Neuralgia of the trigeminal nerve: symptoms and treatment

Neuralgia of the trigeminal nerve (Tricso's pain tick, Phosergil's disease, trigeminal neuralgia) is a fairly common disease of the peripheral nervous system, the main a sign of which is paroxysmal, very intense pain in the innervation zone (connections with the central nervous system) of one of the branches of the trigeminal nerve. The triple nerve is a mixed nerve, it carries out a sensitive innervation of the face and motor innervation of the masticatory muscles.

A wide variety of factors underlying the disease, painful pain, social and labor disadaptation, long-term medication when untimely treatment - not the whole range of reasons that keep this problem at the top of the neurological diseases rating. Symptoms of neuralgia of the trigeminal nerve are easily recognizable even by non-professionals, but only a specialist can prescribe the treatment. Let's talk about this ailment in this article.

Content

1Causes of trigeminal neuralgia
2Symptoms
- 2.1Pain syndrome
3Diagnostics
4Treatment
5Prevention

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Causes of trigeminal neuralgia

The triple nerve is the 5th pair of cranial nerves. A person has two trigeminal nerves: left and right; the disease lies in the defeat of its branches. Total trigeminal nerve has 3 main branches: the optic nerve, the maxillary nerve, the mandibular nerve, each of which breaks up into smaller branches. All of them on their way to the innervated structures pass through certain openings and channels in the bones of the skull, where they can be subjected to compression or irritation. The main reasons for this can be systematized as follows:

congenital constriction of openings and canals along the branches;
pathological changes in blood vessels located near the nerve (aneurysms, or protrusion of the walls of the arteries, any abnormalities of vascular development, atherosclerosis) or their abnormal location (often the upper cerebellar artery);
cystic-adherent processes in the branching of the trigeminal nerve as a result of ocular, otorhinolaryngological, dental diseases (inflammation of the sinuses - frontitis, sinusitis, etmoiditis, odontogenic periostitis, pulpitis, caries, iridocyclitis, etc.);
metabolic disorders (diabetes mellitus, gout);
chronic infectious diseases (tuberculosis, brucellosis, syphilis, herpes);
tumors (any, localized along the nerve path);
hypothermia of the face (draft);
trauma to the face and skull;
multiple sclerosis;
rarely - a stroke.

The pathological process can affect both the entire nerve and its individual branches. More often, of course, there is a lesion of one branch, but in most cases untimely treatment leads to the progression of the disease and the involvement of the entire nerve in the pathological process. During the disease, several stages are isolated. At a late stage (the third stage of the disease) the clinical picture changes and the prognosis regarding recovery considerably worsens. Determining the cause of the disease in each case allows you to select the most effective treatment and, accordingly, accelerate healing.

Symptoms

The disease is more typical for middle-aged people, more often diagnosed in 40-50 years. The female sex suffers more often than the male sex. The right trigeminal nerve is more often affected (70% of all cases). Very rarely trigeminal neuralgia can be bilateral. The disease is cyclical, that is, periods of exacerbation are followed by periods of remission. Aggravations are more characteristic for the autumn-spring period. All manifestations of the disease can be divided into several groups: pain syndrome, motor and reflex disorders, vegetative-trophic symptoms.

Pain syndrome

The nature of the pain: the pain is paroxysmal and very intense, painful, sharp, searing. Patients often stop at the moment of an attack and even do not move, compare a pain with passage of an electric current, a lumbago. Duration of the paroxysm from several seconds to several minutes, but within a day the attacks can be repeated up to 300 (!) Times.

Pain localization: pain can capture both the innervation zone of one of the branches, and the entire nerve on one side (right or left). One of the features of the disease is the irradiation (spread) of pain from one branch to the other with the involvement of the entire half of the face. The longer the disease exists, the more likely it is to spread to other branches. Localization zones:

the optic nerve: the forehead, the anterior hairy part of the head, the nose, the upper eyelid, the eyeball, the inner corner of the eye, the mucosa of the upper nasal cavity, the frontal and latticular sinuses;
maxillary nerve: upper part of cheek, lower eyelid, outer corner of eye, upper jaw and its teeth, nose wing, upper lip, maxillary sinus, nasal mucosa;
the mandibular nerve: the lower part of the cheek, the chin, the lower jaw and its teeth, the lower surface of the tongue, the lower lip, the mucous membranes of the cheeks. Pain can be delivered to the temple, neck, neck. Sometimes the pain is clearly localized in the area of one tooth, which encourages patients to go to the dentist. However, the treatment of this tooth does not eliminate the pain.

Provocation of pain: the development of pain paroxysm can be caused by touching or lightly pressing on the so-called trigger (trigger) zones. These zones are quite variable in each individual patient. More often it is the inner corner of the eye, the back of the nose, the eyebrow, the nasolabial fold, the nose wing, the chin, the corner of the mouth, the mucous membrane of the cheek or gum. Also provocation of an attack is possible at pressing on exit points of branches on the face: supraorbital, infraorbital, chin aperture. Pain can also be caused by talking, chewing, laughing, washing, shaving, brushing teeth, applying make-up, even blowing wind.

Behavior at the time of the attack: the patients do not cry, do not cry, but freeze, trying not to move, rub the area of pain.

Motor and reflex disorders:

spasms of the muscles of the face (hence the name of the disease "pain tick"): during a painful attack involuntary muscle contraction in the circular eye muscle (blepharospasm), in the chewing muscles (trismus), in the other facial muscles. Often, muscle contractions extend to the entire half of the face;
changes in reflexes - superciliary, corneal, mandibular, - that is determined by neurologic examination.

Vegetative-trophic symptoms: observed at the time of attack, at the initial stages are expressed slightly, with the progression of the disease necessarily accompanied by pain paroxysm:

skin color: local pallor or redness;
changes in gland secretion: lachrymation, salivation, runny nose;
late signs: develop with prolonged existence of the disease. There may be swelling of the face, greasiness of the skin or its dryness, loss of eyelashes.

In the late stage of the disease, the focus of pathological pain activity in the visual hillock (thalamus) in the brain is formed. This leads to a change in the nature and localization of pain. Elimination of the cause of the disease in this case no longer leads to recovery. The distinctive features of this stage of the disease are the following:

pain extends to the entire half of the face from the onset of paroxysm;
to the appearance of pain brings touch to any part of the face;
to painful paroxysm can even bring back a memory of it;
pain can occur in response to the action of such stimuli as bright light, loud sound;
pain gradually lose its paroxysmal character and become permanent;
vegetative-trophic disorders become worse.

Diagnostics

The main role in establishing the diagnosis belongs to carefully collected complaints and anamnesis of the disease. With a neurological examination, it is possible to identify areas of decrease or increase in sensitivity on the face, as well as changes in the following reflexes:

superciliary - that is, the closing of the eyes during effleurage along the inner edge of the superciliary arbor;
corneal - that is, the effect of closing eyes in response to external stimuli;
the lower jaw - that is, the contractions of the masticatory and temporal muscles withtapping on the lower jaw).

During the period of remission, a neurological examination may not reveal pathology. To find the cause of neuralgia, the patient can be shown magnetic resonance imaging (MRI), but it does not always reveal the truth.

Treatment

The main methods of treatment of trigeminal neuralgia include:

medicamentous;
physiotherapeutic;
surgical treatment.

The main drug with drug treatment remains carbamazepine (tegretol). It has been used in the treatment of this disease since 1962. It is used according to a special scheme: the initial dose is 200-400 mg / day, Neuralgia of the trigeminal nerve symptoms and treatment gradually the dose increases and is brought to 1000-1200 mg / day in several receptions. When the clinical effect (cessation of pain attacks) is reached, the drug in the maintenance dose is used for a long time to prevent the occurrence of seizures, then the dose also decreases stepwise. Sometimes the patient has to take the drug for 6 months or more. Currently, also use oxcarbazepine (trileptal), which has the same mechanism of action as carbamazepine, but is better tolerated.

In addition to carbamazepine, baclofen 5-10 mg 3p / d is used to stop the pain syndrome (the drug should also be withdrawn gradually), amitriptyline 25-100 mg / day. Of the new drugs synthesized in recent decades, gabapentin (gabagamma, tebantin) is used. In the treatment of gabapentin, titration of the dose is also necessary before reaching clinically effective (the initial dose is usually 300 mg 3 r / d, and the effective is 900-3600 mg / day), followed by a gradual decrease until the drug is withdrawn. For the purpose of arresting a severe exacerbation, sodium oxybutyrate or diazepam may be used intravenously. In complex therapy, nicotinic acid, trental, cavinton, phenibut, pantogam, glycine, vitamins of group B (milgamma, neurorubin) are used.

Physiotherapy treatment is quite diverse. Diadynamic currents, electrophoresis with novocaine, ultraphonophoresis with hydrocortisone, acupuncture, laser therapy can be used. Physiotherapy methods are used only in combination with drug treatment to achieve a faster and better effect.

In the absence of the effect of conservative treatment, and also in cases where trigeminal neuralgia is caused by compression of the rootlet by anatomical formation, surgical methods of treatment are used:

if the cause of compression is a pathologically altered vessel, then microvascular decompression is performed. The essence of the operation is the separation of the vessel and nerve with the use of microsurgical techniques. This operation is highly effective, but very traumatic;
percutaneous stereotaxic rhizotomy: the nerve root is destroyed by applying an electric current supplied to the nerve by means of a needle in the form of an electrode;
percutaneous balloon compression: cessation of pain impulse along the nerve by squeezing its fibers with a balloon delivered to the nerve by a catheter;
glycerin injections: nerve damage by injection of glycerin at the sites of branching of the nerve;
nerve damage with the use of ionizing radiation: non-invasive technique with the use of irradiation;
radiofrequency ablation: destruction of nerve fibers by high temperature;
if the cause was a tumor process, then, of course, the removal of the tumor comes to the fore.

A characteristic feature of all surgical methods is a more pronounced effect in their early implementation. Those. The earlier this or that operation is performed, the higher the probability of cure. It should also be borne in mind that the disappearance of pain attacks does not occur immediately after surgical treatment, but several remotely (the timing depends on the duration of the disease, the extent of the process and the type of surgery). Therefore, all patients with trigeminal neuralgia need timely treatment to the doctor. Previously, the technique of injecting ethyl alcohol into the places of branching of the nerve was used. Such treatment often gave a temporary effect, had a high incidence of complications. With the regeneration of the nerve, the pain resumed, so today this method of treatment is practically not applied.

Prevention

Of course, it is not possible to influence all probable causes of the onset of the disease (for example, congenital narrowness of the canals can not be changed). However, many factors contributing to the development of this disease can be prevented:

avoid facial hypothermia;
timely treatment of diseases that can cause trigeminal neuralgia (diabetes mellitus, atherosclerosis, caries, sinusitis, frontalitis, herpetic infection, tuberculosis, etc.);
prevention of head injuries.

It should also be noted that the methods of secondary prevention (ie, when the disease has already manifested itself) include a qualitative, full-fledged and timely treatment.

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Neuralgia of the trigeminal nerve: symptoms and treatment