Trigeminal Neuralgia or Prosopalgia or Fothergill's Disease: Causes, Treatment- Surgery
Trigeminal Neuralgia is also known as Prosopalgia or Fothergill's Disease.
Causes of Trigeminal Neuralgia or Prosopalgia or Fothergill's Disease
Injury or damage to trigeminal nerve causes trigeminal neuralgia. Trigeminal nerve forms from sensory and motor nerve that originates in the brain and spreads in three separate branches to the jaws, cheeks, and the area around the forehead and eyes. The trigeminal nerve delivers feeling to the face and allows facial movements to occur. It is believed that vascular compression in nerve root can be a cause of trigeminal neuralgia. This may also be as a result of branches of superior cerebellar artery, basilar artery, or local veins that may compress trigeminal nerve. People suffering from multiple sclerosis are also likely to suffer from Trigeminal neuralgia.
Diagnosis of Trigeminal Neuralgia or Prosopalgia or Fothergill's Disease
Diagnostic test or imaging studies like CT as well as MRI is done to rule out the possibility of any tumor or multiple sclerosis.
Signs and Symptoms of Trigeminal Neuralgia or Prosopalgia or Fothergill's Disease
- Symptoms of trigeminal neuralgia resemble like electric shocks that are debilitating and intense in nature that last for a few seconds. The next most commonly affected division is the mandibular branch, affecting the lower lip, cheek, and jaw. Some of trigger points are upper part of lip in case of maxillary division involvement, the eyebrows for ophthalmic division pain, and lower molar teeth in case of mandibular division pain. Any sort of sensory stimulus such as touching, talking, cold, wind, and chewing triggers an attack.
- The pain is caused either without any cause or by certain motions of facial muscles. There are various triggers such as brushing the teeth, washing the face, applying facial make-up, touching the face, shaving, blowing, kissing, and chewing etc that can cause a pain attack. Pain-free periods can go up to some weeks. Long-term remission from this condition is very rare. These attacks tend to cease during the sleep stage but often tends to occur upon getting up from sleep. This plethora of symptoms confirms its diagnosis.
- Patients are greatly affected by intermittent severe pain interfering with ADLs like brushing and eating and tend to cause irritability, anticipatory anxiety, depression, and above all life-threatening malnutrition.
- People suffering from Trigeminal Neuralgia can be described as a medical condition of an acute and excruciating episode of pain. It is stabbing, periodic, and excruciating enough to be described as electric shock being given to some areas of face. It usually tends to appear out of the blue and can last for some seconds or minutes. In some rare instances, pain can continue for a few hours, making the patient completely incapacitated and the individual may not be able to do any other activity until it subsides.
Treatment for Trigeminal Neuralgia or Prosopalgia or Fothergill's Disease
The first line of treatment of trigeminal neuralgia is by way of medications which help the patient to obtain relief within half an hour of administration. They can be anticonvulsive medications like Tegretol. Anticonvulsive medications are not known to help everyone and have their own limitations. For example, they need to be taken for longer duration and have some side effects. For people who find it difficult to control symptoms of trigeminal neuralgia like nausea, ataxia, mental dullness, physical sluggishness or who are desirous of a definitive fix, the only option is surgery.
Trigeminal Nerve Block Treatment
Surgery for Trigeminal Neuralgia or Prosopalgia or Fothergill's Disease
Prior to considering surgery, an MRI is a must with close attention being paid to the posterior fossa. It is important to rule out other causes of compression of trigeminal nerve such as large ectatic vessels, mass lesions, or other vascular malformations.
- Peripheral Neurectomy: This is a conservative method and the relief is temporary. The patient can choose to repeat this procedure when the pain recurs. The total pain-free period obtained from repeated peripheral neurectomies is significant and justifies the use of the procedure. This form of treatment is particularly indicated for people of advanced age or severely debilitated patient in whom craniotomy is contraindicated.
- Microvascular Decompression: This procedure can be called beneficial in the sense that it can relieve pain without causing numbness in face and has better long term success rate when compared to other surgical procedures. This surgery is performed using general anesthesia. Incision is created behind ear at the side where pain stems from. Then, a very small hole is created in skull and the brain is very softly lifted in order to expose trigeminal nerve. Then, the blood vessel which is supposed to be impinging the trigeminal nerve is identified. If found, it is separated from the nerve. Some padding is then put in between blood vessel and nerve to act as a cushion and protect nerve from undue pressure; however, since it is a major surgery it needs hospitalization and much longer recuperating period. This surgery carries a risk of causing hearing impairment, facial numbness, diplopia, and stroke.
- Percutaneous Stereotactic Rhizotomy: This procedure is usually performed by a neurosurgeon and it typically takes about 1 to 2 hours. PSR destroys the part of the nerve that causes pain by suppressing the pain signal to the brain. Electrode introducer is passed (hollow needle) through the skin of the cheek into the selected nerve at the base of the skull. A heating current is passed through the electrode which destroys some of the nerve fibers. This procedure can provide pain relief for those patients where medications are ineffective. PSR can be effective in treating patients of all ages including those with multiple sclerosis and those with some types of tumors. PSR poses lower surgical risks than those of a major operation such as microvascular decompression (MVD).
- Other Options Include: Peripheral nerve blocks or ablation, gasserian ganglion and retrogasserian ablative (needle) procedures, and craniotomy.