Medical therapy ought to be tried first in Trigeminal Neuralgia Treatment. Carbamazepine, gabapentin, baclofen, and IV phenytoin would be the most effective treatments. Oral phenytoin, valproic acid, clonazepam, topiramate, lamotrigine, and pimozide are alternatives. Distal nerve blocks or ablative procedures generally aren't recommended owing to a higher incidence of early recurrence. More proximal procedures include retrogasserian glycerol injections and radiofrequency gangliolysis, that have acceptable recurrence rates and minor complications. Focal radiation (radiosurgery) has better long-term results. The Jannetta procedure involves intracranial search for the trigeminal nerve root and elimination of aberrant blood vessels. It is the best surgical procedure, but it also has got the most complications.
Drug therapy as trigeminal neuralgia treatment
CARBAMAZEPINE proves good at most patients (and help read the diagnosis). Provided toxicity doesn't become troublesome, i.e drowsiness, ataxia, the dosage is increased untill the pain sensation relief occurs. When remission is made, drug therapy could be discontinued.
If pain control is restricted, other drug.- beclofen, lamotrigine, gabapentin, phenytoin- will benefit. Persistence of pain o full drug dosage or perhaps an intolerance of the drugs, indicates the requirement for more radical trigeminal neuralgia treatment.
Operative trigeminal neuralgia treatment Peripheral nerve techniques nerve block with alcohol or phenol provides temporary relief (as much as two years). Avulsion of the supra or infraorbital nerve gives more prolonged pain alleviation.
A radiosurgical lesion from the trigeminal ganglion provides another option to high risk surgical patients. Traumatising the trigeminal ganglion/roots within meckel's cave by either glycerol injection or by Fogarty balloon inflation usually produces good pain alleviation with minimal sensory loss.
Trigeminal root section: Most likely through a subtemporal or posterior fossa approach, the right trigeminal root is identified and divided.
Microvascular decompression: Search for the cerebellopontine angle reveals arteries in contact with the trigeminal nerve root or root entry focus the majority of patients. Seperation of those structures and insertion of the non absorbable sponge provides pain alleviation in most patients, with no associated problems of nerve destruction.
Radiofrequency thermocoagulation: The website of facial tingling made by electrical stimulation of the needle inserted in to the trigeminal ganglion, accurately identifies the position of the needle tip. Once the site of tingling matches the trigger spot or site of pain origin, radiofrequency thermocoagulation under general anaesthetic, creates a permanent lesion- usually leading to analgesia of the appropriate area with retention of sunshine touch.
Trigeminal Neuralgia Treatment Results and complications
Pain alleviation: Accurate comparison from the wide variety of techniques employed for trigeminal neuralgia is difficult; all but peripheral nerve avulsion seem to produce similar results. Approximately 80-85% of patients remain painless for a 5 year period, even though some may relapse in the long run, particularly after balloon compression or glycerol injection. Outcomes of peripheral nerve avulsion are less satisfactory with pain recurring in 50% within 24 months.
Dysaesthesia/ Anaesthesia dolorosa: this troublesome sensory disturbance follows any destructive method to nerve or root in 5-30 % of patients. Microvascular decompression avoids this issue and the risk of a serious deficit is low with glycerol injection.
Coroneal anaesthesia: this happens when root section or thermocoagulation requires the first division and keratitis may result.
Mortality: microvascular decompression and open root section have a very low mortality (<1%>), but this ought not to be ignored when comparing results with safer methods.
Trigeminal Neuralgia Treatment Selection
This largely depends upon the surgeon's personal prefernce and experience. in many centres, the absence of sensory complications make microvascular decompression the process of first trigeminal neuralgia treatment choice, particularly for 1st division pain as well as for younger patients.
Frail and elderly patients may tolerate glycerol injection, balloon compression and thermocoagulation easier than other procedures.
Physiotherapy in Trigeminal Neuralgia Treatment
Both acupuncture and TENS are great great controversy currently in the Western world; their traditional use for chronic pain has been questioned because (again) from the lack of evidence. This remains a controversial field, but both techniques seem to be relatively simple, fairly safe in appropriate hands and reasonably cheap. Acupuncture again has been said to work on descending inhibitory pain pathways also to stimulate endorphins (along with the body's natural cortisone).
Both good and bad results have been shown inside a bewildering variety of trials. There may be a powerful placebo effect, but there seems to be a significant analgesic component, albeit this may last for only a very short time, and the benefits seen with lots of patients may be due to some reduction in distress and disability engendered by their interaction using the therapist.
Again it is not easy to find a wealth of evidence as to the efficacy of TENS, but a restricted, albeit significant quantity of patients appear to get good benefit, which appears in some studies to become better than placebo.
Dorsal column stimulation is constantly on the excite interest. Clearly, this is often a useful therapy for moderate pain, particularly if it encourages entry right into a pain management programme-type approach.