Trigeminal Neuralgia

Young Bui, D.D.S.
Trigeminal Neuralgia

Young Bui	RIGEMINAL NEURALGIA (TN) is a sudden electric-shock-like pain that occurs on one side of the face and is spasmodic. The pain usually comes in short bursts, lasting for only a few seconds, and may repeat many times over the course of the day. Several attacks can follow one another within minutes. There can be periods of remission, which can last from days to years, when pain is completely absent, but without medical treatment the pain usually returns. One of the causes of TN is pressure exerted on the trigeminal nerve by a blood vessel or tumor. Another is demyelinization of the nerve in patients with multiple sclerosis. Dental and surgical procedures, injury to the face, or infections can cause physical damage to the nerve, resulting in TN. Trigeminal neuralgia pain is often triggered by certain stimuli, such as touching the face, eating, talking, or shaving. This condition affects 150 out of 1 million people worldwide. The area of facial pain is reflected according to the branch of the trigeminal nerve that is affected. Shooting pain to the eye, forehead, and nose would indicate a problem with V1, the ophthalmic branch. A V2 (maxillary) problem would send shooting pain to the upper teeth, gum and lip, the side of the nose, lower eyelid, and cheek. The lower teeth, gum, lip, and jaw are affected by V3 (mandibular). One or more of the branches can be involved at the same time. “Classic” TN Pain In classic TN as described in medical literature, the pain is extremely sharp, throbbing, and shock-like. There is no facial numbness or weakness. With classic TN pain, there are distinct periods of remission, when there is no pain at all. Classic TN generally responds well to Tegretol, an anti-convulsive drug used to treat seizure disorders. Atypical TN Pain One typical feature of TN is that it is rarely typical. For many TN patients, the condition does not conform to the symptoms of “classic” TN. In addition to the stabbing shock-like pain, many victims experience various kinds of pain that they may describe as throbbing, burning, crushing, or pulsating. For some, there are no remissions from the pain. These “atypical” forms of TN are often very difficult to treat. Diagnosis A thorough medical exam should be performed and history of symptoms taken along with medical tests to rule out any serious medical problems. These tests can include a CAT scan or MRI. In some cases, high-definition MRI angiography (MRTA) of the trigeminal nerve and the brain stem can identify where the nerve is compressed by a vein or artery but more often than not, no cause is found for the pain. If the pain is diminished with carbamazepine (Tegretol) treatment, this is a positive indicator for a diagnosis of TN. A special MRI technique, 3-D volume acquisition, performed with contrast injection, can detect 80 percent of the time whether a blood vessel pressing on the trigeminal nerve is causing TN pain. However, up to now, no medical test exists that clearly diagnoses all cases of TN. Treatment Initial treatment for TN is usually medication with carbamazepine, Tegretol® being the drug of choice. Other drugs, such as baclofen (Lioresal®), clonazepam (Klonopin®) and gabapentin (Neurontin®) are often used alone or in combination. Trileptal, a drug which was recently approved for use in the US, appears to have fewer side-effects than Tegretol and is often effective in controlling TN pain. When medication fails, surgery may be considered. This excerpt has been taken from the website facial-neuralgia.org. Please refer to that site for more information. Reference Dorweiler, Bryce D., Trigeminal Neuralgia January - March 2006
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