Trigeminal neuralgia
Trigeminal neuralgia is a chronic disease that manifests itself with attacks of severe, burning and shooting pain in the area of innervation of the trigeminal nerve. Pain can be caused by even the most minor irritation — applying makeup, brushing teeth, scratching the face. At the initial stage of the disease, the pain is not very pronounced and disappears quickly. However, gradually it becomes more intense.
The content of the article:
Classification of trigeminal neuralgia
Etiology and pathogenesis of trigeminal neuralgia
Clinical picture and diagnosis
Treatment of trigeminal neuralgia
Prognosis for trigeminal neuralgia
Prevention of trigeminal neuralgia
Trigeminal neuralgia
Statistical studies show that women over the age of 50 often suffer from the disease. Young people get sick much less often, and children have been diagnosed with isolated cases of the disease. The prevalence of trigeminal neuralgia is five cases per one hundred thousand people. Regular attacks of neuralgia can negatively affect the mental health of the patient, so you should not delay the treatment of the disease.
Classification of trigeminal neuralgia
All types of trigeminal neuralgia are conditionally divided into two groups:
Primary (idiopathic) neuralgia is a pathology that has arisen as a result of nerve compression or problems with blood supply in this area.
Secondary (symptomatic) neuralgia is considered a manifestation of other diseases (for example, tumor processes or infectious diseases).
Etiology and pathogenesis of trigeminal neuralgia
The exact causes of trigeminal neuralgia are unknown. However, there are several factors that can trigger the disease:
Viral nerve damage — neuro-AIDS, polio, herpes infection;
Odontogenic causes (caused by dental problems) — dental flux, jaw injury, reaction to anesthesia, unsuccessful tooth filling;
Diseases of the nervous system — cerebral palsy, meningitis, multiple sclerosis, meningoencephalitis (viral, tuberculosis), hypoxia (lack of oxygen in the brain), encephalopathy due to head injuries, epilepsy, infectious process, circulatory disorders and brain tumors;
Compression of the trigeminal nerve — tumor neoplasms of the brain, injuries and scars, excessive growth of connective tissue due to the infectious process, dilation of brain vessels (aneurysms, atherosclerosis, congenital vascular pathologies, ischemic and hemorrhagic strokes, increased intracranial pressure due to osteochondrosis).
In neurology, it is also customary to identify a number of adverse factors that increase the risk of trigeminal neuralgia:
the patient is over 50 years old;
stress;
chronic fatigue;
mental disorders;
autoimmune and allergic diseases;
vitamin deficiency;
metabolic disorders;
infectious diseases (syphilis, botulism, tuberculosis);
inflammation of the oral cavity (pulpitis, gingivitis).
In neurology, there are two mechanisms for the formation of trigeminal neuralgia. One of the mechanisms involves the destruction of the myelin sheath. This process is also called demyelination. The nerve fiber becomes unprotected as a result of damage, and the nerve impulse spreads to the nearest nerve fibers. As a result, there is a strong irritation of neurons and a pain syndrome occurs.
The second mechanism of pathology development involves a violation of the regulation of the functioning of the trigeminal nerve of the central nervous system. Due to damage to nerve fibers, the nerve impulse is inhibited, which leads to irritation of the trigeminal nerve nuclei and, as a result, pain syndrome. There is an assumption that both of these mechanisms can consistently follow each other. Therefore, the treatment of the disease should be aimed at activating the restoration of the myelin sheath of nerve fibers, and at inhibiting nervous processes.
Clinical picture and diagnosis
Painful sensations in the face area: appear after exposure to irritating factors on the trigger zones (smiling, chewing, screaming, brushing teeth, applying cream, shaving, yawning, sneezing, etc.). Usually the pain occurs only on one side of the face, has a paroxysmal character. The pathological process spreads to the second side of the face only with severe brain lesions. Localization of trigger points, after exposure to which pain occurs, is different for everyone. Such points can be located on the nasal wings, cheeks, lips, the junction of the jaw, the oral cavity. Patients complain of bouts of pain that last for several seconds. The period of remission between seizures can range from a couple of hours to months.
Redness of the face, lacrimation, increased salivation: occurs on the affected side during the next attack. Hyperemia of the face, as well as activation of the lacrimal, salivary and mucous glands are caused by disorders of the autonomic nervous system.
Twitching of the facial muscles: occurs against the background of an attack of pain. Muscle tremor is very similar to a nervous tic or local convulsions. On the affected side, the narrowing of the eye slit may occur. During muscle twitching, facial and chewing muscles may be involved.
Mental disorders: appear against the background of intense and frequent attacks of pain. The patient becomes anxious and irritable. If a pain attack causes him to laugh, eat, talk, he closes himself in, is constantly silent, eats little. With a severe course of the disease, suicidal tendencies appear.
Sensitivity disorder: in most patients, this symptom indicates that a painful attack will occur soon. At the same time, the patient complains of a dull aching pain and a feeling of crawling on the skin of goosebumps.
Trophic disorders: may occur within a couple of years after the onset of pathology due to impaired muscle innervation, frequent pain attacks, circulatory disorders. In order not to irritate the trigger zones once again, the patient tries to spare the damaged side of the face. Over time, this leads to atrophy of the facial and masticatory muscles. Patients may experience the following trophic disorders: facial asymmetry, lowering of the eyebrow, loss of eyelashes and eyebrows, weakness of the masticatory muscles, tooth loss, premature appearance of wrinkles, dry skin and peeling.
Treatment of trigeminal neuralgia
Diagnosis of trigeminal neuralgia begins with an examination of the patient by a neurologist, during which complaints and anamnesis of the disease are collected, and the neurological status of the patient is assessed. The most characteristic complaints of the patient, to which the doctor pays attention, are considered to be severe pains that appear after irritation of the trigger zones. Additionally, MRI and CT scans of the brain, electroneurography, electroneuromyography, laboratory tests, consultations of an ENT doctor, dentist, and neurosurgeon are prescribed.
Treatment of trigeminal neuralgia is aimed at solving the following tasks: eliminating the cause of the disease, reducing the excitability of the central nervous system, restoring the myelin sheath of the nerve affected by inflammation, physiotherapeutic effect on the nerve. To eliminate the disease, doctors resort to drug therapy, physiotherapy and surgical treatment.
Medical treatment
Anticonvulsants (carbamazepine, phenytoin, stazepine, gabantin, lamotrigine): they have an antiepileptic and psychotropic effect, relieve pain attacks, reduce the excitability of nerve fibers.
Muscle relaxants: baclofen inhibits the excitability of nerve cells and reduces muscle tone, and midocalm improves blood circulation, has an analgesic effect, inhibits nerve impulses.
Vitamins: Omega-3 acts as a building material for myelin, and B vitamins have an antidepressant effect, participate in the process of restoring myelin sheaths.
Antihistamines: enhance the effect of taking anticonvulsants.
Sedatives: have a calming effect, normalize sleep.
Surgical treatment
The operation is prescribed if the drug treatment has not yielded results or it can be carried out with minimal risk of complications. According to the indications, the doctor may prescribe surgery to eliminate pathologies that caused trigeminal neuralgia: dilation of the subglacial canal, removal of brain tumors, microvascular decompression. To reduce the conduction of the trigeminal nerve, the doctor may prescribe one of the following operations: balloon compression of the trigeminal ganglion, resection of the trigeminal ganglion, gamma knife and cyber knife.
Physical therapy
UHF will allow to improve microcirculation in case of atrophy (exhaustion) of masticatory and mimic muscles. To relax the muscles, doctors usually prescribe electrophoresis, to prolong periods of remission and reduce the intensity of pain during seizures — diadynamic currents. Prevention and elimination of muscle atrophy is carried out during massage. All of the above methods are ideal for eliminating pain.
Prognosis for trigeminal neuralgia
The prognosis for the patient depends on the disease that provoked the neuralgia. Age also plays an important role. Neuralgia in young people, which was provoked by facial trauma, in most cases responds well to treatment, and after recovery, its relapses are not observed. In old age, neuralgia, which is accompanied by metabolic disorders, is not always completely cured.
Prevention of trigeminal neuralgia
It is quite possible to prevent the appearance of trigeminal neuralgia if you follow the recommendations of doctors. It is necessary to treat all chronic and acute diseases of the ENT organs in a timely manner. It is also advisable to undergo preventive medical examinations annually for the timely detection of diseases of the endocrine glands, nervous and cardiovascular systems.
Since trigeminal neuralgia often occurs due to trauma to the face and head, it is advisable to avoid any injuries in every possible way. It is extremely important to avoid hypothermia of the body, which also often causes the disease. Prevention involves maintaining a healthy lifestyle:
physical activity;
full sleep;
hardening;
abstinence from alcohol abuse and smoking;
proper nutrition.
