Best Trigeminal
Neuralgia Treatment
in Bengaluru

Clinical features:

Paroxysmal attacks of pain lasting from a fraction of a second to two minutes that affect one or more division of face

V1 Nerve involvement- Forehead and eye are painful
V2 Nerve involvement- Pain in cheek ,upper lip
V3 Nerve involvement- Pain in ear, side of face, teeth, jaws lower lip and mandible

Pain has at least one of the following characteristics-
sharp, superficial, or stabbing, burning pain or some abnormal sensations like crawling of worms.

Typical attack comes in paroxysm of 2-4 minutes lasting for 2-20 seconds.

Precipitating factors-

• cold wind,
• washing face,
• chewing.
• Eating cold food,
• shaving,
• touching the face.

Causes:

Idiopathic – are caused by compression of the trigeminal nerve close to its exit from the brainstem by an aberrant loop of artery or vein.

Secondary causes– tumours or the demyelinating plaques of multiple sclerosis, produce similar lesions of the root entry zone of the trigeminal nerve

Diagnosis:

Clinical diagnosis– usually the pain is unilateral , bilateral only in cases of multiple sclerosis, comes in paroxysm

MRI Brain in Feista View– May show compression of trigeminal
nerve by aberrant vessel or tumour.

Sometimes no compression of the trigeminal may be seen.

Management-

Medial management-
First line drug– Carbamazepine is the drug of choice

Started in low dose of 100 mg two times daily and later increased to maxium upto 800mg per day. Beyond this dose there is very little efficacy and the side effects become more prevalent.

Second line drugs- Gabapentin, baclofen and lamotrigine are added to decrease the dose and side effects of carbamazepine.

Surgical Procedures-

• Microvascular decompression is done as a major surgery under general anaesthesia only in cases where vessel is seen compressing the trigeminal ganglion. This is a major brain surgery with major complications like excessive blood loss, loss of vision , paralysis, loss of life. One of the major side effect is inspite of this big surgery, there may not be complete pain relief .
• Stereotactic radio surgery using gamma knife or linear accelerator- non invasive procedure.

Advanced Non Surgical treatment:

• Glycerol Rizotomy: Using glycerol will lead to chemical
  neurolysis of trigeminal nerve, outdated now, may cause neuritis
• Ballon compression– done as percutaneous procedure with where an inflated ballon will compress the trigeminal nerve, less side effects but the efficacy is less.
• Radiofrequency Ablation of trigeminal ganglion is done as day care procedure where the culprit nerve is identified and ablated using
  currents. Conventional Radiofrequency ablations are done in operation theatre using a small needle under fluoroscopic machine into a hollow called foramen ovale. Once this hollow is identified then needle is inserted and radiofrequency waves is passed using special machine called radiofrequency machines which guides the treating doctor with exact wave frequency, temperature and time. This procedure may take 30-40 minutes under sedation and the patient is conscious immediately after the procedure.

Advantages of Radiofrequency Ablations

• Day Care treatment
• Immediate pain relief
• No major complications like surgery
• Procedure can be repeated
• Pain relief is more than 98 percent