Trigeminal Neuralgia

Background

EarlyStages keyTrigeminal neuralgia, also known as tic douloureux, is a nerve disorder in which irritation of the trigeminal nerve causes stabbing pain in the face. This pain is usually limited to one side and involves the lower face and jaw. Pain attacks can be triggered by any kind of stimulation to the face, such as touching, drinking, talking, or smiling.

There is no single cause for trigeminal neuralgia; however, the most common cause is when the nerve is irritated by contact with a healthy blood vessel. Tumors and Multiple Sclerosis are other causes.

According to the American Association of Neurological Surgeons, approximately 150,000 people are diagnosed with trigeminal neuralgia each year. An estimated 5 million individuals are affected worldwide. The disorder occurs more commonly among adults older than 50 years.

Current Treatment

Current treatment options for trigeminal neuralgia involve:

Medications

  • Anticonvulsants
  • Antispasmodic agents: These drugs can be used alone or in combination with the anticonvulsants


Invasive Procedures

  • Microvascular decompression: This procedure involves moving aside blood vessels that are in contact with the trigeminal nerve and is considered the gold standard treatment in patients who are healthy enough to undergo surgery.
  • Gamma knife radiosurgery: A focused dose of radiation is aimed at the trigeminal nerve where it enters the brainstem. Damage to the nerve leads to the reduction or elimination of pain.
  • Glycerol injection: A thin needle is used to inject glycerol at the base of the skull. The glycerol damages the insulation of the trigeminal nerve and blocks pain signals. This procedure can be repeated multiple times.
  • Balloon compression: A catheter containing a small balloon is inserted into the cheek using a small needle. The balloon is placed where the trigeminal nerve enters the base of the skull. The balloon is inflated, applying pressure to the nerve and blocking pain signals.
  • Radiofrequency thermal rhizotomy: A catheter containing a small thermal electrode is inserted at the base of the skull. A small electric current is used to create lesions and cause damage to the trigeminal nerve.

Focused Ultrasound Treatment

Focused ultrasound could provide a noninvasive way to heat and destroy the pain fibers of the trigeminal nerve as an alternative to radiofrequency ablation and gamma knife surgery. A recent preclinical study on cadavers has demonstrated the feasibility of focused ultrasound to heat the trigeminal nerve. More work is needed in preclinical models and, eventually, in patients to determine the efficacy and safety of focused ultrasound treatment for trigeminal neuralgia.

Notable Papers

Monteith SJ, Medel R, Kassell NF, Wintermark M, Eames M, Snell J, Zadicario E, Grinfeld J, Sheehand JP, Elias WJ. Transcranial magnetic resonance-guided focused ultrasound surgery for trigeminal neuralgia: a cadaveric and laboratory feasibility study. J Neurosurg. 2013;118(2):319-28.

Click here for additional references from PubMed.

     

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