Q: What symptoms can be diagnosed as trigeminal neuralgia?
A: The manifestation of trigeminal neuralgia is relatively typical. It is mainly a paroxysmal and severe pain occurring in the area innervated by the trigeminal nerve of the face. It is characterized by episodic pain, and the degree of pain is very intense. The patient feels a pain like a knife cut or electric shock. The pain comes on very suddenly, often lasting a few seconds or minutes, and then suddenly subsides. Sometimes the pain comes on suddenly while the patient is being seen, and the patient lies on the floor and rolls around in pain. This pain can have a remission period, where the pain is relieved for a period of time. Some of the relief periods can be as long as tens of days, and then a new cycle of attacks starts again. It is known as the “first pain in the world”, so much so that some patients can’t stand it and even seek suicide. In the past, the diagnosis of this disease was easy, but its treatment was more difficult.
Q: What are the treatments for trigeminal neuralgia?
A: The treatment methods for trigeminal neuralgia are mainly divided into three categories, which are recognized as effective methods at home and abroad. The first method is medication, which mainly allows patients to take oral drugs, including carbamazepine, gabapentin, oxcarbazepine, etc. This drug is effective for many patients. Patients may prefer to take oral carbamazepine for pain relief. The second method is minimally invasive interventional treatment, also known as trigeminal nerve hemimelia disruption. Chemical disruption is used, and radiofrequency thermocoagulation may also be used. Chemical disruption involves puncturing the nerve or ganglion with a nerve block needle and injecting the drug to destroy the responsible nerve, which is less precise and is now generally not recommended as medical conditions improve; radiofrequency thermocoagulation involves placing a very fine radiofrequency needle into the trigeminal meningeal ganglion, the tip of which can be heated to 70 to 80 degrees by technological means, causing a slight This method is more precise, less invasive, less expensive, and more acceptable to the patient. The third method is craniotomy, or microvascular decompression. It is performed by opening the skull to release the compression of the blood vessels on the trigeminal nerve. These three methods can be used separately for patients with different levels of pain.
Q: Some patients do not do well with large doses of carbamazepine. What are the side effects of long-term medication?
A: Carbamazepine is relatively safe if taken in small doses, but there are many side effects if taken in large doses and for a long time. For example, a long time to take a large number of will cause damage to liver and kidney function, we also encountered serious patients even lead to kidney failure, to do a kidney transplant. Another side effect of carbamazepine is that it can cause intractable insomnia, which is not easy to treat once it is formed. Another more serious side effect is exfoliative dermatitis. The patient’s skin may peel, ulcerate, and become painful, and the patient’s internal mucous membranes may also be prone to peeling, which may lead to gastrointestinal bleeding in severe cases. In addition, long-term use can cause damage to the hematopoietic system, and in severe cases, aplastic anemia can occur. Patients who take high doses for a long time should go to the hospital regularly to check liver and kidney function and blood count, preferably once a month. Once abnormal changes in these functions are detected, the drug should be discontinued in a timely manner. You should also pay attention to the occurrence of drug insomnia if you do not sleep well while taking the medication.
Q: What kind of patients are suitable for minimally invasive interventional therapy?
A: Many patients are suitable for minimally invasive treatment.
(1) Primary trigeminal neuralgia with standardized oral carbamazepine, the pain cannot be relieved and the quality of life is seriously affected.
(2) Significant adverse drug reactions to painkillers such as carbamazepine;
(3) Patients with trigeminal neuralgia who are too old and frail to tolerate open surgical treatment;
(4) Patients who are unwilling to undergo cranial trigeminal neurovascular decompression;
(5) Patients with recurrence after cranial trigeminal neurovascular decompression;
(6) Patients with recurrence after controlled radiofrequency thermocoagulation treatment, which can be recoagulated;
(7) Gamma knife treatment is unsatisfactory and pain is not eliminated or reduced;
(8) trigeminal neuralgia due to tumor, the pain is not improved by gamma knife or surgical treatment.
All the above patients can be considered for minimally invasive interventional treatment
Q: What is the trigger point?
A: Trigger point is a very sensitive pain point on the patient’s face, which is often a point of origin for the attack. When you touch this point, the patient will have a painful attack, and this point is often around the lips. So the patient will have an attack when he/she talks, drinks, or brushes his/her teeth. The presence of this point restricts the patient’s ability to eat, drink, and speak, making it very painful for the patient.
Q: Are there any psychological factors related to trigeminal neuralgia attacks such as good or bad moods?
A: Patients we met are not in a good mood, because most patients with chronic severe pain are accompanied by anxiety and depression, and many patients are in a very low mood. Many patients are depressed and have no interest in things around them, and some have even lost confidence in life. We have recently done some research on the psychological changes of trigeminal neuralgia patients, and it has been confirmed that many patients with trigeminal neuralgia have very high depression and anxiety index before treatment, and after treatment, the pain is relieved and the patient’s anxiety and depression index are reduced. The patient’s mood has also improved significantly, and the patient has rediscovered the joy of life.
Q: What is the effect of minimally invasive interventional treatment for trigeminal neuralgia?
A: As far as the current medical conditions are concerned, the effect of minimally invasive interventional treatment for trigeminal neuralgia is very good. Compared with those blind minimally invasive treatments (often called closure) in the past, nowadays, thanks to the positioning guided by CT, C-arm and other imaging equipment, plus the neurophysiological positioning, the treatment is very precise and basically avoids damaging other unnecessary tissues. This allows the pain-related nerve fibers in the trigeminal hemimelia to be more accurately destroyed, so that complications are minimized while treating the pain. This is a revolutionary advance in the treatment of trigeminal neuralgia.
Q: Will I lose consciousness on half of my face after the minimally invasive intervention? Are there any side effects and how long does the procedure take? What are the precautions?
A: After the minimally invasive interventional treatment, the sensation of half of the face will still exist, but the sense of touch will be somewhat dull, that is, the patient will feel some numbness in the original painful area, which will gradually reduce with time and the patient will gradually adapt. This sensation will gradually decrease with time and the patient will gradually adapt to it. Compared with the original severe pain, the patient usually feels that the numbness is nothing. Most patients have their pain go away after surgery, but a few patients need to have their pain go away within 7 to 10 days. So don’t be too anxious after this kind of surgery.
Another point is that patients who have been using a lot of carbamazepine for a long time should not stop the drug suddenly. Otherwise, there will be withdrawal symptoms, he will be very uncomfortable, there will be irritability, panic, dizziness, severe nausea, vomiting. For a large number of patients who have been taking medication for a long time after surgery, the dosage should be gradually reduced and the medication should be stopped within a few days.
In addition, patients in the post-operative period of RF should avoid strong stimulating foods, such as chili peppers and wine, and there are no too specific contraindications for other foods. These patients should also avoid foods that are too cold, too hot, or barbed to avoid adverse stimulation and damage to the nerves or oral mucosa.