Trigerminal Neuralgia

Posted by e-Medical PPT
Trigeminal neuralgia is a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve. One, two, or all three branches of the nerve may be affected. The disorder is characterized by episodes of intense facial pain that last from a few seconds to several minutes or hours. The episodes of intense pain may occur paroxysmally. To describe the pain sensation, patients may describe a trigger area on the face so sensitive that touching or even air currents can trigger an episode; however, in many patients the pain is generated spontaneously without any apparent stimulation. It affects lifestyle as it can be triggered by common activities such as eating, talking, shaving and brushing teeth. Wind, high pitched sounds, loud noises such as concerts or crowds, chewing, and talking can aggravate the condition in many patients.
There is also a variant of trigeminal neuralgia called atypical trigeminal neuralgia. This variant is also called "trigeminal neuralgia, type 2",based on a recent classification of facial pain. In some cases of atypical trigeminal neuralgia the sufferer experiences a severe, relentless underlying pain similar to a migraine in addition to the stabbing shock-like pains.
Several theories exist to explain the possible causes of this pain syndrome. It was once believed that the nerve was compressed in the opening from the inside to the outside of the skull; but newer leading research indicates that it is an enlarged blood vessel - possibly the superior cerebellar artery - compressing or throbbing against the microvasculature of the trigeminal nerve near its connection with the pons. Such a compression can injure the nerve's protective myelin sheath and cause erratic and hyperactive functioning of the nerve. This can lead to pain attacks at the slightest stimulation of any area served by the nerve as well as hinder the nerve's ability to shut off the pain signals after the stimulation ends.
Anticonvulsants are a common treatment strategy for trigeminal neuralgia. Carbamazepine is the first line drug; second line drugs include baclofen, lamotrigine, oxcarbazepine, phenytoin, gabapentin, and sodium valproate. Uncontrolled trials have suggested that clonazepam and lidocaine may be effective.Low doses of some antidepressants such as amitriptyline are thought to be effective in treating neuropathic pain.


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