brain, spinal cord, and nerve disorders
Trigeminal Neuralgia
Treatment of Trigeminal Neuralgia
Antiseizure or other medications Sometimes surgery Because the bouts of pain are brief and recurrent, typical analgesics are not usually helpful, but other medications, especially certain Antiseizure medications , taken by mouth, may help. (Antiseizure medications stabilize nerve cell membranes.) The antiseizure medication (a Heterocyclic (including tricyclic) antidepressants ) may be used instead. If Injecting botulinum toxin (used to paralyze muscles or to treat wrinkles) near the area where pain is experienced may help, but evidence of its effectiveness is limited. If bouts of pain are frequent and severe, doctors may use a nerve block to temporarily relieve the pain until the medication given by mouth takes effect. An anesthetic is injected into the nerve to temporarily block its function. If the pain continues to be severe despite medication, surgery may be done. If the cause is an abnormally positioned artery, a surgeon separates the artery from the nerve and places a small sponge between them. This procedure (called vascular decompression) usually relieves the pain for many years. If the cause is a tumor, the tumor can be surgically removed. If people have pain unrelieved by medications and surgery seems too risky, a nerve block can be done to determine whether other procedures would help. If the injection of the anesthetic into the nerve relieves the pain, disrupting the nerve may relieve the pain, sometimes permanently. Disruptions may involve Cutting the nerve surgically Cutting the nerve with a radiofrequency probe (using heat) or a gamma knife Compressing the nerve with a balloon Destroying the nerve by injecting an agent such as glycerol into it However, surgery that relieves pain often results in facial numbness. Also, pain often recurs. As a result, people may require many procedures. Having many procedures may increase the risk of developing severe pain that is difficult to treat. When pain results from an abnormally positioned artery pressing on a cranial nerve, the pain can be relieved by a surgical procedure called vascular decompression. This procedure may be done to treat trigeminal neuralgia, hemifacial spasms, or glossopharyngeal neuralgia. If the trigeminal nerve is compressed, an area on the back of the head is shaved, and an incision is made. The surgeon cuts a small hole in the skull and lifts the edge of the brain to expose the nerve. Then the surgeon separates the artery from the nerve and places a small sponge between them. A general anesthetic is required, but the risk of side effects from the procedure is small. Side effects include facial numbness, facial weakness, double vision, infection, bleeding, alterations in hearing and balance, and paralysis. Usually, this procedure relieves the pain, but in about 15% of people, pain recurs. 