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Trigeminal nerve neuralgia – diagnosis, treatment

trigeminal nerve neuralgiaDiagnostic criteria for trigeminal nerve neuralgia:

1. Paroxysmal attacks (sudden onset and end) of pain, lasting from fractions of a second to 2 minutes, affecting one or more branches of the trigeminal nerve.
2. The pain has at least one of the following characteristics:

  • Intense, sharp, superficial or like a nudge;
  • It is precipitated by stimulation of trigger areas or by action of trigger factors.

3. The attacks are stereotyped at the same individual.
4. There is no clinically evident neurological deficit (no sensitivity problems, preserved corneal reflex).
5. Not attributed to other diseases.

Trigeminal neuralgia usually begins at 2 and 3 branches of the trigeminal nerve, affecting the cheeks or chin. In less than 5% of cases, is affected the first branch, the ophthalmic.

Pain never affects the opposite part (being stereotyped attacks), but may be bilateral, in this case it is suspected a central cause (multiple sclerosis).

Between attacks, the patient is usually asymptomatic, but a dull ache may persist. After cropping of paroxysmal pain it follows a refractory period, during which the pain can’t be triggered.

The pain is sudden and intense, the patient shudders and has spasms of the face muscles, hence the name of twitch pain.

Trigger zone stimulation is done by touch, talking, chewing, washing teeth.

Triggering can be achieved, especially through the tactile stimulus and less with painful or thermal stimulus.

Laboratory investigations have revealed that patients in question have a compression on trigeminal branch, due to aberrant or tortuous vessels.

Laboratory investigations (MRI) are required to exclude intracranial pathology and to highlight the vascular vessel that makes compression.

Treatment of trigeminal nerve neuralgia

Medications for trigeminal nerve neuralgia

1. AEDs: carbamazepine. It begins with small doses, leading progressive to doses of 600-800 mg / day. Similar effects are obtained with Neurontin, Lyrica, Trileptal.
2. Baclofen – in combination with carbamazepine.
3. Antidepressants: amitriptyline.

Trigeminal nerve neuralgia surgery

Percutaneous methods: percutaneous rhizotomy with glycerol.

Microvascular decompression.

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