TRIGEMINAL NEURALGIA

TRIGEMINAL NEURALGIA

(Tic douloureux, Trifacial neuralgia)

DEFINITION OF TRIGEMINAL NEURALGIA

TRIGEMINAL NEURALGIA is a paroxysmal attack of severe pain in the distribution of the trigeminal nerve, of short duration, not associated with any neurologic sign.

AETIOLOGY

In most of the cases no aetiological cause is found but trigeminal neuralgia may be seen in association with disseminated sclerosis, peroneal muscular atrophy, Paget’s disease, neurofibromatosis, facial hemiatrophy, facial myoclonus or with compression by a tumour at the cerebello- pontine angle or Basilar aneurysm.

CLINICAL  FEATURE

Age: 50 to 70 years.

Sex: Common in females.

The most important symtom of trigeminal neuralgia is pain which has got the following characteristics:

(i) Onset-Sudden, Paroxysmal.

(ii) Precipitating factors-Trauma on the face, exposure to cold or cold wind, emotional upsets, facial movements like talking, laughing, eating etc., touching the face as in washing touching the “Trigger spots” on the face.

(iii) Site-Along the distribution of the trigeminal nerve either involving the maxillary or mandibular division and rarely the ophthalmic division, usually unilateral but may be bilateral in distribution.

(iv) Character-Severe in intensity, stabbing, lancinating or shooting in character.

(v) Spread-In all the three divisions of the trigeminal nerve, i.e. over one-half of face.

(vi) Duration-Few seconds to few minutes, never more than 20 minutes.

(vii) Recurrence-Usually the first attack lasts for few weeks after which there is complete remission with recurrence after months or years. As time passes the duration of pain becomes longer and the duration of remission becomes shorter. No neurological signs are present except in cases where the disease develops in association with some other neurological disorders as mentioned before.

INVESTIGATION

when the disorder is seen in association with other disorders particularly Multiple sclerosis or Posterior fossa tumour, CT scan and MRI will be helpful.

TREATMENT

The best drug is Carbamazepine (Tegretol) 200 mg three or four times daily, never more than 1200 mg daily. In higher doses haematological and cutaneous reactions may occur. Sometimes, Dilantin sodium may also be effective. Baclofen 10-20 mg 3-4 times daily may be helpful either alone or in combination with either Carbamazepine or Dilantin. Clonazepam 1-2 mgm thrice daily may also be given.

When pain cannot be controlled by drugs the pathway of pain may be damaged by injecting Alcohol or phenol in the nerve particularly in elderly individuals. When the pain is more widespred, injection may be given in the Gasserian ganglion. Sometimes the sensory root may be operated called Rhizotomy/Posterior tractectomy which gives a permanent relief.

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