Idiopathic trigeminal neuralgia: A study of 72 cases

Background: The aim of this study is to evaluate the use of carbamazepine as primary definitive diagnostic aid in patients with classical/idiopathic and symptomatic/ pathological trigeminal neuralgia by analyzing the pain relief. Advantages of using carbamazepine is its easy availability, cost effective, non-invasive, no machine needed, simple, no specialized team needed and is itself a mode of treatment for trigeminal neuralgia as compared to MRI and CT. Methods: 100 patients with clinical characteristics signifying trigeminal neuralgia were included in this study in the age group of 50-65 years from both sexes who were examined clinically and radiographically. Sensory input of trigeminal nerve, gross motor input, diagnostic analgesic blocking and 0.5cc of normal saline at test site is also used to differentiate pain. All 100 patients were given tab. carbamazepine 100 mg twice daily to analyze the pain relief.Results and Conclusion: Clinical signs and symptoms were present in all 100 patients who were given tab. carbamazepine. 76 patients without any known cause for trigeminal neuralgia responded well so had pain relief andOther 24 patients did not responded and had pain existing who on further evaluation were diagnosed with symptomatic trigeminal neuralgia due to some other irrelevant pathological causes. This suggests response to treatment with tab. carbamazepine as pain relief can be used as a universal primary definitive diagnostic aid in patients with trigeminal neuralgia. Failure to obtain any improvement with this treatment should bring the diagnosis into question? Sometimes patient is not able to afford costly investigations like MRI and CT, hence the medical management can be started with tab. carbamazepine to diagnose the condition. We recommend MRI and CT as further secondary investigations to rule out cause for symptomatic trigeminal neuralgia due to some other irrelevant pathological causes.

Medicine Today, 2014

Trigeminal neuralgia is a sudden, severe, stabbing, recurrent and usually unilateral pain in the distribution of one or more branches of the fifth cranial nerve. A 55 years old man, diagnosed case of Trigeminal Neuralgia of the left side of the face was treated with oral carbamazepine with good response. But after that the disease became refractory to the drug. With the titration of dose of carbamazepine, raising up to 1200 mg daily in three equal divided doses added with amitryptylene, we could give relief of pain to patient. The patient is now under observation & we are following him for last 6 months with a good response of the combination drug. It justifies that alteration, titration of carbamazepine and combination with amitryptylene can cause remission of trigeminal neuralgia instead of doing surgical intervention.

International Journal for Research Trends and Innovation, 2021

The fifth cranial nerve, the Trigeminal nerve, is amongst the most widely distributed nerves in the human body. Trigeminal neuralgia (TN) is characterized by recurring occurrences of unilateral, intense, lancinating, stabbing discomfort in the distribution of one or more branches of the trigeminal nerve. When compared to men, women are more likely to develop Trigeminal Neuralgia. The trigeminal nerve is compressed and demyelinated, which causes Trigeminal Neuralgia. Diagnostic tests for Trigeminal Neuralgia include physical examinations, neuroimaging techniques, and neurophysiological studies. Initially, the patient was given a low daily intake of anti-epileptic drugs, with carbamazepine being the first-line treatment for Trigeminal Neuralgia. Surgery is a realistic and successful alternative if medical therapy has failed. Microvascular decompression, gamma knife radio surgery, percutaneous treatments at the Gasserian ganglion level and peripheral approaches are some of the surgical procedures used. The clinical symptoms, aetiology, diagnostic testing, and treatment for TN are all detailed in this review.

The diagnosis of Trigeminal Neuralgia (TN) has been a source of confusion for clinicians and remains a difficult condition to manage. The study was conducted on 50 patients to evaluate the area of pain distribution and involved nerve. The diagnosis was based on history, clinical examination and response of pain to carbamazepine. The branch of the nerve was identified and confirmed with 2% lignocain with adrenaline 1:200,000 injection at the identified site and repeated three times on consecutive days. The age of patient's ranges from 21 -79 years with a mean age 50 years. Males (60%) were affected more than female (40%) with ratio of 3:2. The right side was involved in 64% whereas left side in 36% of patients. The mandibular division was most commonly involved (n=30; 60%) followed by (n=17; 34%) and ophthalmic division (n=3; 6%. The most common site of nerve branch involved in descending order were inferior alveolar, infraorbital, long buccal and mental.

Bmj British Medical Journal, 2007

2008

ABSTRACT The diagnosis of Trigeminal Neuralgia (TN) has been a source of confusion for clinicians and remains a difficult condition to manage. The study was conducted on 50 patients to evaluate the area of pain distribution and involved nerve. The diagnosis was based on history, clinical examination and response of pain to carbamazepine. The branch of the nerve was identified and confirmed with 2% lignocain with adrenaline 1: 200,000 injection at the identified site and repeated three times on consecutive days.

World Journal of Dentistry, 2010

Trigeminal neuralgia (TN), also known as tic douloureux, is characterized by recurrent attacks of lancinating pain in the trigeminal nerve distribution. Typically, brief attacks are triggered by talking, chewing, teeth brushing, shaving, a light touch, or even a cool breeze. The pain is nearly always unilateral, and it may occur repeatedly throughout the day. The condition is characterized by intermittent one-sided facial pain. Trigeminal neuralgia can be classified based on the symptoms as typical and atypical trigeminal and according to etiology as primary or idiopathic and secondary or symptomatic. An early and accurate diagnosis of TN is important, because therapeutic interventions can reduce or eliminate pain attacks in the large majority of TN patients. Although various drugs have been used in the management of TN such as baclofen, gabapentin, phenytoin sodium, carbamazepine remains the gold standard drug of choice. Surgical approaches to pain management are performed when medication cannot control pain or patients cannot tolerate the adverse effects of the medication.

International Journal of Basic & Clinical Pharmacology

Pain and fear of pain continue to be the commonest and strongest motivation for the people to seek facial pain treatment. Pain is a personal experience of the sufferer that cannot be shared and wholly belongs to the sufferer. Trigeminal neuralgia (TN) is a notable facial pain disorder resulting in periodic severe pain that produces one of the most severe kinds of pain known to mankind. Treatment of this debilitating condition may be varied, ranging from medical to surgical interventions. However antiepileptic drugs are commonly used for its treatment. This article brings out the recent approaches in diagnosis and treatment of trigeminal neuralgia.

Cureus, 2018

General practitioners (GPs) are often the first clinicians to encounter patients with trigeminal neuralgia (TN). Given the gravity of the debilitating pain associated with TN, it is important for these clinicians to learn how to accurately diagnose and manage this illness. The objective of this article is to provide an up-to-date literature review regarding the presentation, classification, diagnosis, and the treatment of TN. This article also focuses on the long-term management of these patients under the care of GPs. GPs play an important role in the management of patients with TN by following the evidence-based management guidelines. The most important aspects of the management of TN are discussed in this review article.

2005

Introduction: Trigeminal neuralgia (TN) is characterized by touch-evoked unilateral brief shock-like paroxysmal pain in one or more divisions of the trigeminal nerve. In addition to the paroxysmal pain, some patients also have continuous pain. TN is divided into classical TN (CTN) and secondary TN (STN). Etiology and pathophysiology: Demyelination of primary sensory trigeminal afferents in the root entry zone is the predominant pathophysiological mechanism. Most likely, demyelination paves the way for generation of ectopic impulses and ephaptic crosstalk. In a significant proportion of the patients, the demyelination is caused by a neurovascular conflict with morphological changes such as compression of the trigeminal root. However, there are also other unknown etiological factors, as only half of the CTN patients have morphological changes. STN is caused by multiple sclerosis or a space-occupying lesion affecting the trigeminal nerve. Differential diagnosis and treatment: Important differential diagnoses include trigeminal autonomic cephalalgias, posttraumatic or postherpetic pain and other facial pains. First line treatment is prophylactic medication with sodium channel blockers, and second line treatment is neurosurgical intervention. Future perspectives: Future studies should focus on genetics, unexplored etiological factors, sensory function, the neurosurgical outcome and complications, combination and neuromodulation treatment as well as development of new drugs with better tolerability.