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Trigeminal Neuralgia Awareness

October 7, is celebrated as National Trigeminal Neuralgia Awareness Day

There is no reason for the common man to know about the difficult disease called ‘trigeminal neuralgia’ until the time one gets it! But in 2011, actor Salman Khan underwent surgery for the same disease, and on that occasion many people heard the name of this disease. Trigeminal neuralgia has been given another name as ‘suicide disease’ due to the excruciating pain! But let’s find out what is Trigeminal Neuralgia, what is the solution and how is it treated in this article.

Trigeminal neuralgia is presented with excruciating pain in the face, jaw or gums! This pain can come in different ways. Sometimes it starts suddenly. Patients describe it with many adjectives such as unbearable like an electric shock, sometimes lancinating sharp shooting pain lasting for a few seconds to a minute, as if the heels are pricked or as if a part of the face is filled with chili powder in the eyes. Often the pain starts on one side of the face when a certain area is touched on the cheek, forehead, chin, behind the ear or on the gum.

These areas are called ‘trigger points’. This key is triggered by various reasons such as a breeze on the cheek while traveling in a car, touching the area while washing the mouth, while biting food.

The intensity of this key (pain) is so extraordinary that the patient cannot speak at that time. Even opening the mouth becomes impossible at such times. Some people even do not wash their face and teeth on the affected side every day for fear of starting this pain.

A patient’s trigeminal nerve ganglion is under periodic pressure when it is too close to one of the blood vessels, where it enters the brain. Uninterrupted pulsation of such a blood vessel makes the nerve tender and triggers the excruciating pain of trigeminal neuralgia.

Trigeminal Neuralgia @drnitin Dr Nitin Jagdhane

How is it diagnosed and treated?

Trigeminal neuralgia is diagnosed with the help of physical and neurological examination. Doctors may also perform some scanning tests like X-rays, CT scans, and magnetic resonance imaging (MRI) to rule out other causes for facial pain. But, it is mainly a clinical diagnosis based on the characteristic features of this facial pain. There are some deviations from the typical facial pain and such conditions are categorized under the atypical facial pain syndromes. They are even more difficult to treat than the classical trigeminal neuralgia.

Medicines are the first line therapy. Most of the patients are on medications for several years until the medicines are either ineffective or causing side effects. This adds more misery to this miserable condition! Carbamazepine is prescribed for pain relief. It reduces the intensity of pain, but only temporarily! Moreover, as the disease progresses, the effect of the medicine also decreases and then these pills are no longer useful. Excess amount of these pills can cause dizziness, fainting. Liver can also be affected. In short, drugs suppress the pain by numbing the nerves and brain, not curing it.

Trigeminal Neuralgia @drnitin-2 Dr Nitin Jagdhane

So what is the remedy for these patients to eliminate the suffering forever?

The first solution is MVD which stands for ‘Microvascular Decompression’ surgery. This is considered as the Gold standard treatment amongst the all available treatment options. The surgical procedure is done by neurosurgeons trained in microvascular neurosurgery and is technically demanding. It has remission rate of more than 80% at 5 years.

In MVD surgery, the offending vessel is separated from the trigeminal nerve and a Teflon sponge is placed between the two to keep it apart. The idea is to stop transmission of pulsations from the pulsatile blood vessel to the trigeminal nerve ganglion. Adequate control of blood pressure is also very important but  a little under-rated treatment strategy.

Another options are:

Stereotactic Radiosurgery (SRS)

Fluoroscopic lesioning of ganglion

Radiofrequency ablation

All these procedures are used to burn or destroy the nerve without causing any discomfort to the patient. SRS is a kind of focused radiation therapy, where as the other two are direct lesioning procedures done under C arm.  In this, the neurosurgeon or a pain physician specialist performs the treatment in the operation theater using a C-arm machine. Due to this, the unbearable suffering of the patient is reduced without operation. It is a sophisticated non-surgical treatment method.

But technically these are like switching off the alarm system. Although the fluoroscopic ablation injections are obsolete these days, the other two procedures are equally good for remission in selected patients especially those with co-morbid conditions and elderly age.

The author, Dr Nitin Jagdhane is a trained and board certified (by National Medical Council , India) neurosurgeon practicing in Mumbai, India with a huge experience and remarkable skills to treat Trigeminal Neuralgia and facial pain syndromes with both surgical and non surgical treatment modalities. Visit Dr Nitin Jagdhane for your Trigeminal neuralgia treatment.

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