Trigeminal Neuralgia (TN) also called Tic Doloureux is thought to be one of the most painful conditions known to medicine. It is characterized by sudden and severe stabbing, bursts of shock like or electrical pain usually on one side of the face. The pain can be triggered by simple activities like brushing teeth, eating and drinking or talking.
Pain attacks can come and go and can go into remission for long periods of time, from days to weeks to years. Atypical TN, a less common form of the condition, has an aching and burning component to it; sometimes both are experienced. In addition, TN can be a consequence of Multiple Sclerosis.
If medication is ineffective or side effects are too severe there are neurosurgical procedures to either relieve pressure on the nerve or to create numbness instead of pain. About five out of every 100,000 people, or 1,500 people, are diagnosed with TN each year in Canada. In the US it is classified as a rare disease.
TNAC hopes that individuals who suspect they have, or do have, TN, will use the above information, along with the other information and sources we provide, to seek answers. There is always hope and it is our hope that you will find information, support, and help from our pages as you walk through the journey of trigeminal neuralgia.
For a comprehensive description of TN go to: http://www.umanitoba.ca/cranial_nerves/ccndhome.htm.
Treatment Options
Patients are usually treated first with drugs. The ones used are anti-seizure drugs and it is believed that these drugs alter the way the brain transmits pain signals. Drugs include:
- Carbamazepine (Tegretal)
- TNAC Oxcarbazepine (Trileptal)
- TNAC Gabapentin (Neurontin)
- TNAC Phenytoin (Dilantin)
- TNAC Baclofen
Links to Treatment of Trigeminal Neuralgia:
- Treatment Options: A talk by Vancouver neurosurgeon, Dr. Chris Honey
- TNAC Treatment of Trigeminal Neuralgia from the Centre for Cranial Nerve Disorders in Winnipeg, MB
- TNAC Options for Treating Neuropathic Facial Pain and Trigeminal Neuralgia from The Facial Pain Association in the USA
Surgery
If the drugs are ineffective or if the side effects become bothersome, then surgery is an option. Surgical options can be classified in one of two ways: Nerve preserving or nerve damaging.
Nerve Preserving Surgery
The Microvascular Decompression or MVD involves opening the skull and exposing the nerve. The surgeon locates the blood vessels near the nerve and places Teflon padding between the nerve and blood vessel. The MVD has a success rate of 85-90%. After 15 – 20 years about half the patients will have the return of some pain.
This is major surgery and the risks include death (up to 1% in some reports), stroke, hearing loss, facial nerve weakness, meningitis, cerebral spinal fluid leaks, and seizures.
Patients must remain in the hospital for 3 to 5 days and recovery can take about 2 months.d.
Percutaneous Procedures
Percutaneous procedures are done through the skin. The surgeon slides a needle into the skull base so that the tip lies near the Trigeminal nerve’s ganglion.
Glycerol or alcohol – is placed on the nerve and left there to chemically damage the nerve.
Balloon compression – a small balloon at the end of the needle is inflated for a few minutes which damages the nerve mechanically.
Radiofrequency uses electricity to damage the nerve.
In all these percutaneous procedures there is an 85% early success rate but within 5 years about half of the patients will have pain return. These procedures can be repeated.
Stereotactic Radiosurgery
There are several machines used. All provide focused radiation to a small point near the nerve’s origin from the brainstem.The nerve is damaged using radiation.
- Modified LINAC – this is machine currently used in Calgary, Vancouver, Toronto, Ottawa, Halifax, Montreal
- Gamma Knife – uses cobalt radiation and is the machine used in Winnipeg (soon to be in Toronto and Sherbrooke)
- Novalis – currently only Canadian site is Calgary. With this machine the size and shape of the beam can be adjusted to achieve an optimal homogeneous or modulated dose of radiation.)
Secondary TN
The compression of the nerve is caused by a tumor or a vascular abnormality. It occurs in less than 2% of TN. The pain is slightly different with some associated sensory changes, numbness or weakness.
TN Secondary to Facial trauma
The pain may be more throbbing and burning than the electrical shock like pains of typical TN and associated with significant facial trauma or reconstructive surgery.
Post- herpetic Neuralgia
The pain follows an attack of shingles. People describe it as a crawling, prickling and burning sensation.
Anesthesia Dolorosa
A complication of the surgeries for TN. Patients experience a combination of numbness and burning pain. It is very difficult to treat.