Info on Trigeminal Neuralgia from a top Los Angeles Pain Clinic

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Trigeminal Neuralgia top Pain Clinic in Los Angeles

Trigeminal neuralgia (TN) is a painful syndrome, characterized by shooting, intermittent pain of the face that occurs along the fifth cranial nerve (trigeminal nerve). The trigeminal nerve has three divisions that branch to the eyes (ophthalmic), cheeks (maxillary), and jaw (mandible) areas.

Trigeminal neuralgia can occur at any age, but usually affects people over 50 years of age. The male to female ratio is 2:3, with TN affecting women more often. The incidence of this painful condition is 4 in 100,000 people.

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Trigeminal Neuralgia

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What are the symptoms of trigeminal neuralgia?
- The pain of trigeminal neuralgia is intense, sharp, periodical, excruciating, stabbing, and often accompanied by brief fascial spasm or tic. The pain is usually restricted to one side of the face.
What causes trigeminal neuralgia?
- Trigeminal neuralgia occurs due to an abnormality that exists between the level of the inner nerve fibers that carry nerve sensations and line the trigeminal nerve. These fibers work as a cable that carries electricity, so a shock-like pain is induced from any stimulus. TN is triggered by:
  
  Enlarged artery or vein pressing on the nerve
  Aneurysms
  Tumors
  Chronic meningeal inflammation
What triggers the pain associated with trigeminal neuralgia?
- The pain associated with TN can occur without a cause, or can be made worse by certain fascial motions. Common triggers include:
  
  Washing the face
  Brushing the teeth
  Shaving
  Applying facial makeup
  Blowing, kissing, and chewing
How is trigeminal neuralgia diagnosed?
- TN is diagnosed mainly by clinical symptoms, but the doctor may order a MRI scan to assess for abnormal intracranial function. A 3-dimensional MRI neuro-imaging technique is used to assess for offending blood vessels.
What are the treatment options for trigeminal neuralgia?
- Trigeminal neuralgia is treated with:
  
  Medications – Anticonvulsants (carbamazepine and gabapentin) are used to interfere with nerve pain. In addition, antidepressants and narcotic agents are used for pain. Over time, high doses are necessary to maintain efficacy. Muscle relaxers (baclofen, lamotrigine, and pimozide) are used for severe spasms.
  
  Botox injections – Botulinum neurotoxin type A (Botox) is used for some patients, to paralyze the facial muscles and relieve pain. A recent clinical study reported a success rate of 70-100% with Botox for TN.
  
  Trigeminal nerve block – This involves instillation of a neurolytic agent onto the affected nerves to destroy a portion of them. Common agents include phenol, alcohol, and glycerol.
  
  Percutaneous radiofrequency trigeminal gangliolysis (PRTG) – Involves use of radiofrequency energy to destroy a portion of the nerve root. The surgeon inserts a small needle through the corner of the mouth using x-ray guidance. The ganglion (nerve mass) is lysed with the heated needle tip. This procedure has an efficacy rate of 75%, with some minor complications possible.
  
  Percutaneous retrogasserian glycerol rhizotomy (PRGR) – This is the favored procedure due to a higher efficacy rate (78%). With PRGR, a needle is inserted near the trigeminal nerve and a cisternogram is obtained. The doctor then instills a neurolytic agent (glycerol) onto the nerve root. In a clinical study, the majority of patients had complete symptom relief with PRGR, and partial relief was reported in the remaining recipients of the treatment.
  
  The top facial pain treatment is offered at Intelligent Pain Solutions. This includes cutting-edge options for trigeminal neuralgia in Los Angeles & Beverly Hills. Call us today!

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