Trigeminal neuralgia and its management

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.

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.

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]

2014

Trigeminal neuralgia (TN), the most common and the most serious of the facial neuralgias, is characterized by an extremely severe electric shock like or lancinating pain limited to one or more branches of the trigeminal nerve. Among the very many diagnostic and treatment options in the management of TN only very few have proven their efficacy to modern evidence-based medicine standards. For thorough and accurate management, a stepwise diagnostic and treatment approach is recommended. Surgical management should be recommended if sufficient and compliant medical therapy failed. The aim of this review article is to discuss the etiopathogenesis, diagnostic criteria, and treatment strategies for trigeminal neuralgia.

Southeast Asian Journal of Health Professional

Out of all the cranial nerves “Trigeminal Nerve” is the fifth cranial nerve. Trigeminal nerve possesses both the components i.e. mixed components as well as sensitive components that’s why trigeminal nerve is known as a mixed nerve. The sensitive component of the trigeminal nerve takes up the sensation from most of the part of the face and the mucous membrane to the central nervous system and that’s why it is responsible for the disease which is known as trigeminal neuralgia. The characteristic feature of the trigeminal neuralgia is the sudden onset of pain which is sharp and lacerating, and that may last from few of the seconds to few minutes. Trigeminal neuralgia more frequently affects the female as compared to the male.

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.

The Clinical Journal of Pain, 2002

Trigeminal neuralgia is a chronic facial pain classified as a neuropathic pain. There is widespread agreement regarding the International Association for the Study of Pain definition of classical idiopathic trigeminal neuralgia as "a sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve." However, there are variations in presentation that are less easy to diagnose and an erroneous diagnosis of trigeminal neuralgia is occasionally made. In patients with tumors or multiple sclerosis, trigeminal neuralgia is termed secondary. Currently, clinical manifestations are the mainstay for diagnosis because there are no objective tests to validate the diagnosis. The sensitivity and specificity of these clinical manifestations is reviewed. Magnetic resonance imaging (MRI) and three-dimensional fast-inflow with steady-state precession MRI are performed to determine the presence of tumors or plaques of multiple sclerosis and to assess possible compressions and deformations of the trigeminal nerve. Their specificity and sensitivity regarding compressions found at the time of surgery is reviewed. Other differential diagnoses for chronic unilateral orofacial pain are discussed.

2020

Background: Trigeminal neuralgia is a sudden, unilateral, brief, stabbing, recurrent pain in one or more branches of the fifth cranial nerve distribution that affects quality of life of the affected patient. Diagnosis is made using the history alone, based on the pain characteristics. Pain occurs in paroxysms, which can last between a few seconds and a few minutes. The frequency of the paroxysms varies from a few to hundred times per day. Aim: The objective of this article is to provide an up-to-date review regarding the prevalence, etiology, diagnosis, and the management of trigeminal neuralgia. Conclusion: TN is a rare disease but often associated with debilitating pain and disability. TN management is a concern for neurologists and neurosurgeons alike. Progress has been achieved in recent years, leading to the introduction of neuro-radiological approaches for both pathogenesis and surgical treatment. Medical treatment should be done in TN. With an growing variety of medications available, it is possible the surgical alternative may not be available for several years.

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.

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.