose, scalp, forehead, upper jaw, and lower jaw. Trigeminal neuralgia is considered by most physicians to be the most painful condition known to man, and has, in fact, been called the, "suicide disease," because this has been the choice of many people who were unable to have their pain controlled with medications or surgery.

The trigeminal nerve is the fifth cranial nerve, responsible for sensory data such as tactition (pressure), thermoception (temperature), and nociception (pain). In those suffering from trigeminal neuralgia, the myelin sheath of this nerve has been damaged, causing the electrical impusles traveling along it to be erratic or excessive, activating pain regions in the brain. The episodes come on suddenly, sometimes triggered by common movements and activities, and are said to feel like stabbing electric shocks. Individual attacks affect one side of the face at a time, last several seconds, and may come and go throughout the day, or for periods as long as several months. Although trigeminal neuralgia is not fatal, successive recurrences can be incapacitating, and the fear of provoking an attack may make sufferers reluctant to engage in normal activities.

There is a variant of trigeminal neuralgia called, "atypical trigeminal neuralgia." In some cases of atypical trigeminal neuralgia, there is a severe underlying pain all the time, like a migraine, in addition to the stabbing pains. In other cases, the pain is stabbing and intense, but may feel like burning or prickling, rather than a shock. Sometimes, the pain is a combination of the zaps, the migraine-like pain, and the burning/prickly pain.

There is no cure for trigeminal neuralgia, but it can be treated with anticonvulsants such as carbamazepine, phenytoin or gabapentin (Neurontin). Some antidepressants are also effective in treating neuropathic pain. In some cases, surgery may be recommended, either to relieve the pressure on the nerve, or to damage it further to prevent the transmission of pain. Surgery is effective in greater than 75% of people with classic trigeminal neuralgia. The nerve can also be damaged to prevent pain signal transmission using a fine-beam of radiation, so-called gamma knife. This is used especially for those people who are medically unfit for a long general anaesthetic, or who are taking medications for prevention of blood clotting (e.g. warfarin). Excellent success rates using a cost effective percutaneous surgical procedure known as balloon compression have been reported. This technique has been helpful in treating the elderly for whom surgery may not be an option due to existing health conditions. Balloon compression is also the best choice for patients who have ophthalmic nerve pain or have experienced recurrent pain after microvascular decompression (MVD).

Atypical trigeminal neuralgia is harder to treat, both with medications and surgery. The surgeries can leave annoying numbness, and occasionally, it can cause a condition called, "anesthesia dolorosa", which is numbness with intense pain. It should, however, be noted that many people do find dramatic relief with minimal side effects from the various surgeries that are available.

Sources

• Natarajan M. Percutaneous trigeminal ganglion balloon compression : experience in 40 patients. Neurol India 2000, cited 2005 Feb 6;48:330-2. (http://www.neurologyindia.com/article.asp?issn=0028-3886;year=2000;volume=48;issue=4;spage=330;epage=2;aulast=Natarajan)

External links

• Facial neuralgia (http://facial-neuralgia.org/)
• About surgery for trigeminal neuralgia (http://www.kgeh.com/kgBrainSpine/aboutsurgery.html)
• Trigeminal neuralgia (http://www.nlm.nih.gov/medlineplus/trigeminalneuralgia.html). MedlinePlus
• Trigeminal neuralgia (http://www.emedicine.com/emerg/topic617.htm). eMedicine.