Treatment of trigeminal neuralgia

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.

WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES, 2021

Trigeminal neuralgia (TN) is a debilitating disorder that presents with a sudden onset of severe, unilateral, paroxysmal, and lancinating pain in one or more of the distributions of the trigeminal nerve. Trigeminal neuralgia affects the trigeminal nerve, fifth most developed and extensive cranial nerve, with a broad distribution territory. Its name - “trigeminal” - is derived from the fact that each nerve, one on each side of the pons, has three major branches: the ophthalmic nerve (V1), the maxillary nerve (V2) and the mandibular nerve (V3). The ophthalmic and maxillary nerves are purely sensory. The mandibular nerve has both sensory and motor functions.[1] It is a mixed nerve conducting sensitive and motor somatic fibers to the face, and is ideally responsible for all its sensitive innervation (touch, pain, temperature and propioception) together with the motor innervation of the mastication apparatus. Though it has been known by various names in the literature such as tic douloureux, trifacial neuralgia, fothergill’s disease (named after john fothergill), the currently accepted terminology is trigeminal neuralgia.[2]

Current Pain and Headache Reports, 2002

The trigeminal nerve, fifth equal of cranial nerves, a mixed nerve is considered by possessing motor and sensitive components. The sensitive portion takes to the Nervous System Central somesthesics information from the skin and mucous membrane of great area of the face, being responsible also for a neural disease, known as the Trigeminal Neuralgia. The aim of this study was to review the literature on the main characteristics of Trigeminal Neuralgia, the relevant aspects for the diagnosis and treatment options for this pathology. This neuralgia is characterized by hard pains and sudden, similar to electric discharges, with duration between a few seconds to two minutes, in the trigeminal nerve sensorial distribution. The pain is unchained by light touches in specific points in the skin of the face or for movements of the facial muscles, it can be caused by traumatic sequels or physiologic processes degenerative associate the vascular compression. Prevails in the senior population, frequently in the woman. In a unilateral way it attacks more the maxillary and mandibular divisions, rarely happens in a simultaneous way in the three branches of trigeminal nerve three branches.

Stomatological Disease and Science, 2019

Trigeminal neuralgia (TN), also known as tic doloureaux, is a nerve disorder of the face and is considered to be one of the most painful human conditions. A 51-year-old male presented with severe intermittent pain on the left side of his face. Magnetic resonance image scan with contrast revealed a close association of the superior cerebella artery and the trigeminal nerve on the left side of the face. Oral medication is the first line of treatment for TN, because of its non-invasiveness, low cost and high effective rate. Surgical intervention for TN aims to relieve the pressure of the offending artery or vein that is compressing the trigeminal nerve or in other instances; surgery may stop the uncontrolled pain signals. An important criterion for clinical diagnosis is pain that cannot be attributed to another disorder and also the lack of evident neurologic disorder. TN is one of the most debilitating diseases an individual may suffer and an early astute diagnosis of TN will provide patients with relief from suffering, unnecessary dental and medical intervention. Appropriate and early diagnosis of TN is important to formulate an optimal management plan based on the patient's age and general condition. The aim of this case report is to describe a case of Classical TN, and subsequent successful surgical management with microvascular decompression.

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.

Bmj British Medical Journal, 2007

BMJ, 2014

Trigeminal neuralgia is a severe, unilateral, episodic pain of the face that is provoked by light touch; it should be differentiated from dental causes of pain Magnetic resonance imaging (MRI) can distinguish between patients having secondary trigeminal neuralgia related to tumours and that related to multiple sclerosis The first line drug for treatment is either carbamazepine or oxcarbazepine, and doses should be slowly escalated. Neurosurgical options should be discussed at an early stage, but surgery may not be required until quality of life is compromised Microvascular decompression is a major neurosurgical procedure that provides the longest period of pain relief and aims to preserve function of the nerve Percutaneous, palliative destructive procedures and stereotactic radiosurgery can provide temporary relief, but at the risk of facial numbness, which increases with repetition of the procedure Sources and selection criteria We used Medline and Embase and the search terms "trigeminal neuralgia" and "tic doloureux." One author (JZ) has done Cochrane reviews on both medical and surgical outcomes for trigeminal neuralgia, and the search strategy is shown in those publications. We searched the Cochrane Neuromuscular Disease Group specialised register, Cochrane Library, Medline, and Embase using the search terms "trigeminal neuralgia/facial neuralgia/tic douloureux," "tic doloureux," "tic doloreux," or "tic douloreux" with no language exclusion. Clinical knowledge summaries and international guidelines for trigeminal neuralgia were published in 2008, and the search strategy can be found on www.aan. com. We also used our own extensive archives of references.

Oral Diseases, 2007

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.