HISTORICAL CHARACTERIZATION OF TRIGEMINAL NEURALGIA

Neurosurgery ◽  
2009 ◽  
Vol 64 (6) ◽  
pp. 1183-1187 ◽  
Author(s):  
Paula Eboli ◽  
James L. Stone ◽  
Sabri Aydin ◽  
Konstantin V. Slavin
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
John Locke ◽  
Neurovascular Compression ◽  
Ancient Greek ◽  
The Past ◽  
John Hunter ◽  
The Face ◽  
Neurological Surgeon

Abstract TRIGEMINAL NEURALGIA IS a well known clinical entity characterized by agonizing, paroxysmal, and lancinating facial pain, often triggered by movements of the mouth or eating. Historical reviews of facial pain have attempted to describe this severe pain over the past 2.5 millennia. The ancient Greek physicians Hippocrates, Aretaeus, and Galen, described kephalalgias, but their accounts were vague and did not clearly correspond with what we now term trigeminal neuralgia. The first adequate description of trigeminal neuralgia was given in 1671, followed by a fuller description by physician John Locke in 1677. André described the convulsive-like condition in 1756, and named it tic douloureux; in 1773, Fothergill described it as “a painful affection of the face;” and in 1779, John Hunter more clearly characterized the entity as a form of “nervous disorder” with reference to pain of the teeth, gums, or tongue where the disease “does not reside.” One hundred fifty years later, the neurological surgeon Walter Dandy equated neurovascular compression of the trigeminal nerve with trigeminal neuralgia.

Idiopathic Trigeminal Neuralgia: A Case Report

2018 ◽  
Vol 31 (04) ◽  
pp. 254-258
Author(s):  
Shruti Jain ◽  
Chetna Lamba
Keyword(s):  
Case Report ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Conventional Medicine ◽  
Positive Role ◽  
Idiopathic Trigeminal Neuralgia ◽  
Adequate Pain Relief ◽  
The Face

AbstractTrigeminal neuralgia (TN) is the most frequent type of neuropathic facial pain affecting one or more branches of trigeminal nerve. Here, a 51-year-old woman diagnosed with idiopathic trigeminal neuralgia (ITN) presented with complaints of pain over right side of the face with redness of the eyes and excessive lachrymation since 5 years with weekly acute episodes of shooting pain. Chelidonium was chiefly prescribed followed by few doses of Spigelia as per indications which provided adequate pain relief. The complaints flared up following stressful circumstances for which Pulsatilla was prescribed after detailed case taking. The frequency, duration and intensity of pain reduced after homoeopathic treatment. The need for conventional medicine was also reduced. This suggests positive role of individualised homoeopathy in the treatment of ITN. Further studies should be undertaken to evaluate the role of homoeopathy in ITN.

Trigeminal Neuralgia

2018 ◽  
Author(s):  
Jumana T. Alshaikh ◽  
Shaan Sudhakaran ◽  
Helene Rubeiz
Keyword(s):  
Trigeminal Neuralgia ◽  
Age Of Onset ◽  
Neurovascular Compression ◽  
First Line ◽  
Risks And Benefits ◽  
Female Predominance ◽  
Structural Abnormalities ◽  
The Face ◽  
Physical Stimuli ◽  
Sixth Decade

Trigeminal neuralgia is characterized by severe, unilateral, paroxysmal stabbing pain affecting the face in the distribution of one of the divisions of the trigeminal nerve. The episodes of pain are brief and are triggered by innocuous physical stimuli. Typical age of onset is the sixth decade, with a female predominance. The most common cause is neurovascular compression. Other causes include multiple sclerosis and structural abnormalities in the cerebellopontine angle. The diagnosis is made clinically, but MRI can be useful in evaluation of the underlying etiology. First-line pharmacotherapy is carbamazepine or oxcarbazepine. If medical therapy fails, procedural interventions should be considered. From ablations to craniotomy, there is an array of procedural treatments available for trigeminal neuralgia. Patients should be educated on the risks and benefits of each procedure prior to pursuing treatment.

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 Comparison of Trigeminal and Postherpetic Neuralgia

1996 ◽  
Vol 1 (2) ◽  
pp. 125-129
Author(s):  
C Peter N Watson
Keyword(s):  
Trigeminal Neuralgia ◽  
Postherpetic Neuralgia ◽  
Facial Pain ◽  
Tic Douloureux ◽  
Common Causes ◽  
The Face ◽  
Lancinating Pain

Although postherpetic neuralgia and trigeminal neuralgia (tic douloureux) are common causes of facial pain, they have very little in common aside from lancinating pain (other qualities of pain in each disorder are different). Each disorder affects different areas of the face and the treatment of each is quite dissimilar. The pathogenesis of these two disorders quite likely involves different mechanisms. This report reviews aspects of these two difficult pain problems, particularly with reference to the work of the late Gerhard Fromm, to whom this is dedicated.

Radiographic evaluation of trigeminal neurovascular compression in patients with and without trigeminal neuralgia

2009 ◽  
Vol 110 (4) ◽  
pp. 627-632 ◽  
Author(s):  
Jonathan P. Miller ◽  
Feridun Acar ◽  
Bronwyn E. Hamilton ◽  
Kim J. Burchiel
Keyword(s):  
Trigeminal Neuralgia ◽  
Odds Ratio ◽  
Facial Pain ◽  
Radiographic Evaluation ◽  
Fisher Exact Test ◽  
Neurovascular Compression ◽  
Exact Test ◽  
Asymptomatic Patients ◽  
The Difference ◽  
Trigeminal Nerves

Object Neurovascular compression (NVC) of the trigeminal nerve is associated with trigeminal neuralgia (TN), but also occurs in many patients without facial pain. This study is designed to identify anatomical characteristics of NVC associated with TN. Methods Thirty patients with Type 1 TN (intermittent shocklike pain) and 15 patients without facial pain underwent imaging for analysis of 30 trigeminal nerves ipsilateral to TN symptoms, 30 contralateral to TN symptoms, and 30 in asymptomatic patients. Patients underwent 3-T MR imaging including balanced fast-field echo and MR angiography. Images were fused and reconstructed into virtual cisternoscopy images that were evaluated to determine the presence and degree of NVC. Reconstructed coronal images were used to measure nerve diameter and crosssectional area. Results The incidence of arterial NVC in asymptomatic nerves, nerves contralateral to TN symptoms, and nerves ipsilateral to TN symptoms was 17%, 43%, and 57%, respectively. The difference between symptomatic and asymptomatic nerves was significant regarding the presence of NVC, nerve distortion, and the site of compression (p < 0.001, Fisher exact test). The most significant predictors of TN were compression of the proximal nerve (odds ratio 10.4) and nerve indentation or displacement (odds ratio 4.3). There was a tendency for the development of increasingly severe nerve compression with more advanced patient age across all groups. Decreased nerve size was observed in patients with TN but did not correlate with the presence or extent of NVC. Conclusions Trigeminal NVC occurs in asymptomatic patients but is more severe and more proximal in patients with TN. This information may help identify patients who are likely to benefit from microvascular decompression.

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 Trigeminal Neuralgy

2018 ◽  
Vol 1 (4) ◽  
pp. 353-358
Author(s):  
Bélgica Vásquez
Keyword(s):  
Surgical Treatment ◽  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Relevant Information ◽  
Detailed Knowledge ◽  
Neurovascular Compression ◽  
Present Information ◽  
Facial Area

The objective of this review was to present information on the main causes, possible treatments and morpho-quantitative aspects of trigeminal neuralgia. Trigeminal neuralgia is a condition characterized by intense facial pain, severe throbbing or stabbing; it is usually unilateral and recurrent and is located in the facial area innervated by the trigeminal nerve. The causes of this disease are varied and include neurovascular compression stresses. Medical treatment of choice is carbamazepine, reserving surgical treatment for cases resistant to medical therapy or cases when side effects of drugs used, outweigh the risks and disadvantages of surgery. In this context a detailed knowledge of the structure of the trigeminal nerve and its morphoquantitative characteristics could provide relevant information to make type of treatment more effective.

scholarly journals Burden of illness of trigeminal neuralgia among patients managed in a specialist center in England

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Lasair O’Callaghan ◽  
Lysbeth Floden ◽  
Lisa Vinikoor-Imler ◽  
Tara Symonds ◽  
Kathryn Giblin ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Burden Of Illness ◽  
Care Pathway ◽  
Pain Interference ◽  
Cross Sectional Survey ◽  
The Past ◽  
Patient Reported ◽  
Specialist Center ◽  
The Impact

Abstract Background Trigeminal neuralgia (TN) causes severe episodic, unilateral facial pain and is initially treated with antiepileptic medications. For patients not responding or intolerant to medications, surgery is an option. Methods In order to expand understanding of the pain-related burden of illness associated with TN, a cross-sectional survey was conducted of patients at a specialist center that utilizes a multidisciplinary care pathway. Participants provided information regarding their pain experience and treatment history, and completed several patient-reported outcome (PRO) measures. Results Of 129 respondents, 69/128 (54%; 1 missing) reported no pain in the past 4 weeks. However, 84 (65%) respondents were on medications, including 49 (38%) on monotherapy and 35 (27%) on polytherapy. A proportion of patients had discontinued at least one medication in the past, mostly due to lack of efficacy (n = 62, 48%) and side effects (n = 51, 40%). A total of 52 (40%) patients had undergone surgery, of whom 30 had microvascular decompression (MVD). Although surgery, especially MVD, provided satisfactory pain control in many patients, 29% of post-surgical patients reported complications, 19% had pain worsen or stay the same, 48% were still taking pain medications for TN, and 33% reported new and different facial pain. Conclusions In most PRO measures, respondents with current pain interference had poorer scores than those without pain interference. In the Patient Global Impression of Change, 79% expressed improvement since beginning of treatment at this clinic. These results indicate that while the multidisciplinary approach can substantially alleviate the impact of TN, there remains an unmet medical need for additional treatment options.

scholarly journals Complications of Endoscope-Assisted Microvascular Decompression for Trigeminal Neuralgia- An Evaluation of 300 Consecutive Patients

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Alexandra D Baker ◽  
Melvin Field
Keyword(s):  
Hearing Loss ◽  
Adverse Events ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Facial Pain ◽  
Retrospective Chart Review ◽  
Adverse Outcomes ◽  
Surrounding Tissue ◽  
Cerebrospinal Fluid Leakage ◽  
Neurovascular Compression

Abstract INTRODUCTION Trigeminal Neuralgia (TGN) is a horrific facial pain disorder that is paroxysmal, stabbing, shooting pain that affects the face due to compression of the trigeminal nerve. Literature has suggested that the use of an endoscope for microvascular decompression (eMVD), as opposed to a microscope alone, is more likely to identify the source of neurovascular compression and ensure that the nerve is adequately decompressed. MVD for TGN is successful in many patients however, this procedure still occasionally results in hearing loss, cerebellar injury, double vision, infection, dysesthesias, unresolved TGN facial pain, and cerebrospinal fluid leakage. Many of these adverse outcomes are a result of inadvertent damage to surrounding tissue from the surgical tools. Because eMVD requires less retraction, offers better visualization, and is less invasive it seems to be a promising technique in the surgical management of TGN. METHODS This retrospective chart review aims to explore the efficacy of eMVD for TGN by studying rates of adverse events and comparing them to the literature using descriptive statistics. This is the largest study to date evaluating complications associated with eMVD for TGN. RESULTS In this cohort, adverse events include facial numbness (4.3%), dizziness (0.4%), ataxia (0.4%), diplopia (1.9%), infection (0.8%), spinal fluid leak (0.4%), stroke (0.4%), and chronic headaches (0.8%). There were no cases of facial paralysis, hearing loss, or dysphagia. CONCLUSION Despite 2D visualization with the endoscope, neurologic injury does not appear to be any higher than with traditional 3D MVD and is safe in this patient population. The endoscope seems to be a very efficacious tool for TGN. In the literature for traditional MVD rates of adverse events are not consistent. In this cohort of patients, the rates of adverse events seem to be lower or similar to MVD. Regardless of technique, this surgery has low rates of complications so researchers should continue to monitor adverse outcomes to explore significant trends.

Posterior Fossa Exploration for Trigeminal Neuralgia Patients Older Than 70 Years of Age

Neurosurgery ◽  
2011 ◽  
Vol 69 (6) ◽  
pp. 1255-1260 ◽  
Author(s):  
Bruce E. Pollock ◽  
Kathy J. Stien
Keyword(s):  
Pain Relief ◽  
Postoperative Complications ◽  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Basilar Artery ◽  
Facial Pain ◽  
Neurovascular Compression ◽  
Recurrent Pain ◽  
Additional Surgery ◽  
Pain Outcomes

Abstract BACKGROUND Patients with medically unresponsive trigeminal neuralgia (TN) who are &gt;70 years of age often undergo operations that typically provide pain relief for &lt;5 years despite having a life expectancy that can exceed 15 years. OBJECTIVE To review the safety and efficacy of posterior fossa exploration (PFE) for TN patients &lt; 70 years of age. METHODS From 1999 to 2009, 67 TN patients &gt;70 years of age (median, 74 years) underwent a PFE. Thirty-seven patients (55%) had failed ≥1 prior surgeries (median, 2). Fifty-nine patients (88%) had a microvascular decompression, and 8 patients (12%) underwent a partial sensory rhizotomy. Follow-up (median, 40 months) was censored at the time of last contact (n = 51), additional surgery (n = 12), or death (n = 4). RESULTS Complete pain relief (no pain, no medications) was 87% at 1 year and 78% at 5 years. Facial pain outcomes did not correlate with patient age, sex, prior surgery, or pain duration. Postoperative complications were noted in 10 patients (15%) and included ataxia (10%), hearing loss (5%), trigeminal dysesthesias (5%), facial weakness (3%), aseptic meningitis (2%), and pulmonary embolus (2%). Factors associated with postoperative complications were prior PFE (P = .01) and neurovascular compression from a dolicoectatic basilar artery (P = .03). CONCLUSION Posterior fossa exploration is safe and effective for physiologically healthy TN patients &gt;70 years of age. It should be deferred in older patients with TN secondary to a dolicoectatic basilar artery and patients who have persistent/recurrent pain after a previous PFE unless simpler procedures prove ineffective at controlling their facial pain.

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