If you suffer from intolerable pain on one side of your face, you may be suffering from trigeminal neuralgia. We offer several effective treatment options for trigeminal neuralgia. The choice of the right method for trigeminal neuralgia treatment in Delhi depends on each particular situation. In order to prescribe the most efficient and safe treatment method for you, our specialists have to assess the disease, underlying causes, past health checks and treatment.
What does trigeminal neuralgia mean?
Trigeminal neuralgia is often described as one of the most intolerable types of pain. This pain usually appears on the bottom or on both sides of the face, but it can also manifest as pain around the nose or above the eyes. Patients say this pain resembles “electric shock”, “shooting” on one side of the face, burning or a prominent stinging sensation.
Trigeminal neuralgia is the best known among the different types of neuropathic facial pain. It affects about 25 per 100 thousand individuals, being twice as frequent in women than in men. Its peak incidence is between 50-60 years of age and the vast majority of patients have significant functional impairment by the disease, often making work and activities of daily living impossible.
Painful attacks are usually paroxysmal, that is, in attacks. The episodes tend to be very intense and of very short duration (a few seconds), but they can occur hundreds of times a day, usually in the same places on the face. The pain is usually “shock” or “stinging” and can be triggered by touching specific areas called “trigger points”, or in normal activities such as talking and chewing.
In up to 5% of cases, it can be bilateral. Family involvement is quite rare, but cases have been reported in the scientific literature
One of the ways to classify the disease is as classic or idiopathic trigeminal neuralgia (without defined structural cause) and secondary neuralgia (when there is a structural factor such as compression by tumors, multiple sclerosis, etc.). In about 15% of cases, it is possible to identify a cause.
The trigeminal nerve is the fifth of 12 cranial nerves (head), which guarantees sensations in the face region. This nerve is located on both the right and left sides of the face, where it divides into 3 branches, hence its name “triplet”.
Epidemiology
- 150,000 people worldwide are diagnosed with trigeminal neuralgia each year.
- This disease can occur to anyone, regardless of age, but it is more common after 50 years of age.
- Statistics show that this disease is more common in women than in men.
- There is an increased risk of having this condition if there is a family history of trigeminal neuralgia.
- High blood pressure or multiple sclerosis can increase the risk of this disease.
- Most patients are left with an unidentified cause of trigeminal neuralgia, but most of the time it is caused by a neurovascular conflict in the brain stem, where the trigeminal nerve meets the blood vessel.
Symptoms
- Spontaneous, sudden, severe electric shock similar to pain, most often on one side of the face
- They can last from two seconds to 2 minutes.
- The pain may disappear suddenly and not return for several months
- Pain can be caused by eating, touching, talking, washing, wind and other irritants.
Diagnosis
The characterization of pain given by the patient plays the main role. Based on this description, a neurologist in Delhi performs neurological examinations of the face – checks tender spots, sensations, sensitivity to temperature and function.
In order to establish the causes (for example, a tumor or multiple sclerosis, or a neurovascular conflict) that can cause trigeminal neuralgia, it is necessary to perform diagnostic imaging – magnetic resonance imaging.
The diagnosis is purely clinical based on the characteristics of the pain. However, the initial investigation should always include an MRI exam in order to rule out secondary causes. There are theories that until today cause controversies and scientific debates regarding the cause of idiopathic trigeminal neuralgia to be related to vascular compression at the root of the trigeminal nerve. This compression can be seen in some imaging studies, however, it is not present in all patients, just as it can exist in people who are totally asymptomatic and who have vascular contact with the nerve in imaging exams.
Trigeminal Neuralgia Treatment in Delhi
The initial treatment is always clinical, with medications that include Carbamazepine, Baclofen, Gabapentin, Phenytoin, among others. In some cases, multidisciplinary monitoring is important, which may include dental follow-up, psychological support, among others.
Neurovascular Surgery in Delhi is the treatment option for patients who do not respond satisfactorily to drug treatment or when the side effects of drugs are not tolerated. Among the best known techniques, Neurovascular Decompression, percutaneous techniques and Gamma Knife stand out.
Neurovascular decompression presents the best results in the long term and with a very low incidence of permanent sensory changes after the procedure. However, it is the only method that uses an open surgical technique.
In percutaneous techniques, the procedure is performed by the neurosurgeon in Delhi through a needle inserted into the affected trigeminal nerve ganglion, without the need to open the skull. Through this needle, a partial nerve injury is performed, either through balloon compression, radiofrequency injury or chemical damage by glycerol. The clinical response is usually immediate
With an average duration of less than neurovascular decompression but which in many cases can surpass 5 years free of crises. The major disadvantage of percutaneous methods in general, as well as Gamma Knife, is the higher incidence of permanent sensory changes that can lead to the emergence of a new type of pain that is difficult to treat called painful anesthesia, in which despite the sensation of numbness in the patient may have continuous burning pain.
The Gamma Knife technique involves the use of radiation (such as radiotherapy) and has the great advantage of not requiring any type of invasive access and is indicated mainly in patients at high risk of receiving anesthesia or sedation. The injury is caused by the confluence of bundles of ionizing particles in a small region of the trigeminal nerve and the clinical result is similar to that of percutaneous procedures. In addition to the disadvantage of being a harmful procedure, it also carries the risks of using radiation.
The choice of both the drug and the surgical strategy should be discussed individually, as each case has its peculiarities and each patient has its own desires. When well monitored, almost all patients can achieve significant improvement in the quality of life.