What is Trigeminal Neuralgia?
Trigeminal Neuralgia (also called
tic douloureux) is possibly the most painful condition known to medical
science. It is a disorder of the fifth cranial nerve, believed
to result from compression by small blood vessels in the region where the
nerve emerges from the brain stem. Pain may be experienced as "volleys"
of sharp, electric-shock stabs of pain on one side of the face (occasionally
both sides at different times). Pain may be felt in three general
areas that correspond to the three branches of the nerve: from the base
of the jaw, the cheek, "behind" the eye, the forehead, to the
top of the head and ear. Pain attacks may be started by light touch
or stimulus (brushing teeth, wind on the face) on trigger areas in the
face and mouth.
Some patients experience TN with less typical
features including a more constant but somewhat less intense aching and
burning in the face. Such atypical features have been called "Pre-Trigeminal
Neuralgia" by some investigators. Likewise, TN pain sometimes emerges
for the first time after a trauma to the face or neck ("whiplash" injury
in automobile accidents). TN is known to develop over time, and may "come
and go" for periods which gradually lengthen before pain becomes
chronic.
How is TN Diagnosed?
Many patients report that they
(and their physicians) first mistake the pain of TN for a dental or sinus
problem. Thus, it is important that neuralgia be investigated as
part of assessment by a medical or dental care provider, particularly if
X-rays and physical palpation do not reveal a clearly localized focus of
infection. If a first root canal or dental extraction is not
successful in alleviating pain, then assessment for neuralgia is definitely
medically indicated.
There is no "test" that identifies all
cases of TN. The disorder is distinguished from other types of face pain
by evaluating the pain distribution, characteristics, and timing.
MRI is often used to eliminate the small possibility of a slow-growing
brain tumor compressing the nerve; in some cases MRI will also reveal nerve
compressions. Some physicians evaluate for TN by using the patient's
response to nerve blocks. Many doctors regard the most reliable confirmation
of TN to be a rapid, positive response to a short course of anti-convulsant
drugs such as Carbamazepine (Tegretol).
How is TN Treated?
A significant majority of TN patients
obtain successful medical management or total and lasting relief of pain.
The first medical response to TN pain is
usually to administer one of several anti-convulsive or anti-spasmodic
drugs. For many patients, narcotic and anti-inflammatory drugs do
not relieve this disorder. Especially if pain has been severe and long
lasting, the patient and primary care provider are encouraged to remain
alert for indications of emotional depression, and to treat these indications
if they arise. Periodic blood testing is also required for some medications,
to ensure that toxic levels do not build up in the liver or kidneys.
If the patient does not receive satisfactory
relief from medications or has unacceptable side effects, then one of several
types of surgery may be considered. See references for further detail.
Where Can I Find a Healthcare Professional
Who Treats TN?
The Treatment Team at WPAHS
Peter Jannetta, M.D., Professor
of Neurosurgery, Allegheny General Hospital.
Jack Wilberger, M.D., Vice Chairman
(Academic), Division of
Neurosurgery. Professor of Surgery
(Neurosurgery), Medical College of Pennsylvania and Hahnemann University
Medical Career and Accomplishments
Treatment Interests: Neurotrauma; epilepsy
surgery; pain
Publications
(Abstracts) from Pub Med
To
contact Dr. Wilberger
Jon Brillman, M.D. Director,
Division of Neurology, Professor of Neurology, Medical College of
Pennsylvania and Hahnemann University
Medical Career and Accomplishments
Treatment Interests:
Publications (Abstracts) [Note:
J Brillman and JC Brillman are not the same person]
To
contact Dr. Brillman
Moises A. Arriaga, M.D., Adjunct
Associate Professor of Surgery (Otolaryngology and Neurosurgery),
MCP Hahnemann University
Medical Career and Accomplishments
Treatment Interests: Neurotology/otology;
facial nerve disorders; balance disorders; hearing loss; skull base tumors;
Meniere's Disease, Vertigo & Tintinitis
Publications
(Abstracts from Pub Med)
To
contact Dr. Arriaga
D. Kyle Kim, M.D., Ph.D., Assistant
Professor of Neurosurgery, MCP Hahnemann University
Medical Career and Accomplishments
Treatment Interests:
Publications (Vitae)
To
contact Dr. Kim
Patient Support Groups and Bulletin Boards
The Trigeminal Neuralgia Association
Patient Representative may be reached at
Trigeminal
Neuralgia Support Groups -- active TNA support groups and network
contacts, some of which are international. A link is also provided through
this page to TN-L the Trigeminal Neuralgia discussion list, not directly
affiliated with TNA.
Neurology
Web Forums at Massachusetts General Hospital -- http://neuro-mancer.mgh.harvard.edu/cgi-bin/Ultimate.cgi
-- over 170 patient-to-patient bulletin-boards for exchange of concerns
and information.
Additional Information on the Internet
The
Trigeminal Neuralgia Association Homepage -- http://www.tna-support.org
-- extensive information on treatment alternatives, current research, and
patient support groups.
Face
Pain Resources -- Overview of face pain syndromes, Fact
Sheets, Frequently Asked Questions,
Pain Glossary, Medical Abstracts and Reprints, Gateways to Searchable Resources,
compilation of sources for finding a doctor. Over 120 subsidiary
pages and 4000 links.
Facial
Neuralgia Resources -- Large resource site for information on
face pain, with a primary focus on facial neuralgias. Over 200 subsidiary
pages, links to treatment information and patient experience reports.
Surgical
Treatment of Trigeminal Neuralgia and Hemi-facial Spasm -- http://www.neurosurgery.ufl.edu/FacultyPage/TicBrochure.html--
Albert L. Rhoton, Jr., MD, University of Florida.
Trigeminal
Neuralgia -- You Are Not Alone. -- A collection of links and basic
data on treatment of Trigeminal Neuralgia from several perspectives.
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