Trigeminal neuralgia, also known as painful twitching, is a disorder characterized by recurrent, transient paroxysms of severe pain in the trigeminal nerve distribution of the face. There are two types of trigeminal neuralgia: primary and secondary.
Symptoms and treatment of primary trigeminal neuralgia are described below.
Clinical symptoms
1. it mostly starts after middle age, and pain is the most prominent manifestation of the disease.
2, pain is limited to the trigeminal nerve distribution area, mostly unilateral, often located in the upper lip, nose, corners of the mouth, incisors and buccal mucosa.
3, the pain is often without aura before the onset, it is a sudden lightning-like attack, the nature of the cut, burning, pinprick or electric shock-like, lasting a few seconds or minutes and then suddenly stop, the attack is very painful, often accompanied by birth, tears, facial twitching, etc..
4. There are often “trigger points” in the painful area, and pain attacks are triggered by mechanical factors such as washing, brushing, talking and eating.
5. There is no abnormality in physical examination and cranial CT or MRI examination.
Treatment
Principles of treatment for primary trigeminal neuralgia.
Drug treatment should be preferred after clear diagnosis, and surgical methods should be actively considered when drug treatment is ineffective or obvious adverse drug reactions occur.
When drug treatment is ineffective or only partially effective, it is necessary to reconsider whether the diagnosis is correct. If the diagnosis is correct, the medication method is appropriate or the drug has high toxic side effects, then non-conservative treatment should be considered. In addition, it should be noted that drugs can only relieve or reduce the pain symptoms, and patients often have a strong dependence on drugs. As the course of the disease lengthens, it is mostly necessary to increase the dose of drugs to achieve pain relief, and when patients take larger doses of drugs, the treatment should be changed in time. Carbamazepine is currently the drug of choice for the treatment of trigeminal neuralgia. The mechanism is to reduce the response of neurons in the trigeminal nucleus of the spinal cord to stimulation. The initial dose of 200mg is given 1-2 times a day, and the symptoms are not controlled, and the dose is increased by 100mg a day until the pain is relieved or adverse reactions occur. The maximum daily dose is 1000mg-1600mg. about 30% of cases have adverse drug reactions such as dizziness, drowsiness, unstable walking and rash, liver damage, bone marrow suppression, etc. Other drugs are: phenytoinamide, heptaerythrone, baclofen, etc.
2, nerve block: methods include percutaneous puncture radiofrequency disruption, percutaneous puncture postganglionic glycerol injection, percutaneous puncture trigeminal nerve balloon compression, and percutaneous puncture chronic electrical stimulation treatment.
Applicable to.
(1) Those who are ineffective in drug therapy or cannot tolerate adverse drug reactions.
(2) Those who are too old or in poor general condition to tolerate craniotomy.
(3) cases with multiple sclerosis. The main problems of this treatment method are high recurrence rate of pain (23%-54%) and facial numbness, corneal ulcer and chewing difficulty caused by nerve damage.
3.Chinese medicine: Chinese medicine, acupuncture, etc.
4.γ-knife: It is a kind of radiation treatment method, which does not require cranial opening. γ-knife treatment for trigeminal neuralgia is to use one-time, high-dose γ-ray to destroy the trigeminal sensory nerve roots to achieve pain relief.
It is suitable for.
(1) Those who are ineffective in drug treatment or cannot tolerate the adverse effects of drugs.
(2) Those who are ineffective in other treatments or relapse.
(3) Those with combined multiple sclerosis.
(4) Those who are in poor physical condition or old and cannot tolerate the surgery or cannot stop the treatment with certain drugs (such as anticoagulants) due to the surgery. gamma-knife treatment has no surgical risk, but the pain can be relieved only after 3 months or even half a year after the treatment in about 70% of the patients.
5.Surgery.
Microvascular decompression is currently the safest and most effective surgical treatment, other surgical methods are all due to poor therapeutic effect and many surgical complications, and are now less used.
Surgical treatment is suitable for.
(1) Those who have failed in drug or percutaneous puncture treatment.
(2) Those who cannot accept other methods of treatment and then develop facial numbness.
(3) Those with pain in the 1st branch of the trigeminal nerve.
(4) Patients in good general condition, without serious organic lesions, who can tolerate surgery.
(5) Excluding tumors of the pontocerebellar horn, multiple sclerosis, coagulation mechanism disorders and those with serious damage to multiple organs of the body. Most of the patients’ pain can disappear after surgery, and 95% of the patients can be cured.