Manifestations of trigeminal neuralgia
The problem of pain occupies a significant place in medicine, despite the large number of conservative and surgical means for its relief. Often pain is the only reason for which a patient consults a doctor. Trigeminal neuralgia is a very intense and debilitating pain.
It appears in the area of innervation of the branches of the 5th pair of cranial nerves:
- in the upper jaw
- in the lower jaw
- around the nose,
- on the cheek
- in the forehead area
Signs of trigeminal neuralgia
The main clinical sign is that the pain is similar to an electric shock. This disease is difficult to treat and often patients are forced to take painkillers for a long time. At the first stage of treatment, anticonvulsants are used. In the absence of the effect of drug treatment, as well as in the case of side effects, surgical methods of treatment are used.
Causes of trigeminal neuralgia
- Irritation of the nerve by the artery and/or vein that are next to it inside the skull.
- Tumor processes
- Multiple sclerosis.
- Fibromatosis (with Recklinghausen’s disease)
MRI signs of neurovascular conflict between the left trigeminal nerve and the vertebral artery.
Pathogenesis
The trigeminal nerve provides sensory innervation to the face. It has three branches:
- The first branch (ophthalmic nerve) innervates the eyeball, upper eyelid, and skin of the forehead.
- The second branch (maxillary nerve) innervates the lower eyelid, cheek, nose, upper lip, gums, and upper jaw.
- The third branch (mandibular nerve) innervates the lower jaw, lower lip, gums, and some chewing muscles.
Clinic
Sudden onset of intense pain, often without a cause apparent to the patient. Occurring in the upper or lower jaw, it is often confused with toothache and patients are treated by dentists for a long time.
There are cases when, in the fight against this pain, a person has almost all of his teeth pulled out. Also, the pain can be typical and atypical.
- Typical pain – in this case, there are periods of exacerbation and remission during the course of the disease. The pain has a stereotypical nature – it resembles an electric shock and lasts no more than one minute. Most often, there are points on the patient’s face or in the oral cavity that provoke pain – the so-called trigger zones.
- Atypical pain is more often constant, it hurts a large part of the face and is of a burning, unbearable nature.
Provoking factors
- wash
- shaving
- touching the skin of the face
- teeth cleaning
- touching the nose
- conversation
- makeup
- wind flow
- smile
Treatment
- Anticonvulsant drugs (used when seizures occur infrequently and completely disappear with the use of drugs).
- Surgical treatment (blockades, radiofrequency ablation , decompression of the trigeminal nerve).
The neurosurgical department has the most modern equipment to perform all of the above surgical treatment methods.
In addition, there are comfortable conditions for a pleasant stay of patients. Friendly and highly qualified staff can provide safe and high-quality care.
Drugs
Anticonvulsant drugs are the mainstay of treatment for trigeminal neuralgia .
There are many anticonvulsants, but the main one is carbamazepine or its analogues. The initial dose of carbamazepine is usually 200 mg per day. The dose of the drug is gradually increased after 3-4 days until the pain syndrome decreases. The maximum dose is 1200 mg per day.
Recently, new anticonvulsant drugs have appeared – pregabalin, which can be used both independently and in combination with carbamazepine. In the acute pain period, analgesics (dexalgin), nonsteroidal anti-inflammatory drugs (dicloberl, ksefokam) are prescribed.
Antidepressants are necessarily prescribed. In complex therapy, we use B vitamins (vitaxon), antispasmodics in the presence of muscle spasm.
Physiotherapy procedures
Physiotherapy procedures are also included in the treatment complex:
- electrophoresis with lidocaine,
- phonophoresis with hydrocortisone,
- UHF,
- laser therapy.
Neurosurgeons Nazarenko O.S., Leontiev O.Yu.
