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Comprehensive Therapy Jan 1992Although the full and precise etiology of TN still awaits further elucidation, this extremely painful disorder can be treated successfully by a variety of techniques,... (Review)
Review
Although the full and precise etiology of TN still awaits further elucidation, this extremely painful disorder can be treated successfully by a variety of techniques, pharmacologic and surgical, with minimal side effects. There is no excuse in the 1990's for patients with TN not to be diagnosed promptly and treated expeditiously and successfully.
Topics: Carbamazepine; Electrocoagulation; Female; Humans; Male; Trigeminal Nerve; Trigeminal Neuralgia
PubMed: 1737446
DOI: No ID Found -
The Neurologist Mar 2009Trigeminal neuralgia is a syndrome of paroxysmal excruciating, lancinating unilateral facial pain. (Review)
Review
BACKGROUND
Trigeminal neuralgia is a syndrome of paroxysmal excruciating, lancinating unilateral facial pain.
REVIEW SUMMARY
There are several clinical features that are characteristic of trigeminal neuralgia, but there may be red flags that should suggest alternative diagnoses. There is convincing evidence that the idiopathic form develops from focal demyelination at the trigeminal root entry zone with subsequent ephaptic cross-talk between axons. Vascular compression of the nerve root causes this demyelination in most patients. Medical management of this condition, using anticonvulsant therapy and other agents, aims to dampen the abnormal electrical signals and to ameliorate symptoms. In refractory cases, a number of surgical interventions can be considered, the most common of which is microvascular decompression of the trigeminal nerve. Gamma knife therapy is emerging as an alternative treatment for the patient with medically refractive trigeminal neuralgia, particularly in the elderly patient with comorbid conditions.
CONCLUSION
Knowledge of the proper diagnosis and management of trigeminal neuralgia is essential to the successful management of these patients.
Topics: History, 18th Century; History, 19th Century; History, 21st Century; Humans; Radiosurgery; Trigeminal Nerve; Trigeminal Neuralgia
PubMed: 19276786
DOI: 10.1097/NRL.0b013e3181775ac3 -
Cleveland Clinic Journal of Medicine Jun 2023Guidelines for the diagnosis and treatment of patients with trigeminal neuralgia (TN) advocate for a multidisciplinary team approach to improve the care of patients with...
Guidelines for the diagnosis and treatment of patients with trigeminal neuralgia (TN) advocate for a multidisciplinary team approach to improve the care of patients with acute and chronic TN. Evidence-based discussions and decisions are encouraged to establish care pathways for prompt diagnosis and treatment, and long-term outcomes data collection to improve care. The guidelines include summary materials for patients to inform them about their condition and available treatments.
Topics: Humans; Trigeminal Neuralgia; Pain Management; Treatment Outcome
PubMed: 37263669
DOI: 10.3949/ccjm.90a.22052 -
Brain : a Journal of Neurology Dec 2001There is now persuasive evidence that trigeminal neuralgia is usually caused by demyelination of trigeminal sensory fibres within either the nerve root or, less... (Review)
Review
There is now persuasive evidence that trigeminal neuralgia is usually caused by demyelination of trigeminal sensory fibres within either the nerve root or, less commonly, the brainstem. In most cases, the trigeminal nerve root demyelination involves the proximal, CNS part of the root and results from compression by an overlying artery or vein. Other causes of trigeminal neuralgia in which demyelination is involved or implicated include multiple sclerosis and, probably, compressive space-occupying masses in the posterior fossa. Examination of trigeminal nerve roots from patients with compression of the nerve root by an overlying blood vessel has revealed focal demyelination in the region of compression, with close apposition of demyelinated axons and an absence of intervening glial processes. Similar foci of nerve root demyelination and juxtaposition of axons have been demonstrated in multiple sclerosis patients with trigeminal neuralgia. Experimental studies indicate that this anatomical arrangement favours the ectopic generation of spontaneous nerve impulses and their ephaptic conduction to adjacent fibres, and that spontaneous nerve activity is likely to be increased by the deformity associated with pulsatile vascular indentation. Decompression of the nerve root produces rapid relief of symptoms in most patients with vessel-associated trigeminal neuralgia, probably because the resulting separation of demyelinated axons and their release from focal distortion reduce the spontaneous generation of impulses and prevent their ephaptic spread. The role of remyelination in initial symptomatic recovery after decompression is unclear. However, remyelination may help to ensure that relief of symptoms is sustained after decompression of the nerve root and may also be responsible for the spontaneous remission of the neuralgia in some patients. In addition to causing symptomatic relief, vascular decompression leads to rapid recovery of nerve conduction across the indented root, a phenomenon that, we suggest, is likely to reflect the reversal of compression-induced conduction block in larger myelinated fibres outside the region of demyelination. Trigeminal neuralgia can occur in association with a range of other syndromes involving vascular compression and hyperactivity of cranial nerves. Clinical observations and electrophysiological studies support the concept that demyelination and ephaptic spread of excitation underlie most, if not all, of these conditions.
Topics: Humans; Multiple Sclerosis; Nerve Compression Syndromes; Trigeminal Neuralgia
PubMed: 11701590
DOI: 10.1093/brain/124.12.2347 -
Journal of Perioperative Practice Apr 2019
Topics: Denervation; History, 19th Century; History, 20th Century; Humans; Trigeminal Neuralgia
PubMed: 30035693
DOI: 10.1177/1750458918790185 -
Dental Update Mar 2016Trigeminal neuralgia (TN) is also known as 'tic douloureux' (in French, 'painful twitch'). It is a rare chronic facial pain syndrome, characterized by severe, brief,... (Review)
Review
Trigeminal neuralgia (TN) is also known as 'tic douloureux' (in French, 'painful twitch'). It is a rare chronic facial pain syndrome, characterized by severe, brief, stabbing, 'electric shock-like 'recurrent pain attacks felt in one or more divisions of trigeminal nerve innervation areas. So intense is the elicited pain that TN has a significant effect on a sufferer's quality of life, rendering many patients unable to consider a future with the ongoing threat of recurrent pain. The aim of this article is to discuss the diagnosis and management of this disabling facial pain condition. CPD/Clinical Relevance: As general medical practitioners may struggle differentiating TN from toothache, primary care dentists have an important role in excluding odontogenic cause of pain, diagnosing TN and referring patients to a facial pain clinic for further investigations and multidisciplinary team management.
Topics: Anticonvulsants; Decompression, Surgical; Diagnosis, Differential; Excitatory Amino Acid Antagonists; Facial Pain; GABA Agents; Humans; Pain Measurement; Quality of Life; Trigeminal Neuralgia
PubMed: 27188129
DOI: 10.12968/denu.2016.43.2.138 -
Physica Medica : PM : An International... Jul 2014Trigeminal neuralgia is a rare but debilitating pain syndrome with a distinct clinical presentation mainly affecting people advancing in years. Compression of the... (Review)
Review
Trigeminal neuralgia is a rare but debilitating pain syndrome with a distinct clinical presentation mainly affecting people advancing in years. Compression of the trigeminal nerve by an aberrant vascular loop has been proposed as the causative factor in the majority of cases leading to the development of a highly effective surgical treatment approach termed "microvascular decompression". Nevertheless the mainstay of treatment remains medical. This article gives a brief overview of current treatment options for trigeminal neuralgia with special emphasis on radiosurgery. Possible mechanisms underlying the therapeutic effect of radiosurgery are discussed with some consideration of implications for optimizing prescription dose and target definition.
Topics: Animals; Humans; Minimally Invasive Surgical Procedures; Radiation Dosage; Radiosurgery; Trigeminal Neuralgia
PubMed: 24889155
DOI: 10.1016/j.ejmp.2014.05.006 -
Disease-a-month : DM Jun 2022
Topics: Chronic Pain; Facial Pain; Humans; Trigeminal Neuralgia
PubMed: 34972547
DOI: 10.1016/j.disamonth.2021.101301 -
Lakartidningen Dec 2014
Topics: Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Trigeminal Nerve; Trigeminal Neuralgia
PubMed: 25514666
DOI: No ID Found -
Current Neurology and Neuroscience... Mar 2005Trigeminal neuralgia is considered to be one of the most severe forms of pain in the human experience. In this discussion, classical neurology, current advances in... (Review)
Review
Trigeminal neuralgia is considered to be one of the most severe forms of pain in the human experience. In this discussion, classical neurology, current advances in medical science, and the relief of human suffering converge in a single nerve. Improvements in the resolution of neuroimaging have elucidated neurovascular relationships in striking detail. The availability of new antiepileptic medications has expanded the range of therapeutic options for patients whose pain cannot be controlled by first-line agents. Further developments in neurosurgical and radiosurgical techniques have provided effective treatments with increasingly wider margins of safety. Significant advances in cortical stimulation technology are also making headway into pain relief and delineating the central mechanisms of chronic neuropathic pain.
Topics: Analgesics; Diagnosis, Differential; Humans; Motor Cortex; Radiosurgery; Trigeminal Neuralgia
PubMed: 15743543
DOI: 10.1007/s11910-005-0003-6