What is trigeminal neuralgia?
Trigeminal neuralgia is a pain very particular characteristics. Patients describe it as if it were an electric shock, a cramp, located on one side of the face and specifically in some of the Territories to the trigeminal nerve, which reflects the sensitivity of the face.
This nerve has three branches and the pain can be located in the front and in the orbit or cheek, extending to the wing of the nose or front region of the ear; or, finally, in the jaw, extending to the base of the tongue and jaw.
This is a pain of short duration that are repeated, that is, they appear as bursts. They appear in relation to the touch, or coinciding with chewing or speaking and are very disabling for the patient.
What are its causes and what are the symptoms?
Trigeminal neuralgia is characterized by pain in the form of so-called electric shock or cramping is very specific. And then there is, as I mentioned, a characteristic anatomical radiation.
Sometimes there are tumors that are compressing and irritating the trigeminal nerve and remove the tumor alleviates this problem. At other times, we find no clear cause in diagnostic imaging and we are facing the so-called typical neuralgia or trigeminal essential.
The initial response to medication is often very good and is also an aspect that helps us to confirm the diagnosis. Specifically, the first-line drug for treating these patients is the carbomazepina or Tegretol.
Initially, these patients improve with this drug, but later reappear crisis and we have to take other steps. Also characteristically pain and sleep respects these patients, who often can barely eat or shave in the case of men can sleep several hours, and very restful way at night.
How can we treat it?
With respect to the treatment of trigeminal neuralgia, except when there is a cause as is the tumor that I mentioned that can be operated with good results when it comes to essential neuralgia first thing to try is medication. Later, in the second line of treatment is radiosurgery. Radiosurgery has the advantage that it is not an invasive treatment and is effective in 80% of patients suffering from trigeminal neuralgia but takes between three and nine months to work.
Side effects which this treatment is that 30% of patients decreased sensitivity on the affected side of the face in most patients is completely tolerable.
Alternatively it is performing a thermocoagulation in trigeminal ganglion, which causes a decrease in sensitivity and a relief of pain in 70% of patients treated. O compression Gasser ganglion, inserting a small balloon technique called Mullan, which swells with saline and compresses the nerve fibers located in the ganglion of Gasser, also relieving pain.
Finally in young patients can try the so-called microvascular decompression surgery is where the trigeminal nerve is dissected and freed from the arteries or veins that are compressing. This is a procedure particularly suitable for patients with surgical risk and with little possibility of improvement between 80% and 85% of patients treated.