TRIGEMINAL NEURALGIA

TRIGEMINAL NEURALGIA( TIC DOLOREAUX)

The neuralgic pain or facial pain occurring in the territory of a trigeminal nerve is termed as Trigeminal neuralgia.

• Mostly idiopathic, but in some cases, an aberrant loop or artery may press on the rootlets of trigeminal nerve as they emerge from the pons.
• Commonly in middle aged or elderly people.

CLINICAL FEATURES:-

• Pain is the characteristic symptom, sharp or lancinating and radiates to the territory of one or more sensory division of a Trigeminal nerve.
• Pain is triggered by touching, washing of face, shaving, teeth cleaning, cold breeze, eating, talking and applications of lotions and cosmetics.
• Paroxysms of Pain last only for a few minutes but disturb the concentration of the patient.
• If sensory loss or motor symptoms or signs accompany trigeminal neuralgia, then it is considered secondary to certain neurological diseases such as multiple sclerosis and meningioma of a trigeminal nerve.

MANAGEMENT:-

1. Medical
2. Surgical

MEDICAL:-

• Carbamazepine :- initial 100mg once or twice daily for a few days followed by 200-400mg 8 hourly for 2-4 weeks
•    Phenotypic  Averagedose is 300mg(150-500mg) daily for 2-4 weeks
•  Clonazepam 0.5-2.0mg 8 hourly may be effective as an alternative for 2-3 weeks.
• Antidepressants such as Amitriptyline have also been found effective.

SURGICAL:-

Surgical intervention is needed only when drug therapy has either failed or has produced undesirable side-effects.

Procedures are:-

• Injection of phenol or alcohol into a trigeminal ganglion.
• Radiofrequency coagulation of a branch of trigeminal ganglion.
• Sectioning of sensory root of Trigeminal ganglion inside the cranium.
• Microvascular decompression.