Drug treatment for trigeminal neuralgia
The most commonly used treatment for trigeminal neuralgia is medication, mainly divided into two categories: antiepileptic drugs, the most used is carbamazepine; non-epileptic drugs, less used, and of course, some neurotrophic and restorative drugs can be applied. Effective medication is also an element of the diagnosis of trigeminal neuralgia, but the effectiveness of the medication will gradually become worse over time.
Clinical application of carbamazepine.
【Therapeutic principle】Inhibit nerve excitatory impulse transmission to relieve pain
The population for which the drug is recommended for trigeminal neuralgia patients in the early and middle stages of the disease
Treatment characteristics: Carbamazepine and other drugs have high efficiency when first used, and poor effect in the middle and late stages of the disease
Complications and risks】Long-term medication can cause liver and kidney damage, drowsiness, hematologic disorders, such as hematopoietic dysfunction, leukopenia, and immune deficiency
Relapse rate】Can’t be cured, may relapse if you stop taking the drug
Treatment cost】The cost is cheap
The treatment time] long-term use, can not stop the drug, stop the drug can be painful attacks
Trigeminal neuralgia closed treatment
The trigeminal neuralgia closure treatment is also a relatively common treatment, is the use of destructive tissue fluid such as alcohol, glycerin, etc. on the trigeminal nerve stem, branch for the Sun Xing injection, in order to achieve the purpose of pain relief. This method is relatively simple, often performed in the outpatient clinic, 1 injection pain relief period is generally about 6 months, easy to relapse, when ineffective or recurrence can be repeated injection.
Treatment principle】Injecting a chemical drug (anhydrous alcohol, glycerin, etc.) into the peripheral branches of the trigeminal nerve can only be injected into a certain one, breaking the function of a nerve and causing loss of sensation in that area.
The treatment of trigeminal neuralgia can not be cured.
Treatment characteristics] Cannot be cured, pain is obvious during treatment
Complications and risks】More than 60% of patients will have sensory branch damage in the nerve distribution area after the treatment, 10-15% of patients will have nerve palsy keratitis, and 10% of patients will have prolonged masticatory muscle paralysis.
The recurrence rate is extremely easy to recur, many patients have recurrence after closed treatment of trigeminal neuralgia, as short as 3 hours, long patients may recur in half a year
The cost of treatment ranges from a few hundred dollars to more than a thousand
Treatment time】half hour to one hour
Radiofrequency thermal coagulation treatment for trigeminal neuralgia
The treatment is based on the use of a special long needle, which is punctured to the trigeminal nerve, and heated to about 65-90 degrees using a radiofrequency instrument to denature and necroticize the nerve and short circuit the nociceptive conduction. During the heating time, the patient will experience severe pain
The nerve fibers that transmit nociceptive sensation can degenerate at 70-75 degrees and lose their nociceptive conduction function, while the nerve fibers that transmit tactile and proprioceptive sensation are not affected by this temperature.
Applicable groups】1.Ineffective drug treatment or can not tolerate drug side effects
2.Patients who are older or cannot tolerate or do not want to undergo craniotomy
3.Patients who have undergone other pain relief surgeries and then relapsed
Treatment features】Little trauma, fast pain relief, but patients need to endure severe pain during the treatment
Complications and risks】Domestic Professor Wang Yehan has counted 6,205 cases for efficacy analysis: the postoperative remission rate is 91-99%, complications are mainly as follows: 1, facial sensory disorders 94%, 2, eye damage incidence 3-27% (mainly for the loss of corneal reflex) 3, food reperfusion 0.3-3%, 4, zoster 1/3, (self-healing after a few days), other rare complications are Cerebral nerve palsy, arteriovenous fistula, meningitis, masticatory muscle weakness, etc.
Recurrence rate] BROWN has studied 6235 patients, the results suggest that: 98% of patients immediately after surgery pain relief, 3 years after surgery recurrence rate of 2%-8%, 5 years for 25%-37%, complications of corneal paralysis 7%, keratitis <5%
The cost of treatment is about $8,000 and requires hospitalization.
Treatment time】Treatment time is about one hour
Microvascular decompression surgery for trigeminal neuralgia
The trigeminal neuralgia of many patients is due to the compression of the nerve by the blood vessels around the trigeminal nerve root, and the clinical MRI time leap imaging of patients with symptoms of vascular compression can clearly find that the trigeminal nerve root is compressed by blood vessels. After a long period of clinical practice, some domestic experts believe that microvascular decompression is feasible even without vascular imaging in MRI examination, and the efficacy can also reach more than 90% of cases
Treatment principle】A 2*2cm bone hole is made behind the papillae of the posterior cranial fossa, and a Tefflon piece is placed between the responsible vessel and the trigeminal nerve root, which is compressing the nerve root.
[Applicable population] Patients with obvious vascular compression as shown by MRI; young and middle-aged patients, patients with good general physical condition
Treatment features】1. Real etiological treatment, very precise efficacy and low recurrence rate
2. Trigeminal nerve function can be preserved and less permanent neurological deficits are left behind
3, surgery requires craniotomy, there are certain risks
Complications and risks] Complications are rare, mainly cerebrospinal fluid leakage, headache and dizziness, facial sensory loss, etc.
Recurrence rate] The recurrence rate is low, this method is the so-called removal of the root of the disease in Chinese medicine
The cost of treatment is around 30-50,000 yuan
Treatment time】pre-operative examination is required, hospitalization 7~10 days
Gamma knife treatment for trigeminal neuralgia
The nociceptive cells of trigeminal neuralgia are very sensitive to gamma radiation, and the use of a certain dose of radiation to irradiate the nociceptive nerve can achieve the purpose of treating pain, while not damaging the function of the trigeminal nerve
[Treatment principle] a large dose of gamma irradiation trigeminal nerve root nociceptive conduction nerve, blocking the nociceptive conduction pathway, without affecting the normal nerve
[Applicable people] 1, patients with intractable trigeminal neuralgia for which drug treatment is ineffective.
2, patients who receive other treatment modalities that are ineffective or relapse.
3, combined with diabetes, hypertension, heart disease and other chronic diseases, senior patients can be applied
Treatment features] Positioning under MRI, precise positioning, treatment efficiency 90%. Slow onset of action, generally more than a month
Complications and risks】10-15% of patients have slight facial numbness, abnormal sensation, etc. Some patients have masticatory muscle paralysis, and very few have dizziness symptoms
Recurrence rate】High long-term recurrence rate, repeatable treatment
Treatment cost】About 20,000 yuan
Treatment time】Treatment time of about 1 hour, no hospitalization, does not affect normal life, work.