Trigeminal neuralgia treatment options

This article will briefly describe Trigeminal neuralgia treatment options. Trigeminal neuralgia which is also known as Tic Doulourex is an idiopathic facial pain syndrome. It involves the distribution of fifth cranial nerve. It results in episodes of very severe debilitating pain in the face. The frequency of attacks is highly variable.

TRIGGERS

TN attacks can be precipitated by

Chewing food, pronouncing certain words, hot or cold fluids, certain beverages that may have irritant effect, sudden exposure to cold or heat, forceful cough, light or hard touch, even smiling or certain foods can trigger an attack.

THE PAIN OF TRIGEMINAL NEURALGIA 

The pain can be excruciating and the patient may describe it as a stabbing sensation as if someone is stabbing their face with a knife. The pain is well localized by the patient. In most cases the pain starts from the mouth corner and shoots to the jaw angle. In some cases it may involve the mid face region sparing the orbit itself. In very few cases, it may involve the ophthalmic branch of the facial nerve. The pain is sudden in onset and can last for a few second leaving behind a burning sensation in the face. The movements made by the patient are as if the patient wants to escape the pain. Such averse movements or tic produce a certain motion thus the name tic doulourex.

DIAGNOSTIC TESTS

There is no specific diagnostic test for Trigeminal Neuralgia. Treatment is started based on clinical impression.

 Trigeminal neuralgia treatment options (MEDICAL AND SURGICAL)

If there is typical and characteristic history of trigeminal neuralgia with no clinically evident neurological deficit on examination then treatment can be initiated without any further workup.Trigeminal neuralgia treatment options with respect to pharmacological therapy include

Carbamezepine, Oxcarbezepine, Phenytoin, topiramate, Baclofen, Lamotrigine, Gabapentin, Pregabalin, Amitryptiline, Botulinum toxin.

Carbamezepine has been shown to be the first line medication in TN. Its approved by the FDA for trigeminal Neuralgia. Initially, a single drug is used and gradually a second or 3rd drug may be added from the options above accordingly. Surgical options should never be resorted to primarily as pharmacotherapy has been shown to give effective control in more than 70 percent of TN cases.

With carbamazepine therapy, complete blood count and liver function tests should be done prior to initiating therapy and monitored along the way.

Patients not responding to medication or unwilling to take them can be offered surgical options in the form of GKS ( Gamma Knife Surgery ) or MVD (Micro Vascular Decompression). Both can be curative in case of TN in more than 90 percent of patients.