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Trigeminal Neuralgia : Definition, Causes, Symptoms, Diagnosis and Treatment

Monday, July 23rd 2012. | Brain and Nerves, Disease

Trigeminal Neuralgia Definition

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.

Trigeminal Neuralgia Causes

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:

  • Trigeminal Neuralgia
  • Symptomatic 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.

trigeminal neuralgia symptoms

Trigeminal Neuralgia (img : internet search)

Causes of symptomatic trigeminal neuralgia:

  • Multiple Sclerosis
  • Other neuritis
  • Tumor in the brain
  • Cerebral infarction
  • Drop
  • Alterations of the cervical vertebrae
  • Depression, stress
  • Heredity (very rare)

Risk factors that may trigger a trigeminal neuralgia:

  • Chewing, talking, eating
  • Brushing your teeth
  • Shave
  • Smoke
  • Consume alcohol
  • Consume coffee
  • Stress
  • Drugs (overdose)
  • Touch
  • Drafts, to the cold

Like symptoms of trigeminal neuralgia:

  • Atypical facial pain: the patient does not suffer from acute, but chronic pain, these atypical pain can be triggered by surgery on the ears, nose and throat.
  • Diseases of teeth, jaws and jaw joints
  • Diseases of ear, nose and throat
  • Eye diseases (glaucoma)
  • Cluster headaches

Trigeminal Symptoms

In some cases, early symptoms can appear, such as pain in the teeth and sinuses:

  • Breakthrough pain, lasting only a few seconds, hitting a half-face, especially around the cheek, upper lip, chin and lower jaw.
  • Attacks can occur up to 100 times a day, for weeks and months.
  • Muscle spasm in the face
  • Hypersensitivity to touch
  • The duration of access can be extended over time.

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.

Trigeminal Diagnosis

  • History with consideration of symptoms; questioning of dental surgery or pre-
  • Neurological tests are performed to rule out other medical conditions.
  • Specialized tests (ENT)
  • Dental examinations
  • MRI (nuclear magnetic resonance)
  • CT
  • Possibly: angiography (blood vessel images with a contrast medium)
  • Possibly: lumbar puncture
  • Blood tests

Trigeminal  Treatment Options

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.

Trigeminal Medical Drugs Treatment

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:

  • Neuroleptics
  • Antiepileptic
  • Anticonvulsants

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..

Trigeminal Surgery Treatment

Drug treatment always precedes the intervention chirurigicale because it is effective in most cases. A proportion of cases will still undergo surgery.

Three surgical procedures are used:

  • Percutaneous process: thermocoagulation, the rhizolyse to glicerol and percutaneous balloon compression
  • Microvascular decompression
  • Radio-surgical procedures (irradiation of the trigeminal nerve at its entrance into the brainstem)

Percutaneous procedures :

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.

These include:

  • Thermocoagulation: nerve fibers of the trigeminal nerve are destroyed by heat through a cannula. Under visual control, an electrode is used to send electrical stimulation under the skin, which can locate the trigeminal nerve. Under general anesthesia of short duration, we proceed to nerve damage by radiofrequency (time and temperature controlled: 60-70 ° for 60 seconds). Immediately we noted a decrease in sensitivity to touch or pain response, the goal is reached. Studies have shown that this method has a high success rate (80%).
  • Rhizolyse glycerol: chemical lesion of the trigeminal nerve injection of anhydrous glycerol.
  • Decompression by balloon during this process, the trigeminal nerve is injured mechanically by introducing an inflatable balloon catheter.

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).

Microvascular decompression

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.

Radio-surgical process

This method is based on irradiation of the trigeminal nerve at its entrance into the brainstem.

Other treatment methods

  • Cryotherapy (freezing of nerves)
  • Acupuncture
  • Injections of alcohol

Psychotherapy

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).

Trigeminal  Possible Complications

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.

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