The 5th cranial nerve, known as the trigeminal nerve, covers wide areas in the brain. The trigeminal nerve conducts sensations from the face to the brain using three braches—the ophthalmic, maxillary and mandibular branches.
Trigeminal neuralgia (TN) is a chronic condition of neuropathic pain, which is caused by injury or lesion in the trigeminal nerve. This condition is associated with two types of symptoms—a classic form (TN1) characterized by sudden and sharp facial pain, or an atypical form (TN2) with constant aching and burning sensations, which are lower in intensity than the previous form.
Trigeminal neuralgia can result from nerve compression by blood vessels or tumor, leading to damages to the protective nerve myelin sheath. Other causes of trigeminal neuralgia include multiple sclerosis and injury to the trigeminal nerve.
The symptoms of trigeminal neuralgia are quite incapacitating. Pain sensations can vary from sharp, stabbing pain to a constant aching or burning. Activities, such as shaving, wiping the face, etc., can aggravate the symptoms. The pain could be localized to a small area of the face, or may be more spread out. Over time, the bouts of trigeminal neuralgia pain tend to increase, making it harder to maintain normal activities.
Trigeminal neuralgia is more commonly observed in women than men. This condition tends to be more common in people over 50 years of age.
Physical as well as neurological evaluations are necessary to diagnose trigeminal neuralgia and rule out other underlying conditions. Magnetic resonance imaging (MRI) may be necessary to identify the nature and severity of nerve compression or other abnormalities.
Anticonvulsant drugs, such as carbamazepine, oxcarbazepine, clonazepam, phenytoin, valproic acid, are more effective for TN1 than TN2 symptoms. Other classes of medications for this condition include tricyclic antidepressants (e.g. amitriptyline and nortriptyline), analgesics and opioids.
People, who do not respond well to medications, will require surgery to treat TN. Various surgical interventions are available, depending upon the nature of the condition:
The risks of surgery, however, may include loss of hearing, balance issues, cerebrospinal fluid leakage, infection, anesthesia dolorosa, and rarely stroke.
People who may be suffering from chronic painful conditions, such as trigeminal neuralgia, may benefit from stem cell therapy. Stem cells are primitive cells that can undergo differentiation to form different types of cells in the body, such as bone, blood, cartilage, tendon, ligaments, etc.
These cells are responsible for healing tissue damages by generating new healthy cells. However, with age, the body loses its ability to attract enough stem cells to the site of injury. In this regard, stem cell therapy delivers a high concentration of stem cells to the affected area to promote natural healing.
Mesenchymal stem cells (MSCs) are known to alleviate chronic neuropathic pain in animals. A recent study evaluated the injection of autologous MSCs to help reduce human neuropathic pain. The study involved 10 females with trigeminal pain, who underwent liposuction to isolate stem cell fraction from their fat deposits.
These cells were then injected into the patients, who were then followed-up for over a period of 6 months. The findings showed that stem cell treatment was well-tolerated in these subjects, and contributed to a significant reduction of pain symptoms.
Previous studies have also reported the safety of MSCs in various therapeutic conditions. For example, Mazzini et al found that MSCs were safe in amyotrophic lateral sclerosis patients for a follow-up period of 9 years. Moreover, in a randomized, double-blind, placebo-controlled, dose-escalation study of intravenous mesenchymal stem cells in 53 human subjects, no adverse events were observed following treatment.
MSCs exert an anti-inflammatory effect through the secretion of cytokines. In addition, these cells play a role in nerve repair and regeneration. Animal models of trigeminal neuropathic pain, diabetic neuropathy as well as hind paw neuropathic pain showed significant pain reductions following stem cell injections.
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