Monday, January 3, 2011

Trigeminal Neuralgia

Trigeminal neuralgia is a painful condition of the nerve responsible for most facial sensation.

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Trigeminal Neuralgia

Trigeminal neuralgia (TN), tic douloureux (also known as prosopalgia, the ' Suicide Disease' or 'Fothergill's disease') is a neuropathic disorder .

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Dr.Sanjay Mongia

Trigeminal Neuralgia Treatment

Treatment can be subdivided into pharmacologic therapy, percutaneous procedures, surgery, and radiation therapy. Adequate pharmacologic trials should always precede the contemplation of a more invasive approach. Most patients respond well to initial therapy, but some cases are resistant to any type of treatment.

Carbamazepine and oxcarbazepine are considered first-line therapy. Lamotrigine and baclofen are second-line therapy. Other treatments are third line and the evidence for their efficacy is scant.

Treatment for trigeminal neuralgia must be tailored individually, based on the patient's age and general condition. In the case of symptomatic trigeminal neuralgia, adequate treatment is that of its cause. Use of pharmacoprophylaxis or of surgical techniques used for the classic form can be tried.
•Carbamazepine (Tegretol, Carbatrol) was introduced in the 1960s and has proven its efficacy in numerous studies. It remains the criterion standard of treatment for trigeminal neuralgia.  Oxcarbazepine (Trileptal) has not been studied as extensively, but efficacy outcomes are similar. Better tolerability can be considered an advantage over carbamazepine.
Lamotrigine (Lamictal) has been proven more effective than placebo. The dosage should be increased slowly for better tolerance (eg, 25-mg daily dose each week; up to 250 mg twice a day).
Baclofen has demonstrated its efficacy but with a lower degree of evidence.
Dr.Sanjay Mongia


Trigeminal Neuralgia causes facial pain.Trigeminal neuralgia develops in mid to late life. The condition is the most frequently occurring of all the nerve pain disorders. The pain, which comes and goes, feels like bursts of sharp, stabbing, electric-shocks. This pain can last from a few seconds to a few minutes.

People with trigeminal neuralgia become plagued by intermittent severe pain that interferes with common daily activities such as eating and sleep. They live in fear of unpredictable painful attacks, which leads to sleep deprivation and undereating. The condition can lead to irritability, severe anticipatory anxiety and depression, and life-threatening malnutrition. Suicidal depression is not uncommon.

People often call trigeminal neuralgia "tic douloureux" because of a characteristic muscle spasm that accompanies the pain.

•The pain comes from one or more branches of the trigeminal nerve-the major carrier of sensory information from the face to the brain.

◦There are 3 branches of the trigeminal nerve: the ophthalmic, maxillary, and mandibular. The pain of trigeminal neuralgia occurs almost exclusively in the maxillary and mandibular divisions.

◦You most commonly feel pain in the maxillary nerve, which runs along your cheekbone, most of your nose, upper lip, and upper teeth. Next most commonly affected is the mandibular nerve, affecting your lower cheek, lower lip, and jaw.
•In almost all cases (97%), pain will be restricted to one side of your face.
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Dr.Sanjay Mongia