scholarly journals TRIGEMINAL NEURALGIA AND ITS RECENT ADVANCES

2020 ◽  
pp. 1-4
Author(s):  
R. Nithyanand
Keyword(s):  
Trigeminal Neuralgia ◽  
Medical Treatment ◽  
Sodium Channel ◽  
Clinical Investigation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Treatment Options ◽  
Gasserian Ganglion ◽  
Recent Advances ◽  
The 1960S ◽  
The Individual

Despite recent advances in understanding and treating trigeminal neuralgia, its management remains a considerable challenge. Better classification of different types of facial pain and the identification of prognostic factors for different treatment options lead the way toward better quality of life for the individual patient. Although the principles of treating trigeminal neuralgia remain basically the same, antiepileptic drugs, muscle relaxants, and neuroleptic agents are widely used medical treatment options. They were not originally developed for treating trigeminal neuralgia. Carbamazepine was studied in adequate placebo-controlled clinical trials in the 1960s and is still considered the most effective drug. Among emerging treatment options currently under clinical investigation are local botulinum neurotoxin type A injections and a novel sodium channel blocker (CNV1014802) that selectively blocks the Nav1.7 sodium channel. Non-pharmacological treatment options are non-invasive electrical stimulation with either transcranial direct-current stimulation or repetitive transcranial magnetic stimulation which both require further evaluation in regard to applicability. Surgical options remain a valid choice for patients not responding to medical treatment and include Gasserian ganglion percutaneous techniques, gamma knife surgery, and microvascular decompression. There is continual effort to improve these techniques and predict the outcome for better patient selection.

scholarly journals Recent advances in understanding/managing trigeminal neuralgia

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 505 ◽  
Author(s):  
Mark Obermann
Keyword(s):  
Trigeminal Neuralgia ◽  
Medical Treatment ◽  
Sodium Channel ◽  
Clinical Investigation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Treatment Options ◽  
Gasserian Ganglion ◽  
Recent Advances ◽  
The 1960S ◽  
The Individual

Despite recent advances in understanding and treating trigeminal neuralgia, its management remains a considerable challenge. Better classification of different types of facial pain and the identification of prognostic factors for different treatment options lead the way toward better quality of life for the individual patient. Although the principles of treating trigeminal neuralgia remain basically the same, antiepileptic drugs, muscle relaxants, and neuroleptic agents are widely used medical treatment options. They were not originally developed for treating trigeminal neuralgia. Carbamazepine was studied in adequate placebo-controlled clinical trials in the 1960s and is still considered the most effective drug. Among emerging treatment options currently under clinical investigation are local botulinum neurotoxin type A injections and a novel sodium channel blocker (CNV1014802) that selectively blocks the Nav1.7 sodium channel. Non-pharmacological treatment options are non-invasive electrical stimulation with either transcranial direct-current stimulation or repetitive transcranial magnetic stimulation which both require further evaluation in regard to applicability. Surgical options remain a valid choice for patients not responding to medical treatment and include Gasserian ganglion percutaneous techniques, gamma knife surgery, and microvascular decompression. There is continual effort to improve these techniques and predict the outcome for better patient selection.

scholarly journals Microvascular Decompression for Trigeminal Neuralgia: Our Experiences at Bir Hospital

2017 ◽  
Vol 14 (2) ◽  
pp. 3-7
Author(s):  
Gopal R Sharma ◽  
Rajiv Jha ◽  
Prakash Poudel ◽  
Dhrub R Adhikari ◽  
Prakash Bista
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Medical Treatment ◽  
Treatment Options ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Recurrent Pain ◽  
Cerebellar Artery

Trigeminal neuralgia (TGN) is a very peculiar disease, mostly characterized by unilateral paroxysmal facial pain, often described by patient as ‘one of the worst pain in my life’. This condition is also known as ‘Tic Douloureus’. The annual incidence of TN is about 4.7/100000 population, male and female are equally affected. The diagnosis is usually made by history, clinical fi ndings and cranial imaging is required to rule out compressing vascular loop, organic lesions and Multiple Sclerosis (MS) at Trigeminal nerve (TN). Treatment of TGN ranged from medical to surgical intervention. Between September 2007 and April 2015, 20 patients underwent micro vascular decompression (MVD) of TN for TGN who were refractory to medical treatment at department of Neurosurgery, Bir Hospital. All decompressions were performed using operating microscope. Follow up period ranged from 22 months to 8 years.There were 9 males and 11 females and age ranged from 30-70 years. The neuralgic pain was localized on right side in 13 patients and left on 7 patients. Pain distribution was on V3 (mandibular branch) dermatome in 11, V2( Maxillary branch ) in 4, V2-3 in 2 and V1- 2-3 in 3 patients respectively. On intraoperative fi ndings TN was compressed by superior cerebellar artery ( SCA ) in 8, tumors in 4, unidentifi ed vessels in 3, veins in 2, anterior inferior cerebellar artery ( AICA ) in 1 and no cause was found in 2 patients. 7 patients suffered postoperative complications which included hyposthesia in 3, pseudomeningocele in 3 and meningitis in 1. There was no mortality in this series. 20 patients felt pain relief immediately after procedure and 1 patients came after 3 years with recurrent pain requiring second surgery. In conclusion, MVD for TGN in younger patients who are refractory to medical treatment is one of the best treatment options which is safe and long term pain relief is achieved in majority of cases.Nepal Journal of Neuroscience, Vol. 14, No. 2,  2017 Page:11-15

scholarly journals Personalised approaches to pharmacotherapy for schizophrenia

2016 ◽  
Vol 22 (2) ◽  
pp. 78-86 ◽  
Author(s):  
John Lally ◽  
James H. MacCabe
Keyword(s):  
Medical Treatment ◽  
Antipsychotic Medication ◽  
Traditional Approach ◽  
Personalised Medicine ◽  
Individual Characteristics ◽  
Response To Treatment ◽  
Individual Response ◽  
Trial And Error ◽  
Recent Advances ◽  
The Individual

SummaryThe traditional approach to selecting antipsychotic medication involves little more than trial and error. Recent advances in genetics and molecular science offer the hope of a ‘personalised medicine’ approach to antipsychotic development and prescribing in schizophrenia. Personalised medicine is the practice of tailoring medical treatment to the individual characteristics of each patient. In schizophrenia, this will involve the identification of more homogeneous subsets of patients through the application of genetics, epigenetics, proteomics and metabolomics, neuroimaging and other biomarkers, and the use of these findings to stratify patients according to their response to treatment. In this article, we focus on the emerging evidence in pharmacogenetics and biomarkers for assessing individual response and tolerability of antipsychotic medication in schizophrenia.

scholarly journals Peripheral Nerve Pulsed Radiofrequency For Trigeminal Neuralgia Treatment: Is It An Effective Method?

2021 ◽  
Author(s):  
Tuba Tanyel ◽  
Ayten Bilir ◽  
Sacit Gulec
Keyword(s):  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Medical Treatment ◽  
Trigeminal Nerve ◽  
Treatment Options ◽  
Percutaneous Technique ◽  
Pulsed Radiofrequency ◽  
Safe Method ◽  
Duration Of Efficacy ◽  
Effect Duration

Abstract ObjectiveTrigeminal neuralgia is a paroxysmal and shock-like pain in the trigeminal nerve area. Various treatment options have been used for trigeminal neuralgia such as medical treatment, interventional procedures and surgical operations. Pulsed radiofrequency (PRF) is a minimally invasive percutaneous technique which seems to be safer and easier to perform.This retrospective study aims to evaluate the analgesic effect, duration of efficacy and side effects of PRF procedures in the peripheral branches of the trigeminal nerve.Methods and MaterialThe data of the patients with trigeminal neuralgia who were followed up in our hospital's algology clinic from 2016 to 2018 were reviewed retrospectively. Patients aged between 18-70 who didn’t respond to medical treatment or couldn’t use medication due to side effects, were treated with PRF procedure for peripheral branches of trigeminal nerve were selected for this study. Demographic profile, clicinal presentation, pain intensity, duration of efficacy and complications were evaluated from their files.Results21 patients who underwent ultrasonography (USG) guided PRF procedures were included the study.Mean visual analog scale (VAS) value of the patients was found to have decreased from 9.25 ± 0.63 to 1.55 ± 0.88 at the end of the first month (p<0.001). The painless period for the patients lasted up to 12 (9-21) months and no complications occurred.ConclusionPRF procedure seems to be an effective and safe method in patients who respond to block of the peripheral branches of the trigeminal nerve.Key message: The use of pulsed radiofrequency method for the treatment of trigeminal neuralgia seems to be an effective and safe method. In addition, being easily applicable and repeatable is another advantage of the method.

Clinical Biomechanics: Contributions to the Medical Treatment of Physical Abnormalities

2012 ◽  
Vol 1 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Joseph Hamill ◽  
George Gorton ◽  
Peter Masso
Keyword(s):  
Cerebral Palsy ◽  
Medical Treatment ◽  
Treatment Outcomes ◽  
Clinical Assessment ◽  
Treatment Options ◽  
Three Dimensional ◽  
Structure And Function ◽  
Diverse Field ◽  
The Individual ◽  
And Function

Biomechanics is defined as the application of the laws of mechanics to the study or structure and function of movement. It is a relatively new subdiscipline to the domain of kinesiology. Biomechanics was initially closely associated with the study of sports technique. However, over the years, biomechanics has taken on a much more diverse field of study. In this paper, we will describe the contributions that biomechanics has made to the area of clinical biomechanics research in terms of clinical assessment and outcomes and the design of clinical apparatus. The first example examines a clinical assessment of a cerebral palsy child. The goals of such a clinical assessment are 1) to determine the primary problems with the locomotion capabilities of the individual, 2) to recommend treatment options, and 3) to evaluate treatment outcomes. In the second example, a procedure is described for designing braces for scoliosis patients. For this example, a three-dimensional digital twin is developed using a scanning technique. This example illustrates the research conducted on developing a technique to noninvasively and safely determine the torso deformities resulting from scoliosis. While these examples are but two of a wide variety of examples that could be used, they illustrate the contribution of biomechanics to the clinical world.

Trigeminal Neuralgia: Role of Interventional Pain Physician

2019 ◽  
Vol 11 (1) ◽  
pp. 73-77
Author(s):  
Chandra Shekhar Karmakar ◽  
Md Lutfor Rahman ◽  
Md Shahidul Islam ◽  
Atidh Muhammad Molla ◽  
Monirul Islam ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Treatment Options ◽  
Vascular Compression ◽  
Gasserian Ganglion ◽  
Invasive Treatment ◽  
Provide Pain Relief ◽  
Lancinating Pain ◽  
Glycerol Rhizolysis ◽  
Neural Discharge

Trigeminal neuralgia (TN) or tic douloureux is one of the commonest cause of fascial pain after 50 years of age. It is characterized by recurrent, episodic, lancinating pain over the distribution of trigeminal nerve. There is a lack of certainty regarding the aetiology and pathophysiology of TN. Evidence suggests that the likely etiology is vascular compression of the trigeminal nerve leading to focal demyelination and aberrant neural discharge. Secondary causes such as multiple sclerosis or brain tumors can also produce symptomatic TN. The treatment of TN can be very challenging despite the numerous options patients and physicians can choose from. This multitude of treatment options poses the question as to which treatment fits which patient best. For patients refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma knife surgery and microvascular decompression are the most promising invasive treatment options. Among them three common interventions commonly carried out by interventional pain physician to provide pain relief are balloon compression, Glycerol rhizolysis and RF rhizotomy. J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 73-77

scholarly journals Feasibility of Multiple Repeat Gamma Knife Radiosurgeries for Trigeminal Neuralgia: A Case Report and Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Guy C. Jones ◽  
Ameer L. Elaimy ◽  
John J. Demakas ◽  
Hansi Jiang ◽  
Wayne T. Lamoreaux ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Pain Control ◽  
Radiation Treatment ◽  
Treatment Options ◽  
Gamma Knife Radiosurgery ◽  
Treatment Modalities ◽  
Small Subset ◽  
The Individual ◽  
Surgical Treatments

Treatment options for trigeminal neuralgia (TN) must be customized for the individual patient, and physicians must be aware of the medical, surgical, and radiation treatment modalities to prescribe optimal treatment courses for specific patients. The following case illustrates the potential for gamma knife radiosurgery (GKRS) to be repeated multiple times for the purpose of achieving facial pain control in cases of TN that have been refractory to other medical and surgical options, as well as prior GKRS. The patient described failed to achieve pain control with initial GKRS, as well as medical and surgical treatments, but experienced significant pain relief for a period of time with a second GKRS procedure and later underwent a third procedure. Only a small subset of patients have reportedly undergone more than two GKRS for TN; thus, further research and long-term clinical followup will be valuable in determining its usefulness in specific clinical situations.

scholarly journals Trigeminal Neuralgia: Basic and Clinical Aspects

2020 ◽  
Vol 18 (2) ◽  
pp. 109-119
Author(s):  
Erika Ivanna Araya ◽  
Rafaela Franco Claudino ◽  
Elcio Juliato Piovesan ◽  
Juliana Geremias Chichorro
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Treatment Options ◽  
Cranial Nerves ◽  
Sensory Innervation ◽  
Clinical Aspects ◽  
Neurovascular Compression ◽  
Drug Of Choice ◽  
Root Entry Zone ◽  
The 1960S

The trigeminal nerve is the largest of all cranial nerves. It has three branches that provide the main sensory innervation of the anterior two-thirds of the head and face. Trigeminal neuralgia (TN) is characterized by sudden, severe, brief, and stabbing recurrent episodes of facial pain in one or more branches of the trigeminal nerve. Pain attacks can occur spontaneously or can be triggered by non-noxious stimuli, such as talking, eating, washing the face, brushing teeth, shaving, a light touch or even a cool breeze. In addition to pain attacks, a proportion of the patients also experience persistent background pain, which along with autonomic signs and prolonged disease duration, represent predictors of worse treatment outcomes. It is now widely accepted that the presence of a neurovascular compression at the trigeminal root entry zone is an anatomic abnormality with a high correlation with classical TN. However, TN may be related to other etiologies, thus presenting different and/or additional features. Since the 1960s, the anticonvulsant carbamazepine is the drug of choice for TN treatment. Although anti-epileptic drugs are commonly used to treat neuropathic pain in general, the efficacy of carbamazepine has been largely limited to TN. Carbamazepine, however, is associated with dose-limiting side-effects, particularly with prolonged usage. Thus, a better understanding and new treatment options are urgently warranted for this rare, but excruciating disease.

Michel Foucault and Western Medicine

2019 ◽  
Vol 29 (2) ◽  
pp. 64-81
Keyword(s):  
Western Medicine ◽  
18Th Century ◽  
Medical Knowledge ◽  
Social Medicine ◽  
Western Society ◽  
1960S And 1970S ◽  
The Veil ◽  
The 1960S ◽  
The Individual ◽  
The 19Th Century

The article analyzes Michel Foucault’s philosophical ideas on Western medicine and delves into three main insights that the French philosopher developed to expose the presence of power behind the veil of the conventional experience of medicine. These insights probe the power-disciplining function of psychiatry, the administrative function of medical institutions, and the role of social medicine in the administrative and political system of Western society. Foucault arrived at theses insights by way of his intense interest in three elements of the medical system that arose almost simultaneously at the end of the 18th century - psychiatry as “medicine for mental illness”, the hospital as the First and most well-known type of medical institution, and social medicine as a type of medical knowledge focused more on the protection of society and far less on caring for the individual. All the issues Foucault wrote about stemmed from his personal and professional sensitivity to the problems of power and were a part of the “medical turn” in the social and human sciences that occurred in the West in the 1960s and 1970s and led to the emergence of medical humanities. The article argues that Foucault’s stories about the power of medical knowledge were philosophical stories about Western medicine. Foucault always used facts, dates, and names in an attempt to identify some of the general tendencies and patterns in the development of Western medicine and to reveal usually undisclosed mechanisms for managing individuals and populations. Those mechanisms underlie the practice of providing assistance, be it the “moral treatment” practiced by psychiatrists before the advent of effective medication, or treating patients as “clinical cases” in hospitals, or hospitalization campaigns that were considered an effective “technological safe-guard ” in the 18th and most of the 19th century.

scholarly journals Percutaneous radiofrequency treatment of the gasserian ganglion for trigeminal neuralgia complicated by trochlear nerve palsy: a case report

2021 ◽  
pp. rapm-2020-102285
Author(s):  
Pascal SH Smulders ◽  
Michel AMB Terheggen ◽  
José W Geurts ◽  
Jan Willem Kallewaard
Keyword(s):  
Trigeminal Neuralgia ◽  
Cranial Nerve ◽  
Facial Pain ◽  
Anatomical Variations ◽  
Anterior Inferior Cerebellar Artery ◽  
Gasserian Ganglion ◽  
Radiofrequency Treatment ◽  
Experienced Pain ◽  
Cerebellar Artery ◽  
Trochlear Nerve Palsy

BackgroundTrigeminal neuralgia (TN) has the highest incidence of disorders causing facial pain. TN is provoked by benign stimuli, like shaving, leading to severe, short-lasting pain. Patients are initially treated using antiepileptic drugs; however, multiple invasive options are available when conservative treatment proves insufficient. Percutaneous radiofrequency treatment of the trigeminal, or gasserian, ganglion (RF-G) is a procedure regularly used in refractory patients with comorbidities. RF-G involves complex needle maneuvering to perform selective radiofrequency heat treatment of the affected divisions. We present a unique case of cranial nerve 4 (CN4) paralysis after RF-G.Case presentationA male patient in his 60s presented with sharp left-sided facial pain and was diagnosed with TN, attributed to the maxillary and mandibular divisions. MRI showed a vascular loop of the anterior inferior cerebellar artery without interference of the trigeminal complex. The patient opted for RF-G after inadequate conservative therapy. The procedure was performed by an experienced pain physician and guided by live fluoroscopy. The patient was discharged without problems but examined the following day for double vision. Postprocedural MRI showed enhanced signaling between the trigeminal complex and the brainstem. Palsy of CN4 was identified by a neurologist, and spontaneous recovery followed 5 months after the procedure.ConclusionsMention of postprocedural diplopia in guidelines is brief, and the exact incidence remains unknown. Different mechanisms for cranial nerve (CN) palsy have been postulated: incorrect technique, anatomical variations, and secondary heat injury. We observed postprocedural hemorrhage and hypothesized that bleeding might be a contributing factor in injury of CNs after RF-G.

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