Trigeminal neuralgia is a sharp and stabbing pain in the area supplied by the trigeminal nerve and it appears in bouts rather than a continuous pain sometimes described as shooting pain. It is accompanied by facial spasm and tics in the face. It sometimes radiates to other parts of the scalp and also is accompanied by headaches, blurring vision, eye ache, etc.
What Leads To Trigeminal Neuralgia?
Trigeminal neuralgia is commonly idiopathic in nature which means usually without cause. It commonly involves maxillary and mandibular branches of the trigeminal nerve. But according to many researchers, it is most commonly associated with vascular compression, aneurysms and vascular torsion with the number as high as 36%. It is also associated with autoimmune diseases like systemic lupus erythematosus, scleroderma, sarcoidosis, etc. It is also associated with degenerative diseases like multiple sclerosis etc. Sometimes various compressive lesions in the brain like tumors, metastasis, tuberculoma, cavernous hemangioma, etc. can also cause the pain of trigeminal neuralgia by compressing the nerve and its surrounding structures.
Can Trigeminal Neuralgia Be Cured?
Most of the cases present to the clinic after the age of 50 years and can be treated on an outpatient basis. Although it may present as an irreversible disease it has a fairly good prognosis. First line management includes medical treatment only. Most of the cases are either relieved by short term medication and are good enough to live the rest of life without any further pain and the number ranges near 70%. In only very few cases, it can be treated by decompression surgeries and neurological interventions. The cases which are associated with the degenerative diseases are usually not relieved because of the continuous progression of the disease.
Drugs used in relieving the neuropathic pain are usually belonging to antiepileptics like Gabapentin, pregabalin, carbamazepine, oxcarbazepine, valproate, lamotrigine, phenytoin, topiramate, etc. Another group of drugs including tricyclic antidepressants likes amitriptyline, nortriptyline can be used in the treatment. Sometimes skeletal muscle relaxants like baclofen, botulinum toxin are also used for relieving the symptoms. Treatment of trigeminal neuralgia usually lasts for 6-12 months and the disease can go into remission itself. It may require starting the treatment again in the future but usually, it is not required. Sometimes more than one drug can be required because it may become severe enough to be not relieved by single medication.
Trigeminal neuralgia also has surgical treatment in medically resistant cases. Most common surgical treatment includes vascular decompression surgeries which are most effective because of its association with vascular malformations up to 36%. Gamma knife surgery is one of the effective surgeries for the treatment. These are effective for about 15-20 years and the patient is immediately symptom-free and remains the same way. Blockage of Gasserian ganglion of the trigeminal nerve by alcohol etc. is also done in various cases. Alcohol blockage of peripheral nerves and roots of the trigeminal nerve are the treatment of the part and are not used nowadays due to the vast amount of side effects and very less selectivity.
Various percutaneous nerve blockage procedures are used nowadays due to the advancement of the medical field. Percutaneous retrogasserian glycerol rhizotomy [PRGR], percutaneous balloon micro-compression [PBM] and percutaneous radiofrequency trigeminal gangliolysis [PRTG] are few to name in percutaneous procedures. These usually last for 2-5 years and sometimes pain does not recur.
Trigeminal neuralgia is mostly due to idiopathic cause and no relation is found with other diseases. It is a curable disease with a very good success rate and prognosis. Medical treatment has a very high success rate with generally a single medicine effective for the treatment. Surgical treatment can become necessary in few of the intractable cases with high recurrence. Microvascular decompression is a new field of surgeries opened in the treatment of trigeminal neuralgia and is currently the most effective surgical treatment as well. Although it is easy to diagnose even slightest facial features are to be recognized early to get good treatment and prevention of the complications.
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