Trigemini (Fozergilya disease, a painful tic Trousseau) tried to treat the doctors of the Middle Ages of the last century, and the first description of trigeminal neuralgia recorded in the works of ancient Chinese healer Hua - Toa.
Prevalence of trigeminal neuralgia - from 40 to 60 cases for every 10 000 people. Maximum risk trigeminy marked in the middle age group - people between 45 and 60 years. Another feature of the disease is related to the gender of patients - it is known that women suffer from pain teak much more often than men.
What it is?
Trigeminal neuralgia (trigeminal neuralgia) - a chronic disease characterized by attacks of intense shooting, burning pain in the zones of innervation of the trigeminal nerve.
International Association for the Study of Pain (IASP-International Assosiation for the Study of Pain) trigeminal neuralgia defined as a syndrome, characterized by sudden, brief, intensive, repetitive pain innervation zone of one or more branches of the trigeminal nerve, usually with one side of the face.
Distinguish primary (idiopathic) form trigeminal neuralgia, occurring in the absence of other diseases or pathological processes due trigeminal nerve root compression, and a secondary (symptomatic) form another complication induced disease (infections, tumors, scattered sclerosis).
types neuralgia
Conventionally, all types of trigeminal neuralgia can be divided into primary (true) and secondary neuralgia.
- Primary (true) is considered a separate neuralgia pathology arising due to compression of nerve or circulatory disorders in this region.
- Secondary neuralgia - the result of other pathologies. These include tumor processes, severe infectious diseases.
Neuralgia can affect all branches of the nerve immediately and inflammation manifested by one or two branches.
Causes of neuralgia
On the mechanism of trigeminal neuralgia, this pathology can be primary or true (isolated only defeat the trigeminal nerve) or secondary (manifestation neuralgia as a symptom of nervous system diseases system).
The exact cause of trigeminal neuralgia is not clear, as mentioned above, refers to an idiopathic disease. But distinguish factors that often lead to the development of the disease.
Factors that contribute to the development of trigeminal neuralgia:
1) Compression of the trigeminal nerve in the skull or its branches after emerging from the skull:
- trauma and post-traumatic scars;
- trauma in oral and temporal joint;
- congenital malformations of the skull bone structures;
- brain tumor formation or facial region along the branches of the trigeminal nerve;
- proliferation of connective tissue (adhesions) as a result of an infectious inflammation, multiple sclerosis with lesions of the myelin sheath of nerve fibers;
- extension cerebrovascular: aneurysm (pathological vasodilation), atherosclerosis, ischemic and hemorrhagic stroke, increased intracranial pressure as a result of degenerative disc disease of the cervical spine, congenital anomalies of vascular development, and so on - the most common cause of trigeminal neuralgia nerve.
2) Odontogenous reasons (associated with the teeth):
- reaction to anesthesia canals;
- Jaw teeth with damage trauma;
- dental flux;
- "Unsuccessful" filling or removal of teeth or other surgical interventions on the face and the oral cavity.
3) Diseases of the Nervous System:
- multiple sclerosis;
- Children central palsy (CP);
- meningitis, meningoencephalitis (viral, tuberculosis);
- epilepsy;
- brain tumors and poor circulation in the cores and the fibers of the trigeminal nerve and so on;
- encephalopathy due to head trauma, infectious processes, hypoxia (lack of oxygen in the brain), nutrient deficiency;
4) Viral nerve lesions: herpes infection, poliomyelitis, neuro-AIDS.
Symptoms of trigeminal neuralgia
Neuralgia of the facial nerve on the nature of the symptoms are divided into the following groups: reflex and movement disorders, pain, autonomic-trophic symptoms.
Intense, paroxysmal, burning, sharp, excruciating pain. The moment of an attack, patients sometimes freeze describe feeling like chamber, the passage of electric current. Duration spasm - from 3 seconds to several minutes in some cases the repetition rate is 300 per day. Localization of pain:
- Mandibular nerve: the chin, the lower part of the cheeks, the lower part of the lips, neck, head, teeth and the surface of the lower jaw.
- Maxillary: lower eyelid, upper jaw and teeth, upper cheek, nasal mucosa, upper lip, maxillary sinus.
- Optic nerve: the nose, forehead, upper eyelid, the scalp front, inner corner of the eye, ethmoid sinus.
Motor and reflex disorders:
- Muscle spasms face (pain tick). During an attack occurs involuntary muscle contraction in the nature of circular muscle of the eye which is called blepharospasm. Symptom affects chewing and other muscles of the face, often spread to the entire half of the face.
- Corneal changes occur, superciliary, mandibular reflexes that determined by physician examination.
Vegetative-trophic symptoms during the attack in the early stages have a weak intensity, but with progression of pathology is becoming more noticeable:
- runny nose, drooling, watery eyes;
- observed local redness or paleness of skin color;
- the late stages of developing dryness / greasiness of the skin, swelling of the face, loss of eyelashes.
If time does not begin to treat disease is the formation of a painful point of pathological activity in the thalamus. This causes a change in the localization, the nature of pain. At this stage, the removal treatment of the disease does not result in recovery.
This stage is characterized by the following symptoms:
- It covers the entire half of the face;
- Any touch to the face causes pain;
- loud noise, bright light becomes irritating and provoking factor of pain;
- in some cases, even the memory of the disease leads to a paroxysm;
- from paroxysmal pain develops into a permanent (chronic);
- vegetative-trophic disorders worse.
Characteristic of the disease is more for middle-aged people. Diagnose symptoms of trigeminal neuralgia in 40-50 years. In most cases, there is defeat the right side of the face (70%). Rarely trigeminal neuralgia can be two-way, the disease is cyclical: exacerbation are replaced by remissions and again there is a deterioration, exacerbation occur in autumn and spring period.
Diagnostics
Drug therapy can eliminate pain, neuralgia but need to identify and eliminate the underlying cause of the disease. Otherwise, the pain attacks will become more acute, to appear more frequently.
Basic Diagnostic Methods:
- Dental examination. Neuralgia often occurs against a background of dental disease, poor-quality dentures.
- neurologist consultation. Doctor on the results of the initial inspection determines the kinds of further examination.
- MR. The study helps us to see the structure of the nerves, the availability and location of vascular lesions, tumors of various types.
- A panoramic radiograph of teeth and the skull. Education helps to see who could pinch the nerve.
- Blood tests - eliminates the viral origin of pathological changes in the trigeminal nerve.
- Electromyography - designed to study the characteristics of the passage of nerve impulses.
How to treat trigeminal neuralgia?
The method of treatment is chosen depending on the cause that triggered the disease.
The main treatment for trigeminal neuralgia is considered carbamazepine. He develops inhibitory processes in the nerve cells, which are prone to paroxysmal activity (painful stimulation). The dosage of the drug selects the physician, so we will not dwell on the used drug regimens. Suffice it to say that carbamazepine is taken for a long time, up to 8 weeks.
In addition, the drug is quite toxic. It affects the liver, urinary, bronchial system. Among the side effects of carbamazepine marked various mental disorders, memory impairment, somnolence. Carbamazepine is contraindicated in pregnant women. The drug is teratogenic - has toxic effects on the embryo. Just can not take carbamazepine persons with glaucoma, heart blockages, blood diseases.
During treatment with carbamazepine can not eat grapefruit, because the fruit increases the expression of adverse drug reactions. To enhance the effect is recommended to take in conjunction with carbamazepine pipolfenom. Duration of treatment rarely exceeds 30 days.
Other types of drugs:
- anticonvulsants - Phenibut, baclofen;
- tranquilizers - Dizepam;
- antipsychotics - pimozide;
- vazotoniki prescribed for vascular lesions of the brain - Trental, Niacin.
Apart from tablets, in therapy using vitamin injections ascorbic acid, vitamins B. As anesthetics are used NSAIDs in the form of injections or pellets - Neurodiclovit, Milgama, Diclofenac. Neuralgia Antidepressants - amitriptyline, help remove tension and stress condition of the patient. To improve metabolism, prevent the formation of cholesterol plaques appoint Atoris.
No less useful is physiotherapy. It is able to enhance the action of any drug, as well as its efficiency. Treatment of inflammation of the trigeminal nerve is made by means of physical therapy:
- electrophoresis
- phonophoresis
- Ultrasound.
- Acupuncture.
- Laser therapy. It relieves pain, as slowing the passage of the nerve impulse along the fibers.
- Exposure to electromagnetic fields.
- Irradiation with ultraviolet or infrared rays. It makes it possible to eliminate the pain.
Drug therapy is chosen for each patient individually depending on the degree of disease severity, as well as the features of his body.
Surgery
In the absence of effect of conservative treatment at home usloviya, as well as in cases where the trigeminal neuralgia is caused by compression of the spine anatomical structures, used surgical methods:
- if the cause is a compression of the diseased vessel that microvascular decompression is performed. The essence of the procedure is the separation vessel and nerve using microsurgical techniques. This operation is highly efficient, but very traumatic;
- Percutaneous balloon compression: cessation of pain impulses along nerve fibers by compression via its cartridge supplied to the nerve via the catheter;
- Percutaneous stereotactic rhizotomy: destruction of nerve root performed using the electric current supplied to the nerve with a needle to form the electrode;
- nerve destruction using ionizing radiation: a non-invasive technique using irradiation;
- glycerol injections: nerve destruction via injection of glycerol in place of the branching nerve;
- if the cause was a tumor process, of course, comes to the fore removal of the tumor;
- radiofrequency ablation: destruction of nerve fibers via high temperature.
A characteristic feature of all surgical techniques is more pronounced effect when carrying out their early. Those. the sooner we have done this or that operation, the greater the chance of cure. It should also be borne in mind that the disappearance of pain attacks does not occur immediately after surgery, and several remotely (terms depend on the duration of disease, extensiveness of the process and the type of operational intervention). Therefore, all patients with trigeminal neuralgia must be timely treatment to the doctor.
Gymnastics
Movement and facial muscle contractions are not only relief during an attack of the disease, but also help to reduce the compression of the nerve branches in the future. Additional positive effects of gymnastics:
- improvement of blood circulation;
- Optimization of lymph drainage;
- restoring nerve impulse conduction (if violation);
- preventing the development of stagnation in the muscles.
To complete the exercises recommended to stand in front of a mirror to exercise better control over the process. One gym session included such classes:
- Slopes and circular rotating head (2 minutes).
- Stretching the neck and head as far to the side of each arm (4 times).
- Stretch lips in a smile, their reduction in the "tube" (6 times).
- Typesetting air in the cheeks, it exhaling through a narrow slit in the lips (4 times).
- Retraction of the cheeks (6 times).
- Closing and opening of the eyes to strong clenching the eyelids (6 times).
- Raising eyebrows up and simultaneously fixing the forehead arm (6 times).
new developments
The most modern and effective methods of treatment of trigeminal nerve can be called radiosurgical operations using Cyber Knife. This device uses for treating photon flux that penetrates exactly to inflammation and eliminates it. Treatment with Cyber Knife provides highly accurate radiation doses, comfortable and rapid healing. In addition, the procedure is completely safe for the patient.
Modern treatment with Cyber Knife can be considered the most productive. Use this technique not only abroad but also in the former Soviet Union: Russia, Ukraine, Belarus. Information for treatment in Moscow will cost 180 000 rubles.
preventive measures
Disease prevention are:
- Try to keep a balanced diet and multivitamin use.
- In the event of detection of infectious diseases and especially the oral cavity and nasopharynx, try to promptly and fully cure them.
- Avoiding hypothermia as a person, and the whole organism. Dress for the weather much more reasonable than the treatment (sometimes in vain) to severe pain.
- Regular visits to the dentist to detect infections that can subsequently cause disease.
- Atherosclerosis (the appearance of plaques in the blood vessels of the body, the brain is no exception), which are subject, in more people over age group added to a number of causes of trigeminal nerve.
Any disease is easier to prevent than to treat, so the emphasis should be on prevention of trigeminal neuralgia in order to avoid its consequences. If it so happened that the disease prevailed, not self-medicate, do not take any painkillers, relieves pain for a couple of hours, please contact an experienced specialist for the management and the full course treatment.
Forecast
Neuralgia do not bear a direct threat to life. Trigeminal neuralgia is no exception. However, the human mind can strongly be affected by this disease. Frequent and very intense pain syndromes quickly drive the patient into a state of depression. He begins to avoid contact, begins to antisocial lifestyle. It can begin the development of a wide variety of mental disorders.
Early treatment will help minimize damage to the mental health of a person. Even in the most difficult situations, it is not necessary to endure the pain. It is better to decide on the operation, because the disease can be effectively treated, even in the most difficult situations.
