The author - Romanova IN, neurologist. Work experience more than 29 years.
disease name accurately reflects its basic essence. It comes from the Greek words «neuron» - nerve and «algos» - pain. That acute attacks of unbearable shooting pain in the innervation zone of the branches of the trigeminal nerve distinguish a chronic, prone to relapse, disease.
Trigeminal neuralgia (trigeminal neuralgia) described over 500 years ago, and all this time the doctors tried to understand its causes and find effective treatment.
Women are affected three times more often than men. Seven out of ten of pain localized to the right. One person out of a hundred bilateral suffering seizures. More often than not the first time a doctor treated people after 40-50 years. As a rule, it appears that in the past 7-10 years, they have periodically worried about the pain in his face after hypothermia, dental visits, trauma or cold. However, one in three does not find such a link.
Only every fifth patient trigeminal neuralgia immediately manifested violently. Most remember the previous expanded clinic sensations of tingling, burning, twitching in the face.
Insight into the anatomy
Trigeminal nerve - one of the twelve paired cranial nerves of man. Each half of the face innervate your trigeminal nerve. It is so named because its trunk, coming out of the cranial cavity, where its core, is divided into three main branches. Most of all it includes sensory fibers that transmit among other things, the pain impulses.
First, ophthalmic branch, are rarely affected. It supplies the same name of the forehead and the parietal region. The second and third branches are affected much more frequently. The second branch is called nerve of the upper jaw and conducts the sensitivity of the region bounded by the lower eyelid, cheeks and upper half part of the nose. The third branch, or mandibular nerve, innervates not only her, but also of the deep parts of the ear and tongue.
Causes and risk factors for trigeminal neuralgia
There is a primary neuralgia, which is a separate disease. Long believed that it causes include infection foci in the teeth or of the paranasal sinuses, compression (compression) nerve branches into bone canals facial skull. Now, however, it is generally accepted that the main role in the development of the disease belongs to nerve compression pathologically crimped cerebellar artery or other vessels abnormally developed in the region of its entrance into the cerebral structures brain.
secondary neuralgia It is so called because it is only a manifestation of other diseases of the nervous system - multiple sclerosis, Infectious lesions, brain tumors, skull bones, or nerve roots. This variant is more common than primary neuralgia.
Risk factors that increase the likelihood of developing trigeminal neuralgia include:
- anomaly structure of the skull;
- genetic predisposition;
- osteomyelitis skull;
- diabetes;
- a chronic infection in the mouth and otolaryngology;
- head injury.
clinical picture
The most painful and vivid manifestation of trigeminal neuralgia are the attacks of pain in the area of innervation of the affected branches. It is distinguished by specific features, which can be distinguished from other neuralgia facial pain:
- She shoots the nature and very intense;
- It never lasts for more than 2 minutes;
- no matter how often there are attacks (and, in severe cases, sometimes hundreds of them per day), the interval between them is not less than 5 minutes, and a new attack does not occur at this time, even if it provoke;
- the patient during an attack afraid to move, and is fixed with a grimace of pain on his face;
- attack can cause a light touch, sometimes it's just air movement, temperature or irritation of the so-called trigger (starting) point. They may be located on the face or the oral cavity. For this reason, patients try to never touch the person, even pointing to the doctor for these points, afraid to wash, shave, brush your teeth, talk and even eat;
- No violation of pain sensitivity in the area;
- attacks are stereotyped, that is, they may have features different people, but in an individual patient are always the same scenario;
- pain is often accompanied by tearing, eye redness on the affected side, discharge of mucus from the corresponding half of the nose.
Despite the fact that the attack is any discomfort in the face of no patients are in constant anxiety, fearing a repetition of torment. They become unsociable, try less to go out, afraid to catch a cold, characterized by depressed mood, especially in severe disease with frequent attacks.
Diagnosis of trigeminal neuralgia
The clinical picture of the disease is so specific and vivid, that the fact of involvement in the pathological process of the trigeminal nerve is almost never in doubt. Much more important is to find out why. To exclude brain tumors, multiple sclerosis, vascular malformations (congenital abnormal connection between an artery and vein) is carried out:
- computed tomography;
- MRIs;
- ultrasound head and neck vessels - TCD, CDS and other;
- electroneurogram;
- electromyography.
Treatment
For centuries, millions suffer from trigeminal neuralgia were hostages of the disease. Because effective treatments existed. And, finally, it was synthesized in the middle of the last century carbamazepine (Finlepsinum, Tegretol, etc.)., Which began with the era of real help suffering patients. The drug belongs to the group of anticonvulsants (anticonvulsants). Later it turned out that other drugs in this group are effective in the prevention and elimination of neuralgic pains. However, carbamazepine is still the most widely used.
Treatment starts with minimal doses, gradually increasing them to achieve a positive effect. At this dose, the drug take at least one month, and then the patient in smaller doses gradually transferred. If seizures return, the amount of drug to increase again, but half of the newly diagnosed patients manage to eventually completely stop taking carbamazepine. As the duration of the disease the treatment efficiency is reduced and the patients 'experienced' have to be treated several years, and sometimes - decades.
For about one in seven patients carbamazepine is ineffective. In such cases, other means are selected from the group of anticonvulsants. Already in our century there is a new drug in this class, more effective and with fewer side effects than carbamazepine - pregabalin (gabapentin, lyrics).
In addition to anticonvulsant drugs, patients receive:
- antidepressants (amitriptyline), hindering holding of pain impulses;
- miolitiki (sirdalud baclofen) to reduce muscle tone and reduce the stress of the facial muscles;
- nonsteroidal antiinflammatory drugs (diclofenac, ibuprofen).
Medicines play a leading role in the treatment of trigeminal neuralgia, but the additional purpose of physical therapy to reduce their dose and reduce the duration of treatment. In such cases, effective:
- sinusomodulirovannye currents (SMC);
- magnetic therapy;
- electrophoresis;
- reflexology.
In case of failure of conservative treatment, patients are sent to the neurosurgeon to perform the decompression operations (release from nerve compression) or rizolizisa (destruction of the nerve branches). Naturally, the operation is assigned immediately without conservative treatment step, if the cause is neuralgia threatening brain tumor or vascular pathology.
prevention
Trigeminal neuralgia can often be prevented, if we exclude the controllable risk factors. Of course, it is impossible to influence the inheritance and features of the structure of the skull and blood vessels. But you can and should visit the dentist regularly for treatment of initial manifestations of caries, preventing its spread deep and formation of foci of chronic infection.
It is not necessary to walk in the winter without a hat. This causes a spasm of blood vessels of the head, impairs tissue nutrition and a negative impact on the local immunity. In such circumstances, easily activated are always present in the body of the bacteria and the inflammation of the paranasal sinuses or sore throat. If this happened, it is unacceptable to carry the disease on their feet. Treatment and neglect of the regime in such cases, threatens not only the trigeminal nerve.
Planned visits to doctors for preventive purposes even in the absence of complaints at an early stage will allow identify the causes of secondary trigeminal nerve - multiple sclerosis, diabetes, tumor brain. This often makes it possible to not only prevent the development of neurology, but also save lives.
Complications and prognosis
Complications of primary trigeminal neuralgia associated with frequent bouts of fierce pain in his face. Without treatment, they are becoming more frequent and eventually occupy a central place in the consciousness of the patient, determine its behavior. Are always in anticipation of the next attack, they are anxious and depressed. Fearing provoke pain, chew only on the healthy side.Over time this leads to degeneration of muscles and teeth pathology on the side of neuralgia, in turn teaching the twinges.
Prediction of secondary neuralgia is closely related to call it a disease and the stage at which it is detected. For example, blood glucose levels in diabetes compensation or remission of multiple sclerosis when not there are new foci destruction of nerve sheath conductors improves for trigeminal neuralgia and its response to treatment. Brain tumor, identified at an early stage, it is possible to completely remove, eliminate the cause of stimulation of the trigeminal nerve.
Depending on the cause and duration of trigeminal neuralgia, the treatment takes several months to many years. But in any case, modern medicine has the potential, if not completely eliminate the bouts of pain, then make them as rare and less intense and prolonged.
