Neurology

Trigeminal neuralgia (TN), tic douloureux  is a neuropathic disorder of one or both of the trigeminal nerves. It causes episodes of intense pain in any or all of the following: the ear, eye, lips, nose, scalp, forehead, teeth or jaw on one side and alongside of the face. It is estimated that 1 in 15,000 people suffer from trigeminal neuralgia, although the actual figure may be significantly higher due to frequent misdiagnosis. Trigeminal Neuralgia usually develops after the age of 50, more commonly in females, although there have been cases with patients being as young as three years of age .

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Trigeminal Neuralgia brings about stabbing, mind-numbing, electric shock-like pain from just a finger's glance of the cheek or spontaneously without any stimulation by the patient. Cold wind, high pitched sounds, loud noise such as concerts or crowds, chewing, talking, can aggravate the condition, and for the worst cases, even smiling, a scarf, the wind or hair on the side of the face is too much to bear.Several theories exist to explain the possible causes of this painsyndrome. Research indicates that it is an enlarged blood vessel - possibly the superior cerebellar artery - compressing or throbbing against the microvasculature of the trigeminal nerve near its connection with the pons. Such a compression can injure the nerve's protective myelin sheath and cause erratic and hyperactive functioning of the nerve. This can lead to pain attacks at the slightest stimulation of any area served by the nerve as well as hinder the nerve's ability to shut off the pain signals after the stimulation ends. This type of injury may rarely be caused by an aneurysm (an outpouching of a blood vessel); by a tumor; by an arachnoid cyst in the cerebellopontine angle; or by a traumatic event such as a car accident or even a tongue piercing.

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There are some patients who have very mild face pain that may subside and even disappear without treatment. For severe pain, medications, especially Tegretol, are often highly effective. Tegretol can cause many side effects including sleepiness, forgetfulness, confusion, drowsiness, dizziness and nausea. Tegretol can also cause more serious problems such as bone marrow suppression, which can lead to anemia or a decrease in the number of white blood cells.

A Surgical procedure is recommended for patients who continue to experience severe pain or side effects from medications. In the past, patients with TN did not consider neurosurgical options until the pain or medicines became unbearable, because surgical procedures carried higher risks. Now that surgery is safer, and especially with GKRS, which is not only highly effective but safer than any of the other procedures, patients no longer have to wait to be in agony in order to undergo neurosurgical intervention.

Important Neurosurgical procedures are : Gamma Knife radiosurgery (GKRS), radiofrequency electrocoagulation (RFE),  and microvascular decompression (MVD). All of these procedures treat the trigeminal nerve at around the same place, close to where it leaves the brain.Gamma Knife Radiosurgery is the most recent and least invasive neurosurgical treatment for trigeminal neuralgia. Of all the surgical procedures, it is least likely to cause complications and uncomfortable new facial sensations (dysesthesias).

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