Trigeminal Neuralgia
Table of Contents
About Trigeminal Neuralgia
The trigeminal nerve is the fifth cranial nerve of the body. This nerve is responsible for transmitting sensory information from the face to the brain, which includes general touch, as well as pain. Trigeminal neuralgia is a chronic condition where pain is felt in areas served by the trigeminal nerve, like the eye and cheek. Trigeminal neuralgia is sometimes referred to as the “suicide disease” because of the severity of the pain and the years that individuals often suffer without knowing the cause. Stereotactic radiosurgery at a Gamma Knife center has proven to be an effective trigeminal neuralgia treatment, with studies demonstrating 75 to 80 percent of patients experiencing good to excellent pain relief following treatment. If procedures such as Gamma Knife aren’t recommended, anti-seizure drugs may be prescribed to relieve pain and lessen the number of attacks.
Trigeminal Neuralgia Development
When it comes to the development of trigeminal neuralgia, just about anyone can develop this condition, but it occurs most frequently in women older than age 50. This condition is most commonly triggered when a blood vessel next to the brain stem compresses the trigeminal nerve. In some cases, the cause of trigeminal neuralgia can be related to multiple sclerosis or a tumor compressing the trigeminal nerve. In rare cases, the cause is unknown.
Symptoms and Diagnosis of Trigeminal Neuralgia
Because trigeminal neuralgia is a condition causing chronic pain, all patients will experience symptoms, including:
- Pain on one side of the face around the eye, cheek or lower portion of the face, which is often described as extreme stabbing or “electrical” pain; the episode lasts a few seconds or minutes and comes and goes, but worsens over time
- Pain triggered by normal daily activities that typically would not cause discomfort, such as brushing your teeth, eating or chewing
- Avoidance of everyday activities out of fear of triggering another attack
- Tingling, numbness or a dull, constant ache before the onset of more intense trigeminal neuralgia pain
Trigeminal neuralgia can only be diagnosed when the patient discusses their symptoms with an experienced physician. Unfortunately, there are no blood tests or images that can make the diagnosis. As a result, getting the correct diagnosis can be difficult. A diagnosis of trigeminal neuralgia is most often made by a neurologist, internist, neurosurgeon or dentist (when patients believe the pain is tooth related).
Treatment of Trigeminal Neuralgia
A doctor will work with each patient to develop a treatment plan to help manage trigeminal neuralgia. Potential trigeminal neuralgia treatments include:
- Trigeminal Neuralgia Surgery: During a microvascular decompression procedure, blood vessels that are impacting the trigeminal root are relocated or removed to restore proper function of the nerve.
- Stereotactic Radiosurgery: A focused beam of radiation is delivered using technology such as the Leksell Gamma Knife®Icon™ in an outpatient setting. This is the least invasive and the least likely of all surgical treatments to cause complications.
- Medications: For patients who are not surgical candidates, anti-seizure drugs, muscle relaxants or tricyclic antidepressants may be prescribed to relieve pain and reduce the number of attacks.
Outcomes for Trigeminal Neuralgia
Trigeminal Neuralgia (TN) is a debilitating facial pain syndrome that we treat at The Valley Gamma Knife Center. To date, we have successfully treated over 100 patients with medically refractory TN. When TN is referred to as “medically refractory,” it indicates that the condition was previously treated unsuccessfully with other treatment methods. In a minority of patients who respond to Gamma Knife, pain can recur and might require a second treatment. Gamma Knife treatment, although quite safe, does carry a 5-10% risk of delayed facial numbness.
On average, most patients experience pain relief at 8 weeks post-treatment.
Atypical trigeminal neuralgia occurs when a patient experiences constant pain rather than sharp and fleeting pain, which is typical. When accounting for these TN sub-types, we see that patients with atypical TN take an additional 4 weeks to realize favorable results.
Anthony D’Ambrosio, M.D., M.B.A., F.A.A.N.S
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