Treatment Options for Trigeminal Neuralgia

On some days, the pain is beyond terrible. Patients wonder how they can go on with such a terrible condition. Fortunately, when treatment obliterates the extreme pain from trigeminal neuralgia, their lives can take a 360-degree turn toward normalcy.

What is Trigeminal Neuralgia?

It's a chronic condition affecting the fifth cranial nerve, according to the National Institute of Neurological Disorders and Stroke (NINDS). Individuals with trigeminal neuralgia (TN) experience extreme pain sometimes described as agony. It's often a sporadic burning pain or one resembling a shock in the face. Episodes last a few seconds to two minutes. Sometimes attacks occur one right after another.

The trigeminal nerve carries sensations back and forth from the face to the brain. It's one of 12 pairs of cranial nerves that begin at the base of a patient's brain. TN can affect more than one of its three branches.

The Mayo Clinic reports that patients typically experience mild initial attacks. The disorder often progresses into bouts of searing pain that grow in length and intensity. More women than men are affected. TN most often strikes individuals past 50.

Trigeminal neuralgia sometimes occurs due to the aging process. Multiple sclerosis and another neurological condition can damage the myelin sheath covering specific nerves to cause the disorder. While a tumor might be the cause, often the culprit remains unknown.

After a dozen years of suffering from this disorder, Andrew Gifford, heir to a Washington, DC-area business, found relief through surgery. According to the Washington Post, Gifford, eventually cured, said that even a breeze on his cheeks was agonizing.

Treatment Options

Doctors can offer TN patients several types of treatment. Medication is usually the initial choice. When patients no longer respond to medication or experience severe side effects, treatment usually advances to injections, surgery or other options.

Medications. Two types are effective in treating trigeminal neuralgia. Anticonvulsants include carbamazepine (brand name: Tegretol, Carbatrol), oxcarbazepine (Trileptal), phenytoin (Dilantin, Phenytek), lamotrigine (Lamictal) and gabapentin (Neurontin). Many patients require a steadily higher dose. Potential side effects include dizziness, confusion, double vision, nausea and drowsiness.

Antispasmodic drugs include muscle-relaxing medication alone or with carbamazepin or phenytoin. Among the side effects are nausea, drowsiness and confusion.

Injections. Doctors inject alcohol into a patient's face to numb an area and provide temporary pain relief. The targeted site corresponds to the part of the nerve responsible for the pain.

Many sufferers require a series of injections or a different treatment. Potential side effects include damage to nerves in the area, bleeding and an infection at the injection site.

Surgery. Surgery can cure some patients who suffer from trigeminal neuralgia. For others, the pain might come back years later. Surgery has two objectives. One goal is to halt the compression of the trigeminal nerve by a blood vessel. A second approach is to deliberately damage the nerve to keep it from causing pain, often resulting in short-term or permanent facial numbness.

At least half a dozen types of surgery treat TN. Using gamma-knife radiosurgery (GKR), surgeons focus a high dose of radiation on the base of the trigeminal nerve to deliberately damage it. The procedure can subsequently be repeated. Fewer than 5 out of 100 patients experience side effects.

During microvascular decompression (MVD), surgeons relocate or take out blood vessels touching the root of the trigeminal nerve. Patients risk decreased hearing, facial numbness or weakness, double vision, strokes and even death.

A glycerol injection intentionally damages the trigeminal nerve to block pain signals. In some patients, the pain recurs. Facial numbness or tingling isn't uncommon.

During a balloon compression, a surgeon inserts an inflated balloon that presses on the trigeminal nerve to block pain. Other techniques include electric radiofrequency thermal rhizotomy to destroy nerve fibers linked to pain and rhizotomy to sever part of the trigeminal nerve.

Alternative medicine. Alternative treatments include acupuncture, vitamin therapy, acupuncture, nutritional therapy and electrical stimulation of nerves.

For patients with trigeminal neuralgia, pain might be so severe that it's indescribable. While living with this disorder can be difficult, current treatments significantly reduce the hold of the disorder on a patient's life.

Sources:

http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/detail_trigeminal_neuralgia.htm

http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446

http://www.washingtonpost.com/lifestyle/style/whatever-happened-toandrew-gifford-the-ice-cream-heir/2011/02/10/ABPmcRP_story.html