Q&A Topic: Trigeminal Neuralgia
Alain C.J. de Lotbinière, MD, CM, FACS, FRCSC
Q. What is trigeminal neuralgia (TN)?
A. Imagine a stabbing pain in your jaw or cheek triggered by a mere touch or breath of wind, or a constant aching, burning sensation in your face that doesn’t respond to pain killers. This is what sufferers of trigeminal neuralgia (TN) experience, and it can be so incredibly painful that trigeminal neuralgia has also been called “the suicide disease.” For many sufferers, the pain worsens during the winter months.
Q. How common is this disease?
A. TN typically hits people in their 50s or older and, for reasons that aren’t completely clear, more women suffer from TN than men. While the National Institute of Neurological Disorders and Stroke puts the incidence of new cases at about 14,000 a year, I think it’s very likely that this is an underestimate because so many people have trouble getting a proper diagnosis.
Q. What causes the extreme pain in TN?A. The pain is usually the result of pressure on the trigeminal nerve, which transmits sensations from the face to the brain. A nearby artery can enlarge, putting pressure on the nerve and wear away its protective sheath. This leads to intermittent or constant pain signaling to the brain, and the attacks can worsen over time. Often my TN patients have already been to see several other specialists in the attempt to get a diagnosis and find relief. The baffling pain that often eludes the correct diagnosis can be sudden and shock-like or an ever-present ache. It’s typically felt only on one side of the face. Everyday activities like washing your face, brushing your teeth, eating, drinking, shaving, and applying makeup can trigger the pain. Patients will often consult a dentist because they believe they have a toothache; or they might see an ear-nose-and-throat specialist to rule out jaw overuse conditions, such as temporomandibular joint (TMJ) disorder.
Q. How is TN diagnosed and what is the most effective treatment?
A. I usually begin by taking a medical history and getting a description of symptoms, followed by physical and neurological exams and medical imaging, if necessary. Medical treatment usually includes anticonvulsant drugs to help calm the hyperactive nerve. Antidepressants seem to help some patients. But TN can become resistant to drug treatment over time, leading patients to seek a surgical solution. Surgeons can use different methods—from invasive to non-invasive—to accomplish the goal of blocking the pain signaling to the brain. The least invasive neurosurgical treatment is Gamma Knife radiosurgery. At Northern Westchester Hospital we have the most advanced Gamma Knife available and we are the only hospital to offer this technology in this region. Using computer imaging, I’m able to direct beams of radiation at the nerve to create a lesion that will calm the pain signals to the brain. Because the procedure is non-invasive, it doesn’t carry many of the potential risks of invasive surgery and requires only local anesthesia and mild sedation. Patients go home the same day and can return to their regular activities the following day. The results have been promising with up to 50 to 78 percent of patients report excellent pain relief within a few weeks.
Q. Are there other treatment options?
A. Other neurosurgical treatments include radiofrequency ablations, injecting a chemical called glycerol and using a microcatheter attached to a balloon to compress the trigeminal nerve under general anesthesia. However, the most effective procedure with regards to long-term pain relief is a microvascular decompression (MVD), an operation in which a tiny sponge is placed between the offending vessel and the nerve. If you or a loved one is experiencing mysterious facial pain, talk with your doctor about getting tested for TN.
Northern Westchester Hospital
Medical Director of the Gamma Knife Center
Medical Director of the Cancer Treatment and Wellness Center
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