03 Apr Trigeminal Neuralgia Treatment

Trigeminal neuralgia is an extremely painful condition characterized by irritation of the trigeminal nerve resulting in sharp shooting pain along its distribution. The pain can be so severe that it is disabling. The diagnosis is difficult as it can be confused with other disorders.

There are several effective ways to control the pain, which is the main aim in its management. Some salient ones include:

• Carbamazepine: an anticonvulsant drug, and the most common medication that doctors use to treat trigeminal neuralgia. It is quite effective in pain relief in the early stages of the disease. But the effectiveness of carbamazepine decreases over time. It has a few troublesome side effects, including dizziness, double vision, drowsiness, and nausea.
• Baclofen: a muscle relaxant. It’s often prescribed along with either carbamazepine or phenytoin, as it has been found to have greater efficacy that way. Possible side effects include confusion, depression, and drowsiness.
• Phenytoin, an anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. It has notable side effects such as gum overgrowth, balance disturbances, and drowsiness.
• Oxcarbazepine: a newer medication being used more recently as the first line of treatment. It is structurally similar to carbamazepine but preferred over it because it has fewer side effects, which include dizziness and double vision.
• Other medications include gabapentin, clonazepam, sodium valproate, lamotrigine and topiramate.

There are several things to consider when prescribing these medications. Oftentimes, these patients need relatively high doses to alleviate the pain, and the side effects can become quite problematic at higher doses. Furthermore, anticonvulsants may lose their effectiveness over time. This is mitigated by either increasing the dose or adding or adding a second anticonvulsant. These patients must have their blood monitored to ensure their safety from toxic effects of these drugs.

If medications have proven ineffective in treating trigeminal neuralgia, one has to resort to surgical procedures for pain control. Conditions where trigeminal neuralgia is precipitated by the adjacent blood vessel, surgical correction is required. On the other hand, lesioning interventions are performed to severe the trigeminal nerve on purpose in order to disrupt the transmission of pain. Such procedures can be risky, partially effective, or lead to complications such as facial numbness. These procedures are often considered for patients who have recurrent pain after open surgery, those without evidence of a blood vessel pushing on the nerve, and those who are poor surgical candidates otherwise. Some examples include percutaneous glycerol rhizotomy (glycerol injected through a needle into the area where the nerve divides into three main branches), percutaneous balloon compression (needle passes through the cheek to the trigeminal nerve and a balloon placed in the trigeminal nerve through a catheter). These methods aim to injure the pain-causing fibers.

Stereotactic radiosurgery (Gamma Knife, Cyberknife, LINAC, etc.) can be performed to deliver a single highly concentrated dose of ionizing radiation to a small, precise target at the trigeminal nerve root. This is a noninvasive procedure and is quite effective.

Overall, the benefits of each of these treatment options should be weighed carefully against the risks. Their efficacy is variable and each patient may respond to a unique approach best suited to their needs.