The age of onset of trigeminal neuralgia is wide, and the literature reports that the youngest age of onset is 10 years old and the oldest is 89 years old, but most of the age of onset is middle-aged and elderly, and some people count an average of 51 years old. When trigeminal neuralgia occurs at the age of 20-40 years, it should be mostly considered as demyelinating damage in the pontine brain due to multiple sclerosis. The incidence of trigeminal neuralgia is slightly higher in women than in men, and it is generally believed that the ratio of men to women is 2:3.
The treatment methods for primary trigeminal neuralgia are as follows.
I. Drug treatment.
1, carbamazepine: also known as aminometrazine, carbamazepine, pain spasmodicin, is currently considered the best drug for the treatment of trigeminal neuralgia. Treatment begins with oral 0.1 to 0.2 grams , 1 to 2 times a day. Gradually increase the dosage until the pain disappears, maintain for about 2 weeks, and then gradually reduce the dosage. General daily dosage of 0.4 to 0.6 grams, the maximum dose does not exceed 1.2 grams / day.
2. Phenytoin sodium: Adults start treatment with 0.1 gram each time and take it orally 3 times a day, gradually increase the dosage to a maximum of 0.8 gram/day, and then gradually reduce the dosage after the pain disappears for a week. Intramuscular or intravenous injection of 0.125~0.25g once, the total daily amount should not exceed 0.5g, temporarily applied after dissolving with isotonic saline. Side effects include dizziness, drowsiness, and ataxia.
3. Aminolevulinic acid: It can be used as an alternative to the above two drugs. The dose is 10 mg per dose, 3 times a day, increasing daily to 60-80 mg per day. Side effects: Drowsiness, nausea or vomiting.
4. Clonidine: The initial oral dose is 1 mg/day, divided into three oral doses to produce therapeutic effects, and then the dose is adjusted by 0.5 to 1 mg every three days until there is satisfactory therapeutic effect, and the maintenance dose is 3 to 12 mg/day. The maintenance dose is 3-12 mg/day. This drug varies greatly among individuals and can reach a maximum of 20 mg/day. The dose should be gradually reduced when discontinuing the drug.
5.Mark Phenolsen: take 1 gram orally 3 times a day, if tolerated, gradually increase 3 grams each time, 3-5 times a day, until the pain disappears. Or dissolve 4 grams of mark phenol raw in 5% glucose 500 ml, in 12 hours of drops, with 2-3 days of pain relief to oral.
6, vitamin B12: use each 100 micrograms, once a day, intramuscular injection, for 10 days, to 2 to 3 times a week for 3 weeks. It is usually combined with carbamazepine or phenytoin sodium.
7. Scopolamine: i.e. “6542”, 5-10 mg per dose orally, 3 times a day. After the pain is relieved, it should be changed to 10 mg once a day.
8.Seven-leaf lotus: 3 tablets each time, 4 times a day. Intramuscular injection of 4 ml each time, 1 to 2 times daily. Can be combined with other drugs.
9.Mao Dongqing: 2 to 4 tablets each time, 3 times daily. Severe symptoms can be injected intramuscularly, 2 ml each time, 2 times a day.
Second, closure therapy.
Inject anhydrous alcohol or other chemical drugs directly into the peripheral branches of the trigeminal nerve, nerve trunk or semilunar ganglion, causing coagulative necrosis of the nerve tissue at the injection site, blocking the conduction function of the nerve, resulting in the loss of sensation in the distribution area of the nerve, thus eliminating the disease. The most commonly used drug for occlusion therapy is anhydrous alcohol, followed by glycerin, vitamin B12, prednisolone, etc. The puncture site is chosen as the fixed puncture point in the area of the corresponding trigeminal neuralgia attack, such as the supraorbital foramen of the first branch, the infraorbital foramen of the second branch, and the chin foramen of the third branch. If the comprehensive treatment such as medicine and alcohol closure does not work, and the condition is serious and the physical condition allows, surgery can be considered.
Third, the current surgical treatment can be broadly divided into the following four types.
1.Severance of the peripheral branches of the trigeminal nerve.
2, trigeminal nerve sensory root amputation, as the current preferred procedure.
3.Trigeminal nerve spinal tractotomy, only for individuals with severe first branch pain or in bilateral trigeminal neuralgia, choose one side for this operation.
4. decompression of the semilunar ganglion and posterior roots.
5, for young people suffering from first branch pain or bilateral trigeminal neuralgia.