Trigeminal neuralgia is one of the most intense pain known. These are crises of pain localized in one half of the face: the pain is brief, paroxysmal, occurring periodically. Seizures may develop into chronic pain.
Trigeminal neuralgia affects four to five people in 100,000. Women are affected more frequently than men. Nearly 1% of patients with multiple sclerosis develop trigeminal neuralgia. The likelihood of suffering from trigeminal neuralgia increases with age.
In 60-90% of cases, facial pain resulting from an injury, irritation or compression (by a vessel or a tumor) of the root of the fifth cranial nerve, called the trigeminal nerve.
There are two forms of trigeminal neuralgia:
We do not know the exact cause of trigeminal neuralgia. It is estimated that this neuralgia is mostly due to compression of the nerve fibers of the trigeminal nerve by blood vessels, as they enter the brainstem. The disease primarily affects the elderly over 50 years and with hypertension.
In some cases, early symptoms can appear, such as pain in the teeth and sinuses:
Due to the thrills of facial muscles, the disease is often called “tic douloureux”. Between attacks, there may be pain-free periods may last months or even years. As the opening of the mouth and chewing can trigger seizures, patients avoid eating and drinking, which is causing a significant weight loss over time. The medication is too often overlooked.
Self-medication with analgesics is not recommended because these drugs are addictive fast, are ineffective and can damage the kidneys and liver long term. In half the patients, there is asymptomatic periods lasting more than six months, even in the absence of medication, in up to 20% of these subjects pain-free periods can last more than a year.
The trigeminal neuralgia responds well to drug therapy, which helps distinguish it easily from symptomatic trigeminal neuralgia.
Treatment is based mainly on anti-epileptic drugs, alone or in combination with other drugs:
It should properly evaluate the advantages and disadvantages of these drugs since they can cause side effects such as confusion, fatigue, skin rashes, dizziness, constipation, loss of balance, tremors, memory problems, etc..
Drug treatment always precedes the intervention chirurigicale because it is effective in most cases. A proportion of cases will still undergo surgery.
These treatment methods are used frequently because they do not require opening the skull. Moreover, these procedures are performed under anesthesia of short duration, as an outpatient.
Compared to other treatment methods (rhizolyse glycerol and radio-surgical process) thermocoagulation seems to have a higher success rate (over 80% of absence of pain). However, complications are more common with this process, as demonstrated by several studies conducted in 2004 (Source: BC Lopez et al. Neurosurgery. Apr 2004, 54 (4) :973-82; Discussion 982-983).
This surgical technique aims to remove the compression of the trigeminal nerve by blood vessels and must be done to open the skull under general anesthesia. The success rate of this method are high and complications reduced to less than 1% (bleeding, hearing loss, episodes of vertigo after the operation). However this method is not recommended in the elderly due to too much risk.
This method is based on irradiation of the trigeminal nerve at its entrance into the brainstem.
Other treatment methods
Psychotherapy is indicated for depression and psychological problems following the painful crises. In many cases, to discuss and exchange experience with other patients brings relief (support groups).
At the onset, spontaneous recovery can last several years is possible. Nearly half of those living phases without any pain. In contrast, continuous pain of trigeminal neuralgia can cause serious psychological problems.