What is trigeminal neuralgia?

Trigeminal neuralgia is a painful neuropathic condition affecting the nerves in the face, specifically the trigeminal nerve.  The trigeminal nerves are responsible for pressure, temperature, and pain, meaning that any injury or disorder in the tissue surrounding the nerves will cause a variety of pain.  The trigeminal nerve is also responsible for the motor function of chewing, meaning trigeminal neuralgia can impair one’s ability to chew food.

Three major branches come off the trigeminal nerve. All of which can be involved in trigeminal neuralgia.  They are the maxillary nerve, which is the sensory nerve, the ophthalmic nerve, and the mandibular nerve. The mandibular nerve affects nearly all parts of the face. Trigeminal neuralgia is extremely painful and only affects around 1 in 15,000 people, though misdiagnosis may mean the number is probably much higher.  Pain occurs in the eyes, ears, lips, nose, scalp, forehead, cheeks, teeth, jaw or the entire side of the face.

Usually pain is characterized by incredibly intense shooting pain, felt in one side of the face, though occasionally (10%-12% of the time) it is felt on both sides.  This happens when two or three of the trigeminal nerves are affected.  The pain of a trigeminal neuralgia attack lasts anywhere from several seconds to several minutes and can reoccur hundreds of times throughout a day.

What causes trigeminal neuralgia?
Trigeminal neuralgia’s cause is somewhat of a mystery.  Whereas, it was formerly believed to be caused by pressure, new evidence suggests an enlarged blood vessel, the superior cerebral artery, pulsating against the trigeminal nerve and leading it to become hyperactive or sensitive. Trigeminal neuralgia  can be caused by blunt trauma to the head, such as in a car accident.  Tumors, cysts and, rarely, aneurysms, have been found to cause trigeminal neuralgia as well.  Though the exact connection is not clearly defined, a large portion of multiple sclerosis  patients suffer from trigeminal neuralgia.  Idiopathic cases, which are quite common, are defined as cases wherein no structural damage can be found.

Trigeminal Neuralgia Treatment?
Similar to many nerve-related disorders, a diagnosis can be difficult to obtain.  For this reason, many cases are misdiagnosed and treatment does not affect the cause of trigeminal neuralgia.  Evidence suggests that treating trigeminal neuralgia quickly is beneficial and prevents the disease from becoming chronic.

There are several medical options available for treating TN including:
•    The anticonvulsant medication carbamazepine
•    Lamotrigine, baclofen, sodium valproate, phenytoin, oxcarbazepine, and gabapentin
•    Amitriptyline and duloxetine.
•     Morphine and oxycodone

 

There is evidence that clonazepam is effective in treating trigeminal neuralgia, but it’s possible that it simply eases the anxiety resulting from the disease itself. Very few surgical options have been found to be effective.  There is one exception: percutaneous surgical options, where needles are used to puncture the skin.  Percutaneious surgery is especially effective in treatment of the elderly because it is minimally invasive.  Another minimally invasive procedure is glycerol injections.  Glycerol attacks  begins to corrode the nerve casing, damaging it, but thereby hindering the nerve’s functioning enough to cease its hyperactivity.

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