Trigeminal evoked potentials in patients with trigeminal neuralgia, persistent idiopathic facial pain and pain due to temporomandibular joint diorders

2008 ◽  
Vol 39 (01) ◽  
Author(s):  
M Lanz ◽  
M Ahlborn ◽  
S Dempewolf ◽  
S Bunten ◽  
A Bremerich ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Evoked Potentials ◽  
Temporomandibular Joint ◽  
Facial Pain ◽  
Persistent Idiopathic Facial Pain

Comparison of Clinical Symptoms and Magnetic Resonance Angiographic (MRA) Results in Patients with Trigeminal Neuralgia and Persistent Idiopathic Facial Pain. Medium-Term Outcome after Microvascular Decompression of Cases with Positive MRA Findings

Cephalalgia ◽  
2006 ◽  
Vol 26 (3) ◽  
pp. 266-276 ◽  
Author(s):  
A Kuncz ◽  
E Vörös ◽  
P Barzó ◽  
J Tajti ◽  
P Milassin ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Facial Pain ◽  
Clinical Symptoms ◽  
Vascular Compression ◽  
Term Outcome ◽  
Persistent Idiopathic Facial Pain ◽  
Venous Compression ◽  
Imaging Results

To evaluate whether NC could be demonstrated preoperatively, high-resolution magnetic resonance angiography (MRA) was performed in 287 consecutive patients with TN and persistent idiopathic facial pain (PIFP) on a 0.5-T and a 1-T MR unit. Depending on the clinical symptoms, the TN cases were divided into typical TN and trigeminal neuralgia with non-neuralgic interparoxysmal pain (TNWIP) groups. Microvascular decompression (MVD) was performed in 103 of the MRA-positive cases. The patients were followed up postoperatively for from 1 to 10 years. The clinical symptoms were compared with the imaging results. The value of MRA was assessed on the basis of the clinical symptoms and surgical findings. The outcome of MVD was graded as excellent, good or poor. The clinical symptoms were compared with the type of vascular compression and the outcome of MVD. The MRA image was positive in 161 (56%) of the 287 cases. There were significant differences between the clinical groups: 66.5% of the typical TN group, 47.5% of the TNWIP group and 3.4% of the PIFP group were positive. The quality of the MR unit significantly determined the ratio of positive/negative MRA results. The surgical findings corresponded with the MRA images. Six patients from the MRA-negative group were operated on for selective rhizotomy and no NC was found. Venous compression of the trigeminal nerve was observed in a significantly higher proportion in the background of TNWIP than in that of typical TN on MRA imaging (24.1% and 0.8%, respectively) and also during MVD (31.2% and 1.2%, respectively). Four years following the MVD, 69% of the patients gave an excellent, 23% a good and 8% a poor result. The rate of some kind of recurrence of pain was 20% in the typical TN and 44% in TNWIP group. The rate of recurrence was 57% when pure venous compression was present. The only patient who was operated on from the PIFP group did not react to the MVD. The clinical symptoms and preoperative MRA performed by at least a 1-T MR unit furnish considerable information, which can play a role in the planning of the treatment of TN.

Cranial neuralgias and persistent idiopathic facial pain

2020 ◽  
pp. 237-247
Author(s):  
Aydin Gozalov ◽  
Messoud Ashina ◽  
Joanna M. Zakrzewska
Keyword(s):  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Orofacial Pain ◽  
Treatment Modalities ◽  
Management Approach ◽  
Trigeminal Neuropathy ◽  
Facial Region ◽  
Persistent Idiopathic Facial Pain ◽  
Chronic Orofacial Pain

Orofacial pain is a complex problem and affects up to 7% of the population. Although trigeminal neuralgia has been considered the prime neuralgic condition in the facial region, other forms of neuropathic pain are now being more frequently recognized and require recognition and a different management approach. Many patients with chronic orofacial pain report numerous comorbidities, such as psychiatric or personality disorders, which significantly affect management. Various pain conditions present in the facial region. Some of them rarely present extra-orally (unless as radiating pain) such as atypical odontalgia or persistent dento-alveolar pain disorder and burning mouth syndrome, whereas others will present in both areas such as classical trigeminal neuralgia, post-traumatic trigeminal neuropathy, trigeminal neuropathy attributed to multiple sclerosis, and persistent idiopathic facial pain. Myofascial pain syndrome related to the muscles of mastication is very common and may also be associated with temporomandibular joint problems. Trigeminal neuralgia and the rarer glossopharyngeal neuralgia are similar in quality and characteristics with specific treatment modalities, but differ in pain location. Trigeminal neuropathic pain is caused most frequently by trauma. If no other diagnostic criteria are fulfilled, a diagnosis of persistent idiopathic facial pain is made. It is crucial for these patients to be managed by multidisciplinary teams.

scholarly journals Chronic Facial Pain: Trigeminal Neuralgia, Persistent Idiopathic Facial Pain, and Myofascial Pain Syndrome—An Evidence-Based Narrative Review and Etiological Hypothesis

2020 ◽  
Vol 17 (19) ◽  
pp. 7012
Author(s):  
Robert Gerwin
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Myofascial Pain ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Adverse Outcomes ◽  
Neck Muscle ◽  
Neurovascular Compression ◽  
Persistent Idiopathic Facial Pain ◽  
Possible Cause

Trigeminal neuralgia (TN), the most common form of severe facial pain, may be confused with an ill-defined persistent idiopathic facial pain (PIFP). Facial pain is reviewed and a detailed discussion of TN and PIFP is presented. A possible cause for PIFP is proposed. (1) Methods: Databases were searched for articles related to facial pain, TN, and PIFP. Relevant articles were selected, and all systematic reviews and meta-analyses were included. (2) Discussion: The lifetime prevalence for TN is approximately 0.3% and for PIFP approximately 0.03%. TN is 15–20 times more common in persons with multiple sclerosis. Most cases of TN are caused by neurovascular compression, but a significant number are secondary to inflammation, tumor or trauma. The cause of PIFP remains unknown. Well-established TN treatment protocols include pharmacotherapy, neurotoxin denervation, peripheral nerve ablation, focused radiation, and microvascular decompression, with high rates of relief and varying degrees of adverse outcomes. No such protocols exist for PIFP. (3) Conclusion: PIFP may be confused with TN, but treatment possibilities differ greatly. Head and neck muscle myofascial pain syndrome is suggested as a possible cause of PIFP, a consideration that could open new approaches to treatment.

scholarly journals Trigeminal neuralgia and persistent idiopathic facial pain

2012 ◽  
pp. 76-87
Author(s):  
Mark Obermann ◽  
Dagny Holle ◽  
Zaza Katsarava
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Persistent Idiopathic Facial Pain ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Epidemiologic Evidence ◽  
Clinical Investigations ◽  
Background Pain ◽  
The Face ◽  
Underlying Pathophysiology

Trigeminal neuralgia (TN) and persistent idiopathic facial pain (PIFP) are two of the most puzzling orofacial pain conditions and affected patients often are very difficult to treat. TN is characterized by paroxysms of brief but crucial pain, followed by asymptomatic periods without pain. In some patients a constant dull background pain may persist. This constant dull pain sometimes makes the distinction from PIFP difficult. PIFP is defined as continuous facial pain, typically localized in a circumscribed area of the face, which is not accompanied by any neurological or other lesion identified by clinical examination or clinical investigations. The pain usually does not stay within the usual anatomic boundaries of the trigeminal nerve distribution and is a diagnosis of exclusion. Epidemiologic evidence on TN and even more so on PIFP is quite scarce, but generally both conditions are considered to be rare diseases. The aetiology and underlying pathophysiology of TN and more so PIFP remain unknown. Treatment is based on only few randomized controlled clinical trials and insufficiently evaluated surgical procedures.

scholarly journals Differential Diagnostics of Pain in the Course of Trigeminal Neuralgia and Temporomandibular Joint Dysfunction

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
M. Pihut ◽  
M. Szuta ◽  
E. Ferendiuk ◽  
D. Zeńczak-Więckiewicz
Keyword(s):  
Trigeminal Neuralgia ◽  
Temporomandibular Joint ◽  
Facial Pain ◽  
Differential Diagnostics ◽  
Complex Nature ◽  
Neurogenic Pain ◽  
Temporomandibular Joint Dysfunction ◽  
Medical Specialties ◽  
History Of ◽  
Vascular Pain

Chronic oral and facial pain syndromes are an indication for intervention of physicians of numerous medical specialties, while the complex nature of these complaints warrants interdisciplinary diagnostic and therapeutic approach. Oftentimes, lack of proper differentiation of pain associated with pathological changes of the surrounding tissues, neurogenic pain, vascular pain, or radiating pain from idiopathic facial pain leads to improper treatment.The objective of the paperis to provide detailed characterization of pain developing in the natural history of trigeminal neuralgia and temporomandibular joint dysfunction, with particular focus on similarities accounting for the difficulties in diagnosis and treatment as well as on differences between both types of pain. It might seem that trigeminal neuralgia can be easily differentiated from temporomandibular joint dysfunction due to the acute, piercing, and stabbing nature of neuralgic pain occurring at a single facial location to spread along the course of the nerve on one side, sometimes a dozen or so times a day, without forewarning periods. Both forms differ significantly in the character and intensity of pain. The exact analysis of the nature, intensity, and duration of pain may be crucial for the differential diagnostics of the disorders of our interest.

scholarly journals Peripheral nerve field stimulation for trigeminal neuralgia, trigeminal neuropathic pain, and persistent idiopathic facial pain

Cephalalgia ◽  
2015 ◽  
Vol 36 (5) ◽  
pp. 445-453 ◽  
Author(s):  
Johann Klein ◽  
Sahr Sandi-Gahun ◽  
Gabriele Schackert ◽  
Tareq A Juratli
Keyword(s):  
Trigeminal Neuralgia ◽  
Peripheral Nerve ◽  
Facial Pain ◽  
Symptom Duration ◽  
Field Stimulation ◽  
Trigeminal Neuropathy ◽  
Persistent Idiopathic Facial Pain ◽  
Constant Pain ◽  
Classical Trigeminal Neuralgia ◽  
Peripheral Nerve Field Stimulation

Objective Peripheral nerve field stimulation (PNFS) is a promising modality for treatment of intractable facial pain. However, evidence is sparse. We are therefore presenting our experience with this technique in a small patient cohort. Methods Records of 10 patients (five men, five women) with intractable facial pain who underwent implantation of one or several subcutaneous electrodes for trigeminal nerve field stimulation were retrospectively analyzed. Patients’ data, including pain location, etiology, duration, previous treatments, long-term effects and complications, were evaluated. Results Four patients suffered from recurrent classical trigeminal neuralgia, one had classical trigeminal neuralgia and was medically unfit for microvascular decompression. Two patients suffered from trigeminal neuropathy attributed to multiple sclerosis, one from post-herpetic neuropathy, one from trigeminal neuropathy following radiation therapy and one from persistent idiopathic facial pain. Average patient age was 74.2 years (range 57–87), and average symptom duration was 10.6 years (range 2–17). Eight patients proceeded to implantation after successful trial. Average follow-up after implantation was 11.3 months (range 5–28). Using the visual analog scale, average pain intensity was 9.3 (range 7–10) preoperatively and 0.75 (range 0–3) postoperatively. Six patients reported absence of pain with stimulation; two had only slight constant pain without attacks. Conclusion PNFS may be an effective treatment for refractory facial pain and yields high patient satisfaction.

Facial Pain: A Review of 200 Cases Treated with Acupuncture

1995 ◽  
Vol 13 (2) ◽  
pp. 110-111 ◽  
Author(s):  
Nazim Merchant
Keyword(s):  
Visual Analogue Scale ◽  
Trigeminal Neuralgia ◽  
Small Group ◽  
Temporomandibular Joint ◽  
Facial Pain ◽  
Analogue Scale ◽  
Response Rates ◽  
Considerable Improvement ◽  
Full Recovery ◽  
Muscular Pain

A group of 201 patients who had received acupuncture for chronic facial pain during the last 10 years was reviewed. Of patients with temporomandibular joint or muscular pain, 46% claimed full recovery after acupuncture and 61% reported benefit. In trigeminal neuralgia there was a 30.8% claim of considerable improvement with a 69.2% overall benefit. It was felt that greater accuracy in interpreting response rates would result from the use of a visual analogue scale to record pain; so this was assessed in a small group, in which 75% showed improvement after acupuncture.

Prevalence of trigeminal neuralgia and persistent idiopathic facial pain: A population-based study

Cephalalgia ◽  
2011 ◽  
Vol 31 (15) ◽  
pp. 1542-1548 ◽  
Author(s):  
Daniel Mueller ◽  
Mark Obermann ◽  
Min-Suk Yoon ◽  
Franziska Poitz ◽  
Niels Hansen ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Population Based ◽  
Lifetime Prevalence ◽  
Population Based Study ◽  
Phone Interview ◽  
Face To Face ◽  
Persistent Idiopathic Facial Pain ◽  
Thin Slice ◽  
Cranial Mri

Objective: To estimate the lifetime prevalence of trigeminal neuralgia (TN) and persistent idiopathic facial pain (PIFP) in a population-based sample in Germany. Methods: A total of 3336 responders of 6000 contacted inhabitants of the city of Essen in Germany were screened using a self-assessment questionnaire. 327 individuals, who reported recurrent facial pain and randomly selected 150 (5% of 3009) screening negative subjects, received a phone interview by one of six neurologists and if necessary a face-to-face examination. Those with suspected TN or PIFP following the phone interview underwent neurological examination by two neurologists who were unaware of the presumed diagnosis. A random group of 25 (10% of 247) phone interview negative subjects was examined face-to-face. All suspected cases of PIFP received otorhinolaryngological examination and diagnostic cranial magnetic resonance imaging (MRI). In TN patients the number of vessel-nerve contacts was determined by thin-slice cranial MRI. Results: Lifetime prevalence of TN was estimated to be 0.3% [10 of 3336; 95% CI 0.1–0.5%], of PIFP 0.03% [1 of 3336; 95% CI < 0.08%]. Thin-slice cranial MRI detected five vessel-nerve contacts and no symptomatic lesions in the 10 TN patients. Conclusions: This large population-based study revealed that TN and PIFP are rare facial pain disorders.

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