Trigeminal neuralgia Treatment in Nagpur

Trigeminal neuralgia is a chronic neuropathic pain condition on one side of the face presenting in paroxysm along the distribution of trigeminal nerve which is a nerve carrying sensations from brain to face.Trigeminal nerve is the 5 th cranial nerve and is the largest of all the cranial nerves which comes out of the brain and divides into three branches- Opthalmic branch(V1), Maxillary branch (V2), Mandibular branch(V3).Paroxysmal attacks of pain lasting from a fraction of a second to two minutes that affect one or more division of face
V1 Nerve involvement- Forehead and eye are painful
V2 Nerve involvement- Pain in cheek ,upper lip
V3 Nerve involvement- Pain in ear, side of face, teeth, jaws lower lip and mandible
Pain has at least one of the following characteristics-
sharp, superficial, or stabbing, burning pain or some abnormal sensations like crawling of worms. Typical attack comes in paroxysm of 2-4 minutes lasting for 2-20 seconds.

Signs and Symptoms

Trigeminal neuralgia pain is usually accompanied with the following signs and symptoms:

• Sudden, Severe Facial Pain
• Unilateral Pain
• Sensory Changes
• facial pain
• muscle twitching or spasms in the face
• Episodic Attacks
• triggers for pain

Precipitating factors

• cold wind
• washing face
• chewing & shaving
• touching the face
• Eating cold food

Causes

Trigeminal neuralgia is a condition characterized by severe facial pain that is often triggered by everyday activities and is caused by irritation or damage to the trigeminal nerve, one of the cranial nerves responsible for sensation in the face

• Idiopathic- are caused by compression of the trigeminal nerve close to its exit from the brainstem by an aberrant loop of artery or vein.
• Secondary causes– tumours or the demyelinating plaques of multiple sclerosis, produce similar lesions of the root entry zone of the trigeminal nerve

Management-

Medial management-

• First line drug– Carbamazepine is the drug of choice Started in low dose of 100 mg two times daily and later increased to maxium upto 800mg per day. Beyond this dose there is very little efficacy and the side effects become more prevalent.
• Second line drugs- Gabapentin, baclofen and lamotrigine are added to decrease the dose and side effects of carbamazepine.

Surgical Procedures-

• Microvascular decompression is done as a major surgery under general anaesthesia only in cases where vessel is seen compressing the trigeminal ganglion. This is a major brain surgery with major complications like excessive blood loss, loss of vision , paralysis, loss of life. One of the major side effect is inspite of this big surgery, there may not be complete pain relief .
• Stereotactic radio surgery using gamma knife or linear accelerator- non invasive procedure.

Advanced Non Surgical treatment:

• Glycerol Rizotomy: Using glycerol will lead to chemical neurolysis of trigeminal nerve, outdated now, may cause neuritis
• Ballon compression– done as percutaneous procedure with where an inflated ballon will compress the trigeminal nerve, less side effects but the efficacy is less.
• Radiofrequency Ablation of trigeminal ganglion is done as day care procedure where the culprit nerve is identified and ablated using currents. Conventional Radiofrequency ablations are done in operation theatre using a small needle under fluoroscopic machine into a hollow called foramen ovale. Once this hollow is identified then needle is inserted and radiofrequency waves is passed using special machine called radiofrequency machines which guides the treating doctor with exact wave frequency, temperature and time. This procedure may take 30-40 minutes under sedation and the patient is conscious immediately after the procedure.

Advantages of Radiofrequency Ablations

Day Care treatment

Immediate pain relief

No major complications like surgery

Procedure can be repeated

Pain relief is more than 98 percent