Best Trigeminal
Neuralgia Treatment
in Hyderabad
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Trigeminal neuralgia is a chronic neuropathic pain condition on one side of the face presenting in paroxysm along the distribution of trigeminal nerve which is a nerve carrying sensations from brain to face.
Trigeminal nerve is the 5 th cranial nerve and is the largest of all the cranial nerves which comes out of the brain and divides into three branches- Opthalmic branch(V1), Maxillary branch (V2), Mandibular branch(V3).
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.
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
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.
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.