Trigeminal Neuralgia (TN)
Trigeminal Neuralgia(TN) is typically characterized by sudden and brief attacks of intense and stabbing or an electrical shock pain and is usually limited to one area of the face. It is also known as Tic Douloureux It is a neuropathic disorder and is episodic. It usually occurs in older age group and is commoner in woman. The attacks are triggered by anything that stimulates the nerve like touching, washing, shaving, talking etc.
Trigeminal neuralgia is assumed to be caused by a blood vessel pressing on the nerve that supplies the sensation to the forehead, cheek and lower jaw. It can also be caused by the pressure of a tumor on the nerve , multiple sclerosis damaging the lining of nerve.
The first line of management is to rule out the cause. Once the other causes are ruled out, it is usually treated with medication which includes
Carbamazepine, also an anticonvulsant and is the first line of treatment
Phenytoin, an anticonvulsant
Baclofen, a muscle relaxant, should be used in combination with either of the two above for best results.
Oxcarbazepine, a comparatively newer medicine and is regarded as having minimum side effects.
Other medicines include pregabalin, gabapentin, clonazepam, sodium valporate, lamotrigine and topiramate.
If the cause of the neuralgia is due to blood vessel compression or if it is not responding to medications.
Percutaneous glycerol rhizotomy
Percutaneous balloon compression
Motor cortex stimulation