Request for Question Clarification by
tlspiegel-ga
on
16 Oct 2005 11:45 PDT
Hi geronimogo,
Please let me know if this would be a fully satisfactory answer to your question.
CNN.com - Trigeminal neuralgia From MayoClinic.com
http://www.cnn.com/HEALTH/library/DS/00446.html
"Treatment
Medications are the usual initial treatment for trigeminal neuralgia.
Medications are often effective in lessening or blocking the pain
signals sent to your brain. A number of drugs are available. If you
stop responding to a particular medication or experience too many side
effects, switching to another medication may work better for you.
Medications
- Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an
anticonvulsant drug, is the most common medication that doctors use to
treat trigeminal neuralgia. In the early stages of the disease,
carbamazepine controls pain for most people. However, the
effectiveness of carbamazepine decreases over time. Side effects
include dizziness, double vision, sleepiness and nausea.
- Baclofen (Lioresal). Baclofen is a muscle relaxant. Its
effectiveness may increase when it's used in combination with
carbamazepine or phenytoin. Side effects include confusion, mental
depression and drowsiness.
- Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant
medication, was the first medication used to treat trigeminal
neuralgia. Side effects include gum overgrowth, problems with balance
and drowsiness.
- Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant
medication and is similar to carbamazepine. Side effects include
dizziness and double vision.
Some people with trigeminal neuralgia eventually stop responding to
medications, or they experience unpleasant side effects. For those
people, surgery ? or a combination of surgery and medications ? may be
an option.
Surgery
The goal of a number of surgical procedures is to either damage or
destroy the part of the trigeminal nerve that's the source of the
pain. Because the success of these procedures depends on damaging the
nerve, facial numbness of varying degree is a common side effect.
These procedures involve:
- Alcohol injection. Alcohol injections under the skin of your face,
where the branches of the trigeminal nerve leave the bones of your
face, may offer temporary pain relief by numbing the areas for weeks
or months. Because the pain relief isn't permanent, you may need
repeated injections or a different procedure.
- Glycerol injection. This procedure is called percutaneous glycerol
rhizotomy (PGR). Percutaneous means through the skin. Your doctor
inserts a needle through your face and into an opening in your skull.
The needle is guided into the trigeminal cistern, a small sac of
spinal fluid that surrounds the trigeminal nerve ganglion (the area
where the trigeminal nerve divides into three branches) and part of
its root. Images are made to confirm that the needle is in the proper
location. Once the location is confirmed, your doctor injects a small
amount of sterile glycerol. After three or four hours, the glycerol
damages the trigeminal nerve and blocks pain signals.
Initially, PGR relieves pain in most people. However, many people have
a recurrence of pain, and many experience facial numbness or tingling.
- Balloon compression. In a procedure called percutaneous balloon
compression of the trigeminal nerve (PBCTN), your doctor inserts a
hollow needle through your face and into an opening in your skull.
Then, a thin, flexible tube (catheter) with a balloon on the end is
threaded through the needle. The balloon is inflated with enough
pressure to damage the nerve and block pain signals.
PBCTN successfully controls pain in most people, at least for a while.
Most people undergoing PBCTN experience facial numbness of varying
degrees, and more than half experience nerve damage resulting in a
temporary or permanent weakness of the muscles used to chew.
- Electric current. A procedure called percutaneous stereotactic
radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve
fibers associated with pain. Your doctor threads a needle through your
face and into an opening in your skull. Once in place, an electrode is
threaded through the needle until it rests against the nerve root.
An electric current is passed through the tip of the electrode until
it is heated to the desired temperature. This damages the nerve fibers
and creates an area of injury (lesion). If your pain isn't eliminated,
your doctor may create additional lesions.
- PSRTR successfully controls pain in most people. Facial numbness is
a common side effect of this type of treatment. The pain may return
after a few years.
- Microvascular decompression (MVD). A procedure called microvascular
decompression (MVD) doesn't damage or destroy part of the trigeminal
nerve. Instead, MVD involves relocating or removing blood vessels that
are in contact with the trigeminal root and separating the nerve root
and blood vessels with a small pad.
During MVD, your doctor makes an incision behind one ear. Then,
through a quarter-sized hole in your skull, part of your brain is
lifted to expose the trigeminal nerve. If your doctor finds an artery
in contact with the nerve root, he or she directs it away from the
nerve and places a pad between the nerve and the artery. Doctors
usually remove a vein that is found to be compressing the trigeminal
nerve.
MVD can successfully eliminate or reduce pain most of the time, but as
with all other surgical procedures for trigeminal neuralgia, pain can
recur in some people.
While MVD has a high success rate, it also carries risks. There are
small chances of decreased hearing, facial weakness, facial numbness,
double vision and even a stroke or death. The risk of facial numbness
is less with MVD than with procedures that involve damaging the
trigeminal nerve.
- Severing the nerve. A procedure called partial sensory rhizotomy
(PSR) involves cutting part of the trigeminal nerve at the base of
your brain. Through an incision behind your ear, your doctor makes a
quarter-sized hole in your skull to access the nerve. This procedure
usually is helpful, but almost always causes facial numbness. If your
doctor doesn't find an artery or vein in contact with the trigeminal
nerve, he or she won't be able to perform an MVD, and a PSR may be
done instead.
- Radiation. Gamma-knife radiosurgery (GKR) involves delivering a
focused, high dose of radiation to the root of the trigeminal nerve.
The radiation damages the trigeminal nerve and reduces or eliminates
the pain. Relief isn't immediate and can take several weeks to begin.
GKR is successful in eliminating pain more than half of the time. The
procedure is painless and typically is done without anesthesia.
Because it's relatively new, the long-term risks of this type of
radiation are not yet known.
- Gamma-knife radiosurgery: Neurosurgery without a scalpel
Coping skills
Living with trigeminal neuralgia can be difficult. The disorder may
affect your interaction with friends and family, your productivity at
work, and the overall quality of your life.
[edit]
You may find that talking to a counselor or therapist can help you
cope with the effects of trigeminal neuralgia, or you may find
encouragement and understanding in a support group."
=========
neurosurgerytoday.org -Trigeminal Neuralgia
http://www.neurosurgerytoday.org/what/patient_e/trigeminal.asp
"Today, there are several effective ways to alleviate the pain.
The first line of treatment is usually an anti-convulsant drug such as
Tegretol (carbamazepine) that slows the function of the irritated
nerve and consequently relieves the pain. Many patients find
significant or total relief from pain with these drugs. The drugs can
have several drawbacks, however. Some patients may need a relatively
high dose to alleviate the pain and the side effects at high doses
include blurred vision, drowsiness, memory problems and balance
problems. Secondly, the anticonvulsant may lose its efficacy over
time. Patients may need a higher dose to reduce the pain or may need a
second anticonvulsant, which can lead to adverse drug reactions.
The drugs can have a toxic effect on some patients, particularly
people with a history of bone marrow suppression and kidney and liver
toxicity. Such patients must have their blood monitored to ensure
their safety.
Patients for whom drugs aren''t effective can opt for surgery.
Twenty-five to 50 percent of patients will eventually stop responding
to drug therapy and may need surgery. Fortunately, about 85 percent of
patients who undergo surgery experience significant pain relief.
Several types of surgical procedures are available. The two most
common are microvascular decompression and percutaneous neurolysis.
Vascular decompression provides many years of pain relief but, as a
more invasive procedure, carries more risks. Percutaneous neurolysis
with mechanical radiofrequency or chemical lesioning can produce
numbness of the face and brief symptom relief. These techniques are
preferable for older patients and those whose health problems argue
against an invasive surgery and general anesthesia.
Vascular decompression relieves trigeminal neuralgia by placing a
small pad between the nerve and the adjoining blood vessels. A
neurosurgeon makes an incision in the back of the head to expose the
trigeminal nerve at the base of the brain. The pad is inserted between
the nerve and the blood vessels to alleviate compression. Pain relief
is realized in about 90 percent of patients.
There is a small risk of facial numbness, facial weakness, double
vision, infection or deficiencies in hearing or balance. The operation
requires a general anesthetic and about a five-day stay in the
hospital following the procedure. Most patients need to take two weeks
off from work to recover.
Vascular decompression generally provides long-term pain relief. It
can be repeated if necessary. Often, as with other types of surgical
treatments for trigeminal neuralgia, many patients will continue to
require some pain medication but usually at a lower dose. Percutaneous
techniques are performed with a needle passed through the skin. The
needle is directed by X-ray control. The trigeminal nerve is "lysed"
or lesioned through the needle in one or several ways. Under x-ray
control, a needle is passed into the cheek on the side of the face
where the patient feels pain and through a small, natural opening in
the base of the skull (the foramen ovale) into the trigeminal nerve.
Radiofrequency energy can be applied to burn a portion of the nerve. A
small balloon can be used to compress the nerve. Or lastly, a chemical
such a glycerol can be injected into the nerve to damage the nerve.
Relief of trigeminal neuralgia through percutaneous techniques results
from making the region of the pain permanently numb. The procedure
takes less than an hour and patients can usually go home the same day.
Most can return to work in a day or two.
An undesirable side effect is that the numbness of the face may
produce an unpleasant sensation such as a "tingling" or "stiffening."
Other side effects are chewing muscle weakness and, if the pain had
been near the eye and treatment targeted that area, numbness of the
eye. That in itself is not harmful but such patients cannot feel a
foreign body in their eye and can develop serious corneal abrasions.
They must inspect the eye in the mirror regularly to ensure that there
is no irritation.
Patients who undergo percutaneous treatment can expect to have relief
from pain for three to four years after which the procedure can be
repeated. This technique is well tolerated even by patients who are 80
or older. Many surgeons will refrain from performing a microvascular
decompression for people over 70, though the general health of the
patient takes precedent over actual age in choosing a surgical
treatment.
Both surgical procedures are more effective when used in the early
stages of the disease. Surgical treatment also produces better results
with classic trigeminal neuralgia than with atypical trigeminal
neuralgia."
Best regards,
tlspiegel
