Treatment of trigeminal neuralgia

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More information about the diagnosis can be found at the link TRIGEMINAL NEURALGIA

Treatment of trigeminal neuralgia usually begins with the appointment of drugs that suppress pain, and for many people this is enough for a long time. However, over time, some patients become addicted to drugs, which leads to a decrease in their effectiveness, up to complete loss of effect. There are also frequent cases of significant unwanted side effects. There are more radical treatments for such cases.

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The generally accepted world approach is to start treatment with drug therapy followed by (if necessary) reconstructive interventions (microvascular decompression of the trigeminal nerve root), and if it is impossible or ineffective, destructive (nerve-destroying) interventions are performed.

Approach to treatment
Medical treatment
For the treatment of trigeminal neuralgia, you may be prescribed medications that reduce or stop the transmission of pain signals to your brain.

  • Anticonvulsants. Usually prescribed carbamazepine (finlepsin), the effectiveness of which in the treatment of trigeminal neuralgia is confirmed. Other anticonvulsants that can be used in this disease are oxcarbazepine (Trileptal), lamotrigine (Lamictal) topyromates (Topiromax). Drugs of other groups, such as clonazepam, gabapentin, pregabalin, can also be used. If the medicines you are taking lose their effectiveness, you may need to adjust the dose or change the medicine, which should be carried out under the supervision of a doctor. Side effects may include dizziness, lethargy, drowsiness, double vision, and nausea. When taking drugs, you should refrain from driving or operating machinery that requires special attention or is dangerous.

  • Antispasmodics. Muscle-relaxing drugs that relax the muscles, such as baclofen (Gablofen, Lioresal) can be used alone or in combination with carbamazepine.

  • Antidepressants. Many protocols for the treatment of chronic pain syndromes include a drug from the group of antidepressants (Amitriptyline, Fluoxetine (Prozac), Paroxetine), which have shown their effectiveness when used correctly.
Surgical treatment
In trigeminal neuralgia, the surgeon's goal is to stop squeezing the compression and irritation of the trigeminal nerve by an adjacent vessel or, in some cases, to destroy its fibers, to interrupt the pathological functioning. The destruction of the nerve leads to numbness of the face on the side of the intervention, which, depending on the procedure and features of the disease, may persist. After any surgery, the pain may return in a few months or years. The frequency of relapses depends on the type of neuralgia and the nature of the intervention.
Options for surgery include:
Microvascular decompression
The procedure is to divert the vessel from the trigeminal nerve in the area of ​​their contact.

During the operation, the surgeon makes an incision behind the ear on the side of the pain. Then through a small hole in the skull, the surgeon removes all the vessels from the nerve all the vessels that are in contact with it and isolates them from each other with a special gasket. If the nerve is compressed by a vein, the surgeon can remove it.
The doctor may also cross part of the nerve fibers (neurotomy) during the operation, depending on the features of the anatomical relationship and the nature of the vascular-nervous conflict.

In the vast majority of cases, microvascular decompression leads to complete cessation of pain or a significant reduction. This procedure, like all surgeries, carries certain risks, which include a small percentage of hearing loss, facial muscle weakness, facial numbness, double vision, and other general surgical complications. More detailed information will be provided by your doctor during a personal interview.

Most patients do not have any persistent neurological symptoms after this procedure. This procedure has the lowest percentage of pain recovery in the long run, compared to other treatments.
Destructive methods of surgical treatment

Other methods of surgical treatment are destructive, ie involve the destruction of the fibers of the trigeminal nerve or other structures involved in the process.

Radiosurgery. In this procedure, a focused radiation exposure to the trigeminal nerve root is performed. This technique uses radiation to destroy the trigeminal nerve and reduce or stop the transmission of pain impulses. The effect is gradual, which can take several weeks. After the procedure, numbness of half of the face occurs, which persists for a long time. In case of recurrence and recovery of pain, the procedure is repeated.

The undoubted advantage and plus of the procedure is its painlessness and the absence of the need for hospitalization and surgery. Among the disadvantages - the high cost, and the fact that it does not eliminate the cause of the disease - compression of the nerve root. The destructive nature of the procedure, in case of its ineffectiveness, significantly reduces or nullifies the effectiveness of possible microvascular decompression. Sometimes there may be increased pain on the background of numbness of the face - the so-called "painful painful anesthesia" - "anesthesia dolorosa"

Other procedures that can be used to treat trigeminal neuralgia are called "rhizotomy" or "ablation", ie - "destruction". At a rhizotomy, the surgeon destroys nerve fibers, which leads to numbness of the face.

Methods of rhizotomy
  • Glycerol injections (Glycerol blockades). During this procedure, the needle is passed through the face to the hole at the base of the skull, through which the needle is inserted into the trigeminal cistern, a small cavity with cerebrospinal fluid that surrounds the trigeminal nerve - the place where the nerve divides into three branches - and part of its root. The doctor then injects a small amount of sterile glycerol, which damages the trigeminal nerve and interrupts the pain impulse. This procedure usually relieves pain. However, sometimes the pain, after a while, resumes, and many patients retain numbness of the face or a tingling sensation.
  • Balloon compression. With balloon compression, your doctor inserts a hollow needle through your face into the part of the nerve that extends to the base of the skull. He then passes a thin flexible tube (catheter) through the needle with a syringe at the end. The doctor inflates the balloon with enough pressure to damage the trigeminal nerve and block pain signals. Balloon compression successfully relieves pain in most patients, at least for some time. Most patients experience numbness of the face after the procedure, and some have temporary or permanent weakness of the masticatory muscles.
  • Radio frequency temperature damage (destruction). The procedure selectively destroys nerve fibers associated with pain. The technique of holding the needle to the nerve outlet at the base of the skull is similar to that described above. After the location of the needle, an electrode is passed through its lumen, to which a small electric current is applied. During the procedure you will be asked to say where and when you felt the tingling. When the neurosurgeon determines the part of the nerve involved in the transmission of pain, the electrode is heated until it leads to the destruction of nerve fibers, creating a zone of damage (destruction). If the pain persists, the doctor may create additional areas of destruction. Radio-frequency thermodestruction usually leads to some numbness of the face after the procedure.
  • Alcoholization. Carrying out blockade of branches of a trigeminal nerve in places of their exit on the person with use of alcohol solution which lead to destruction of nerve fibers. The technique to date has almost lost its relevance due to low efficiency and in such a process as the treatment of trigeminal neuralgia and a high percentage of recurrences and complications. None of the professional pain treatment associations recommend alcoholism as a method of treating trigeminal neuralgia. Carrying out alcoholism can make sense as a last resort, when it is impossible to perform other techniques.
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