NationMaster - Encyclopedia: Trigeminal neuralgia

Trigeminal neuralgia, or Tic Douloureux, is a neuropathic disorder of the trigeminal nerve that causes episodes of intense pain in the eyes, lips, nose, scalp, forehead, and jaw.^[1] Trigeminal neuralgia is considered by many to be among the most painful of conditions and has been labeled the suicide disease, due to the significant numbers of people taking their own lives because they were unable to have their pain controlled with medications or surgery. An estimated one in 15,000 people suffers from trigeminal neuralgia, although numbers may be significantly higher due to frequent misdiagnosis. It usually develops after the age of 40, although there have been cases with patients being as young as three years of age ^[2]. Image File history File links Gray778. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // G00-G99 - Diseases of the nervous system (G00-G09) Inflammatory diseases of the central nervous system (G00) Bacterial meningitis, not elsewhere classified (G01) Meningitis in bacterial diseases classified elsewhere (G02) Meningitis in other infectious and parasitic diseases classified elsewhere (G03) Meningitis due to other and unspecified causes (G04) Encephalitis, myelitis... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Neuropathy is usually short for peripheral neuropathy, meaning a disease of the peripheral nervous system. ... The trigeminal nerve is the fifth (V) cranial nerve, and carries sensory information from most of the face, as well as motor supply to the muscles of mastication (the muscles enabling chewing), tensor tympani (in the middle ear), and other muscles in the floor of the mouth, such as the...

Pathophysiology

The trigeminal nerve is the fifth cranial nerve, a mixed cranial nerve responsible for sensory data such as tactition (pressure), thermoception (temperature), and nociception (pain) originating from the face above the jawline; it is also responsible for the motor function of the muscles of mastication, the muscles involved in chewing but not facial expression. Several theories exist to explain the possible causes of this pain syndrome. Among the structural causes, damage to the myelin sheath of this nerve causes the electrical impulses traveling along it to be erratic or excessive, activating pain regions or deactivating pain inhibitory regions in the brain. The damage may be caused by an aneurysm (an outpouching of a blood vessel) or abnormally coursing artery compressing the nerve, most frequently at the area of its cerebellopontine nerve root; the superior cerebellar artery has been an oft-cited culprit. Two to four percent of patients with TN, usually younger, have evidence of multiple sclerosis, which may damage either the trigeminal nerve or other related parts of the brain. Trigeminal Neuralgia may also be caused by a tumor, an arachnoid cyst in the cerebellopontine angle^[3], or a traumatic event such as a car accident or even a tongue piercing.[1] When there is no structural cause, the syndrome is called idiopathic. Postherpetic Neuralgia, which occurs after shingles, may cause similar symptoms if the trigeminal nerve is affected. Cranial nerves are nerves which start directly from the brainstem instead of the spinal cord. ... This article or section does not cite its references or sources. ... Thermoception or thermoreception is the sense by which an organism perceives temperature. ... â€œHurtingâ€ redirects here. ... Mastication is a name for the process of breaking up of food and mixing it with saliva. ... In neuroscience, myelin is an electrically insulating fatty layer that surrounds the axons of many neurons, especially those in the peripheral nervous system. ... Italic text // ahh addiing sum spiice iin hurr`` For other uses, see Brain (disambiguation). ... Post surgical photo of brain aneurysm survivor. ... f you all The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... The Cerebellopontine angle refers to the junction between the cerebellum and the pons. ... Nerve roots can refer to: Dorsal root Ventral root Category: ... The superior cerebellar artery arises near the termination of the basilar. ... Tumor or tumour literally means swelling, and is sometimes still used with that meaning. ... Arachnoid cysts are cerebrospinal fluid covered by arachnoidal cells and collagen[1] that may develop between the surface of the brain and the cranial base or on the arachnoid membrane, one of the three membranes that cover the brain and the spinal cord. ... Figure 1a: A human brain, with the cerebellum in purple. ... A fully healed tongue piercing. ... Idiopathic means arising spontaneously or from an obscure or unknown cause. ... Postherpetic neuralgia (PHN) is a painful condition caused by the varicella zoster virus in a dermatomal distribution (the area governed by a particular sensory nerve) after an attack of herpes zoster (HZ) (commonly known as shingles), usually manifesting after the vesicles have crusted over and begun to heal. ... Herpes zoster, colloquially known as shingles, is the reactivation of varicella zoster virus, leading to a crop of painful blisters over the area of a dermatome. ...

Symptoms

The episodes of pain occur paroxysmally, or suddenly. A number of patients develop TN after a root canal and may go repeatedly to dentists as the pain can radiate through the teeth. Extractions do not help for the pain is originating in the Trigeminal Nerve and not in an individual nerve of a tooth. Because of this difficulty, many patients may go untreated for long periods of time before a correct diagnosis is made. To describe the pain sensation, patients describe a trigger area on the face, so sensitive that touching or even air currents can trigger an episode of pain. It affects lifestyle as it can be triggered by common activities in a patient's daily life, such as toothbrushing. Breezes, whether cold or warm, wintry weather or even light touching such as a kiss can set off an attack. The attacks are said to feel like stabbing electric shocks or shooting pain that becomes intractable. Individual attacks affect one side of the face at a time, last several seconds or longer, and repeats up to hundreds of times throughout the day, or may go on for periods as long as several months or years. 3-5% of cases are bilateral, and attacks may increase in frequency or severity over time. A great deal of patients develop the pain in one branch, then over years the pain will travel through the other nerve branches.

Signs of this can be seen in males who may deliberately miss an area of their face when shaving, in order to avoid triggering an episode. Although trigeminal neuralgia is not fatal, successive recurrences may be incapacitating, and the fear of provoking an attack may make sufferers reluctant to engage in normal activities.

There is a variant of trigeminal neuralgia called "atypical trigeminal neuralgia". In some cases of atypical trigeminal neuralgia, the sufferer experiences a severe, relentless underlying pain similar to a migraine in addition to the stabbing pains. This variant is sometimes called "trigeminal neuralgia, type 2"[2], based on a recent classification of facial pain^[4]. In other cases, the pain is stabbing and intense, but may feel like burning or prickling, rather than a shock. Sometimes, the pain is a combination of shock-like sensations, migraine-like pain, and burning or prickling pain. It can also feel as if a boring piercing pain is unrelenting.

Treatment

There is no cure for trigeminal neuralgia, but it can be treated with anticonvulsants such as carbamazepine (Tegretol), topiramate (Topamax), phenytoin, or gabapentin (Neurontin). Anticonvulsant effects may be potentiated with an adjuvant such as baclofen or clonazepam. Baclofen may also help some patients eat more normally if jaw movement tends to aggravate the symptoms. Pain may be treated long-term with an opioid such as methadone in some patients, but due to the nature of the neuralgia, traditional analgesics typically have negligible effect. Low doses of some antidepressants such as nortriptyline can also be effective in treating neuropathic pain. A new treatment medication is Lyrica. Botox, can be injected neurologically by a physician, and has been found helpful using the "migraine" pattern adapted to the patient's special needs. Many patients can not tolerate medications for years, and an alternate treatment is to take a drug such as gabapentin and place it in an externally applied cream base by a pharmacist who compounds drugs. The anticonvulsants, sometimes also called antiepileptics, belong to a diverse group of pharmaceuticals used in prevention of the occurrence of epileptic seizures. ... Carbamazepine (sold under the brand-names Biston, Calepsin, Carbatrol, Epitol, Equetro, Finlepsin, Sirtal, Stazepine, Tegretol, Telesmin, Timonil, sometimes abbreviated CBZ) is an anticonvulsant and mood stabilizing drug, used primarily in the treatment of epilepsy and bipolar disorder. ... Topiramate (brand name Topamax) is an anticonvulsant drug produced by Ortho-McNeil Neurologics, a division of Johnson & Johnson. ... Phenytoin sodium (marketed as DilantinÂ® in the USA and as EpanutinÂ® in the UK, by Parke-Davis, now part of Pfizer) is a commonly used antiepileptic. ... Gabapentin (brand name: NeurontinÂ®) was initially synthesized to mimic the structure of GABA for the treatment of epilepsy. ... Baclofen (brand names KemstroÂ® and LioresalÂ®) is a derivative of gamma-aminobutyric acid, and is an agonist specific to mammalian but not fruit fly (Drosophila) GABAB receptors[1][2]. It is used for the treatment of spastic movement, especially in instances of spinal cord injury, spastic diplegia and multiple sclerosis. ... Clonazepam (marketed by Roche under the trade-names Klonopin in the United States and Rivotril in Europe, South America, Canada, India, and Australia) is a drug which is a benzodiazepine derivative. ... An opioid is a chemical substance that has a morphine-like action in the body. ... Methadone is a synthetic opioid, used medically as an analgesic and in the treatment of narcotic addiction. ... A recent form of antidepressant medication - Prozac Serotonin-norepinephrine reuptake inhibitor, Venlafaxine An antidepressant, in the most common usage, is a psychiatric medication taken to alleviate clinical depression or dysthymia (milder depression). ... Nortriptyline is a tricyclic antidepressant marketed under the tradenames Aventyl® and Pamelor®. It is used to treat depression. ... Pregabalin (brand name: LyricaÂ®) is a new anticonvulsant drug indicated as an add on therapy for partial onset seizures and for certain types of neuropathic pain. ... Botulin toxin or botox is the toxic compound produced by the bacterium Clostridium botulinum. ... Gabapentin (brand name: NeurontinÂ®) was initially synthesized to mimic the structure of GABA for the treatment of epilepsy. ...

Surgery may be recommended, either to relieve the pressure on the nerve or to damage it further to prevent the transmission of pain. Surgery is effective in more than 75% of people with classic trigeminal neuralgia. The nerve can also be damaged to prevent pain signal transmission using a fine beam of radiation, so-called gamma knife. This is used especially for those people who are medically unfit for a long general anaesthetic, or who are taking medications for prevention of blood clotting (e.g., warfarin). Excellent success rates using a cost effective percutaneous surgical procedure known as balloon compression have been reported^[5]. This technique has been helpful in treating the elderly for whom surgery may not be an option due to coexisting health conditions. Balloon compression is also the best choice for patients who have ophthalmic nerve pain or have experienced recurrent pain after microvascular decompression (MVD). In medicine, Leksell Gamma Knife is a neurosurgical device used to treat brain tumors. ... This article or section may be confusing for some readers, and should be edited to be clearer. ... Warfarin (also known under the brand names of Coumadin, Jantoven, Marevan, and Waran) is an anticoagulant medication that is administered orally or, very rarely, by injection. ... In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an open approach where inner organs or tissue are exposed (typically with the use of a scalpel). ... Ophthalmology is the branch of medicine which deals with the diseases of the eye and their treatment. ... Microvascular Decompression is a neurosurgical procedure used to treat trigeminal neuralgia. ...

Alternative and Complementary health care treatments such as Chiropractic or Acupuncture are sometimes used either in combination with drugs or alone to help manage pain caused by this disorder.

Electric and Magnetic Field or EMF for short is a new treatment being used to treat Trigeminal Neuralgia.

Atypical trigeminal neuralgia is more difficult to treat, both with medications and surgery. Surgery may result in areas of numbness bothersome to the patient and lead occasionally to "anesthesia dolorosa," which is numbness with intense pain. It should, however, be noted that many people do find dramatic relief with minimal side effects from the various surgeries that are available.

Capsaicin can be helpful in short term temporary pain control of trigeminal neuralgia. It works by over stimulating the nerve endings at the site of current trip points on the face. Some patients have found relief with keeping the face covered to prevent breezes, the use of Alpha Stim Technology, Hot Tubs, Myofacial release of any spasms in the muscles by a trained Physical Therapist. Some have tried Cranial Sacral Therapy. Capsaicin (8-methyl-N-vanillyl-6-nonenamide) is the active component of chili peppers, which are plants belonging to the genus Capsicum. ...

In one^[6] case of trigeminal neuralgia associated with tongue-piercing, the condition resolved after the jewelry was removed.

Sources

Many patients have had success with Radiofrequency Rhizotomy. Specifically at Johns Hopkins with Doctor Benjamin Carson. A procedure where the Nerve center is deadened. The face stays numb but movement is not affected.

References

External links

Categories: Neurosurgery | Pain | Neurological disorders MedlinePlus (medlineplus. ... The Human Nervous System A human being coordinates its nervous system, the activity of the muscles, monitors the organs, constructs and also stops input from the senses, and initiates actions. ... Pathology (from Greek pathos, feeling, pain, suffering; and logos, study of; see also -ology) is the study of the processes underlying disease and other forms of illness, harmful abnormality, or dysfunction. ... Nerves (yellow) Nerves redirects here. ... Nerve roots can refer to: Dorsal root Ventral root Category: ... PLEXUS (Physics Learning EXperience Using Software) is a name of project that was started by Vibor Cipan, physics student form Croatia and it is based on utilization of usage of computer technology to enhance learning of physics. ... Bells palsy (or facial palsy) is characterised by facial drooping on the affected half, due to malfunction of the facial nerve (VII cranial nerve), which controls the muscles of the face. ... Thoracic outlet syndrome (TOS) consists of a group of distinct disorders that affect the nerves in the brachial plexus (nerves that pass into the arms from the neck) and various nerves and blood vessels between the base of the neck and axilla (armpit). ... This article is about the syndrome. ... Mononeuropathy (or mononeuritis) is a type of neuropathy that only affects a single peripheral or cranial nerve. ... This article is about the medical condition. ... Radial neuropathy (or radial mononeuropathy) is a type of mononeuropathy which results from acute trauma to the radial nerve that runs the length of the arm. ... Complex regional pain syndrome (CRPS) is a chronic condition characterized by severe pain following injury to bone and soft tissue. ... Meralgia paraesthetica or meralgia paresthetica (see spelling differences) (me-ral-gee-a par-es-thet-i-ka) is numbness or pain in the outer thigh not caused by injury to the thigh, but by injury to a nerve that extends from the thigh to the spinal column. ... Tarsal tunnel syndrome is a painful foot condition in which the tibial nerve is impinged and compressed as it travels though the tarsal tunnel. ... Polyneuropathy is a neurological disorder that occurs when many peripheral nerves throughout the body malfunction simultaneously. ... The peripheral nervous system or PNS, is part of the nervous system, and consists of the nerves and neurons that reside or extend outside the central nervous system (the brain and spinal cord) to serve the limbs and organs, for example. ... Charcot-Marie-Tooth disease (CMT), known also as Hereditary Motor and Sensory Neuropathy (HMSN) or Peroneal Muscular Atrophy, is a heterogeneous inherited disorder of nerves (neuropathy) that is characterized by loss of muscle tissue and touch sensation, predominantly in the feet and legs but also in the hands and arms... Dejerine-Sottas Syndrome/Neuropathy (hereditary motor and sensory polyneuropathy type III; sometimes also described as a subtype III of Charcot-Marie-Tooth disease) is an autosomal dominant or autosomal recessive neuropathy. ... Refsums disease (Refsum-ThiÃ©baut disease, Refsum-ThiÃ©baut-Klenk-Kahlke disease), named after Norwegian neurologist Sigvald Bernhard Refsum (1907-1991), is an autosomal recessive (Chromosome 10) neurological disease that results in the malformation of myelin sheaths around nerve cells. ... Morvans syndrome (or fibrillary chorea) is a rare disease named after nineteenth century French physician Augustin Marie Morvan (1819-1897). ... Guillain-BarrÃ© syndrome (GBS) or acute inflammatory demyelinating polyradiculoneuropathy is an acute, autoimmune disease that affects the peripheral nervous system and is usually triggered by an acute infectious process. ... Polyneuropathy is a neurological disorder that occurs when many peripheral nerves throughout the body malfunction simultaneously. ... Alcoholic polyneuropathy is a neurological disorder in which many peripheral nerves throughout the body malfunction simultaneously (a polyneuropathy). ... Electron micrograph showing a cross section through the neuromuscular junction. ... A top-down view of skeletal muscle Muscle (from Latin musculus little mouse [1]) is contractile tissue of the body and is derived from the mesodermal layer of embryonic germ cells. ... Myasthenia gravis (sometimes abbreviated MG; from the Greek myastheneia, lit. ... Muscular dystrophy refers to a group of genetic, hereditary muscle diseases that cause progressive muscle weakness. ... Myotonic dystrophy (DM) is a chronic, slowly progressing, highly variable inherited multisystemic disease that can manifest at any age from birth to old age. ... Myotonia congenita is a genetic, neuromuscular disorder characterized by the slow relaxation of the muscles. ... Thomsen disease, a form of Myotonia congenita, is a muscular genetic disorder characterized by muscle stiffness (cramp) and an inability of the muscle to relax after a voluntary contraction. ... Neuromyotonia is spontaneous muscular activity resulting from repetitive motor unit action potentials of peripheral origin. ... Paramyotonia congenita is a rare congenital neuromuscular disorder which is characterized by a condition in which the muscles do not relax after contracting (myotonia). ... Centronuclear myopathies (CNM) are a group of congenital myopathies where cell nuclei are abnormally located in skeletal muscle cells. ... Periodic paralysis is a rare group of genetic diseases that lead to weakness or paralysis (rarely death) from common triggers such as cold, heat, high carbohydrate meals, not eating, stress or excitement and physical activity of any kind. ... Hypokalemic periodic paralysis is characterized by a fall in potassium levels in the blood. ... Hyperkalemic periodic paralysis (HYPP), also known as Impressive Syndrome, is an inherited autosomal dominant disorder which affects sodium channels in muscle cells and the ability to regulate potassium levels in the blood of horses. ... Lambert-Eaton myasthenic syndrome (LEMS) is a rare disorder of nerve-muscle (neuromuscular) junction. ... Peripheral neuropathy is the term for damage to nerves of the peripheral nervous system, which may be caused either by diseases of the nerve or from the side-effects of systemic illness. ... Familial dysautonomia, or FD, is a disorder of the autonomic nervous system which affects the development and survival of sensory, sympathetic and some parasympathetic neurons in the autonomic and sensory nervous system resulting in variable symptoms including: insensitivity to pain, inability to produce tears, poor growth, and labile blood pressure... Horners syndrome is a clinical syndrome caused by damage to the sympathetic nervous system. ... Multiple system atrophy (MSA) is a degenerative neurological disorder. ... Shy-Drager syndrome is a rare, progressively degenerative disease of the autonomic nervous system. ...

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