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Trigeminal neuralgia is a disease of the elderly, the average age of patients is more than 60 years. Trigeminal neuralgia usually develops in women.

Reasons for this disease

It is believed that in most cases, the cause of this pathology is vascular compression of the trigeminal root at the level of cerebral pons. In simple words, the superior cerebellar artery passes near the trigeminal nerve and, under certain conditions, mechanical vibrations of the arterial wall are transmitted to the nerve, which causes demyelination (damage to the nerve membrane) of the nerve. A pathological focus of excitation is formed.

Trigeminal neuralgia develops due to the following reasons:

  • the presence of tumours and inflammatory processes that compress the nerve;
  • development of multiple sclerosis (the cause of secondary trigeminal neuralgia in 2-4% of cases);
  • the presence of meningitis;
  • inflammation in the sinuses;
  • blood vessel aneurysm;

How is the disease manifested?

Symptoms of trigeminal neuralgia are:

  • attacks of facial or head (frontal) aches;
  • the duration of the attacks is 5-20 seconds, but not more than 2 minutes;
  • a pain attack has at least 4 of the factors listed below

– spreads to one or more areas innervated by the trigeminal nerve;

– sudden, piercing, shooting, burning pain;

– pain most often occurs during exposure to triggering factors (food, conversation, brushing, etc.);

– during the attack, a certain behaviour of the patient is observed: he freezes, does not move, tries not to speak);

– in the interictal period, neurological symptoms are absent;

  • in each patient, seizures are stereotypical and individual.

Diagnostic measures

Diagnosis of trigeminal neuralgia involves the exclusion of other causes of facial pain based on the studying of the medical history, neurological examination, the use of special diagnostic methods – CT, MRI.

 

Trigeminal neuralgia treatment should be started as soon as the first signs of the disease have appeared. Prolonged compression of a nerve can lead to irreversible pathological processes. The treatment of trigeminal neuralgia is selected by the doctor individually in each case.

The main goal of treatment is relief of pain and prevention of the attacks relapsing.

The main methods used in the treatment of trigeminal neuralgia:

  1. Conservative
  • acupuncture;
  • injections;
  • the use of special simulators that relieve muscle spasms and release the nerve from pressure;
  • blockade (used for severe pain that cannot be stopped with medications);
  • pharmacotherapy;
  • conducting a course of physiotherapy.

The main medications used to treat this pathology are:

  • Carbamazepine (Finlepsin) – at the beginning of therapy is effective in 85-90% of cases, but in the future, its effectiveness decreases. The average daily dose is 600-800 mg in 2-3 doses;
  • Lyrica (pregabalin)
  • TCAs (tricyclic antidepressants);
  • selective serotonin reuptake inhibitors;
  • Tramadol, methadone, valproate and other anticonvulsants.

With the ineffectiveness of drug therapy, as well as in cases of pronounced side effects that impede its implementation, the question of surgical treatment is raised.

  1. Surgical
  • percutaneous high-frequency selective rhizotomy;
  • balloon microcompression;
  • glycerol rhizotomy;
  • microvascular decompression.
  1. Radiosurgical method – gamma knife.

At the Medical Center «MedClinic» radiofrequency destruction of the trigeminal ganglion is performed – the most accurate medical technology, which is based on selective thermocoagulation of nerve structures with special electrodes.

Features:

  • Hospitalisation is required for 1-2 days.
  • Preoperative laboratory and instrumental examination are necessary.
  • It is conducted in an x-ray room under the control of an electron-optical converter.
  • It is carried out under intravenous anaesthesia.
  • The affected area is neatly and reliably controlled.
  • Short recovery period.
  • Persistent and long-lasting effect.

Trigeminal neuralgia

Media

13.04.2020

Алгология

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