Neuralgia 2 branches of the trigeminal nerve treatment. Trigeminal neuralgia - treatment, causes, symptoms, first signs

Trigeminal neuralgia is one of the most common diseases of the peripheral nervous system. It is known to mankind since the beginning of our era for its excruciating, maddening pains.

Medics of the last century tried to treat trigeminia (Fosergil's disease, Trusso's pain tic), and the first description of trigeminal neuralgia was recorded in the works of the ancient Chinese healer Hua Toa.

The prevalence of trigeminal neuralgia is 40 to 60 cases in every 10,000 people. The maximum risk of trigeminia is observed in the middle age group - in persons from 45 to 60 years old. Another feature of the disease is associated with the gender of patients - it is known that women suffer from pain tics much more often than men.

What it is?

Trigeminal neuralgia (trigeminal neuralgia) is a chronic disease manifested by bouts of intense, shooting, burning pain in the areas of innervation of the trigeminal nerve.

The International Association for the Study of Pain (IASP) defines trigeminal neuralgia as a syndrome characterized by sudden, intermittent, intense, repetitive pain in the innervation zone of one or more branches of the trigeminal nerve, usually on one side of the face.

Distinguish between the primary (idiopathic) form of trigeminal neuralgia, which occurs in the absence of other diseases or pathological processes due to compression of the trigeminal nerve root, and the secondary (symptomatic) form caused by the complication of another disease (infection, tumors, multiple sclerosis).

Types of neuralgia

Conventionally, all types of trigeminal neuralgia can be divided into primary (true) and secondary neuralgia.

• Primary (true) neuralgia is considered a separate pathology arising from compression of a nerve or a violation of blood supply in this area.
• Secondary neuralgia is the result of other pathologies. These include tumor processes, severe infectious diseases.

Neuralgia can affect both all nerve branches at once, and manifest itself as inflammation of one or two branches.

Causes of neuralgia

According to the mechanism of occurrence of trigeminal neuralgia, this pathology can be primary or true (isolated lesion of only the trigeminal nerve) or secondary (manifestation of neuralgia as a symptom of systemic diseases of the nervous system).

The exact cause of the development of trigeminal neuralgia has not been clarified, as mentioned above, refers to idiopathic diseases. But there are factors that most often lead to the development of this disease.

Factors that contribute to the development of trigeminal neuralgia:

1) Compression of the trigeminal nerve in the cranium or its branches after leaving the skull:

• trauma and post-traumatic scars;
• injuries in the area of ​​the jaw-temporal joint;
• congenital anomalies in the development of the bone structures of the skull;
• tumor formations of the brain or facial region along the branches of the trigeminal nerve;
• proliferation of connective tissue (adhesions) as a result of an infectious inflammatory process, sclerosis with damage to the myelin sheath of nerve fibers;
• vasodilation of the brain: aneurysms (pathological vasodilation), atherosclerosis, hemorrhagic and ischemic strokes, increased intracranial pressure as a result of osteochondrosis of the cervical spine, congenital anomalies in the development of blood vessels, and so on - the most common cause of trigeminal neuralgia.

2) Odontogenic causes (related to teeth):

• reaction to dental canal anesthesia;
• trauma to the jaw with damage to the teeth;
• dental flux;
• "Unsuccessful" filling or extraction of teeth or other surgical interventions in the face and mouth.

3) Diseases of the nervous system:

• multiple sclerosis;
• infantile central paralysis (cerebral palsy);
• meningitis, meningoencephalitis (viral, tuberculous);
• epilepsy;
• brain tumors and circulatory disorders in the area of ​​the nuclei and fibers of the trigeminal nerve, and so on;
• encephalopathy due to head trauma, infectious processes, hypoxia (lack of oxygen in the brain), lack of nutrients;

4) Viral lesions of the nerve: herpes infection, polio, neuro-AIDS.

Symptoms of trigeminal neuralgia

According to the nature of the symptoms, neuralgia of the facial nerve is divided into the following groups: reflex and movement disorders, pain syndrome, vegetative-trophic symptoms.

Intense, paroxysmal, burning, sharp, excruciating pain. At the time of an attack, patients sometimes freeze, describe the sensation as a lumbago, the passage of an electric current. The duration of the spasm is from 3 seconds to several minutes, in some cases the repetition rate reaches 300 per day. Localization of pain syndrome:

• Mandibular nerve: chin, lower cheek, lower lip, neck, occiput, teeth and surface of the lower jaw.
• Maxillary: lower eyelid, upper jaw and teeth, upper cheek, nasal mucosa, upper lip, maxillary sinus.
• Optic nerve: bridge of the nose, forehead, upper eyelid, scalp anterior, inner corner of the eye, ethmoid sinus.

Movement and Reflex Disorders:

• Muscle spasms of the face (pain tic). During an attack, an involuntary muscle contraction occurs in the circular muscles of the eye, which is called blepharospasm. Affects the symptom of the chewing and other muscles of the face, often extending to the entire half of the face.
• There are changes in the corneal, superciliary, mandibular reflexes, which is determined upon examination by a doctor.

Vegetative-trophic symptoms appear during an attack, at the first stages they are weak, but with the progression of the pathology they become more noticeable:

• runny nose, drooling, lacrimation;
• there is local redness or pallor of the skin color;
• in the later stages, dry / greasy skin, facial swelling, and eyelash loss develop.

If you do not start to treat the disease in time, a point of painful pathological activity is formed in the thalamus. This causes a change in the localization, the nature of the pain. At this stage, elimination of the treatment of the disease does not lead to recovery.

This stage is characterized by the following symptoms:

• applies to the entire half of the face;
• any touch on the face causes pain;
• loud sound, bright light become irritants and a provoking factor of pain;
• in some cases, even remembering the disease leads to paroxysm;
• pain syndrome from paroxysmal develops into permanent (chronic);
• vegetative-trophic disorders intensify.

The disease is more typical for middle-aged people. Diagnose signs of trigeminal neuralgia at the age of 40-50. In most cases, the right side of the face is affected (70%). Rarely, trigeminal neuralgia can be bilateral, the disease is cyclical: exacerbation is replaced by remission and deterioration occurs again, exacerbations occur in the autumn-spring period.

Diagnostics

Drug therapy can eliminate pain, but with neuralgia, it is necessary to identify and eliminate the underlying cause of the disease. Otherwise, the attacks of pain will become more acute and appear more often.

Basic diagnostic methods:

• Dental examination. Neuralgia often occurs against the background of dental diseases, poor-quality dentures.
• Consultation with a neurologist. The doctor, based on the results of the initial examination, determines the further types of examination.
• MRI. The study helps to see the structure of the nerves, the presence and localization of vascular pathologies, various kinds of tumors.
• Panoramic X-ray of the skull and teeth. Helps to see formations that could pinch a nerve.
• Blood test - allows you to exclude the viral origin of pathological changes in the trigeminal nerve.
• Electromyography - designed to study the features of the passage of impulses along the nerve.

How is trigeminal neuralgia treated?

The method of treatment is selected depending on the cause that provoked the disease.

The main drug for the treatment of trigeminal neuralgia is carbamazepine. It develops inhibitory processes in nerve cells that are prone to paroxysmal activity (painful excitement). The dosage of the drug is selected by the doctor, so we will not dwell on the drug regimens used. Let's just say that carbamazepine is taken for a long time, up to 8 weeks.

In addition, the drug is quite toxic. Affects the liver, urinary, bronchial system. Among the side effects from taking carbamazepine, various mental disorders, memory impairment, and drowsiness were noted. Carbamazepine is contraindicated in pregnant women. The drug has a teratogenic effect - it has a toxic effect on the embryo. Also, carbamazepine should not be taken by people with glaucoma, heart block, blood diseases.

During treatment with carbamazepine, grapefruit should not be consumed, since the fruit enhances the manifestation of side effects of the drug. To enhance the effect, it is recommended to take Carbamazepine together with Pipolfen. The duration of treatment rarely exceeds 30 days.

Other types of drugs:

• anticonvulsants - Phenibut, Baclofen;
• tranquilizers - Dizepam;
• antipsychotics - Pimozide;
• vasotonics are prescribed for damage to the vessels of the brain - Trental, Nicotinic acid.

In addition to tablets, vitamin injections of ascorbic acid, B vitamins are used in therapy. Non-steroidal anti-inflammatory drugs in the form of injections or tablets are used as pain relievers - Neurodiclovit, Milgama, Diclofenac. Antidepressants for neuralgia - Amitriptyline, help to eliminate the nervous tension and stress of the patient. To improve metabolic processes, prevent the formation of cholesterol plaques, Atoris is prescribed.

Physiotherapy is equally helpful. It can enhance the effect of any drug, as well as its effectiveness. Treatment of inflammation of the trigeminal nerve is performed using the following physiotherapy procedures:

• Electrophoresis
• Phonophoresis
• Ultrasound.
• Acupuncture.
• Laser therapy. It relieves pain, as it slows down the passage of a nerve impulse through the fibers.
• Exposure to an electromagnetic field.
• Irradiation with ultraviolet or infrared rays. It makes it possible to eliminate pain.

Drug therapy is selected for each patient individually, depending on the severity of the pathology, as well as the characteristics of his body.

Surgery

In the absence of the effect of conservative treatment at home, as well as in cases where trigeminal neuralgia is caused by compression of the root by an anatomical formation, surgical methods are used:

• if the cause of the compression is a pathologically altered vessel, then microvascular decompression is performed. The essence of the operation is to separate the vessel and nerve using microsurgical techniques. This operation is highly effective, but very traumatic;
• percutaneous balloon compression: termination of painful impulses along the nerve by compressing its fibers with a balloon supplied to the nerve with a catheter;
• percutaneous stereotaxic rhizotomy: the destruction of the nerve root is performed using an electric current supplied to the nerve using a needle in the form of an electrode;
• nerve destruction using ionizing radiation: non-invasive technique using radiation;
• glycerine injections: destruction of the nerve by injecting glycerin into the nerve branches;
• if the cause was a tumor process, then, of course, the removal of the tumor comes to the fore;
• radiofrequency ablation: the destruction of nerve fibers using heat.

A characteristic feature of all surgical methods is a more pronounced effect when they are performed early. Those. the earlier this or that operation is performed, the higher the likelihood of cure. It should also be borne in mind that the disappearance of pain attacks does not occur immediately after surgical treatment, but somewhat distantly (the timing depends on the duration of the disease, the extent of the process and the type of surgery). Therefore, all patients with trigeminal neuralgia need a timely visit to a doctor.

Gymnastics

The movements and contractions of the facial muscles cause not only relief during the next attack of the disease, but also help to reduce the compression of the nerve branches in the future. Additional positive effects of gymnastics:

• improved blood circulation;
• optimization of lymph outflow;
• restoration of the conduction of nerve impulses (in case of its violation);
• prevention of the development of stagnation in the muscles.

• Tilts and circular rotations of the head (2 minutes).
• Stretching the neck and head as far as possible towards each shoulder (4 times).
• Stretching the lips in a smile, bringing them into a "tube" (6 times).
• Gathering air into the cheeks, exhaling it through a narrow slit in the lips (4 times).
• Retraction of the cheeks (6 times).
• Closing and opening the eyes with strong squeezing of the eyelids (6 times).
• Raising the eyebrows upwards while fixing the forehead with the hand (6 times).

New developments

The most modern and effective methods of treating trigeminal neuralgia are radiosurgery with the Cyber ​​Knife. This device uses a photon flux for treatment, which penetrates precisely into the area of ​​inflammation and eliminates it. Cyber ​​Knife treatment provides high precision of radiation doses, comfortable and fast healing. Moreover, the procedure is absolutely safe for the patient.

Modern treatment with Cyber ​​Knife can be considered the most effective. This technique is used not only abroad, but also in the vastness of the former USSR: in Russia, Ukraine, Belarus. For your information, treatment in Moscow will cost 180,000 rubles.

Preventive measures

Disease prevention is provided by:

• Try to follow a balanced diet and take multivitamins.
• In the event of the occurrence and detection of infectious diseases, especially of the oral cavity and nasopharynx, try to heal them in a timely manner and completely.
• Avoiding hypothermia of both the face and the whole body as a whole. Dressing for the weather is much wiser than treating (sometimes to no avail) severe pain.
• A systematic visit to the dentist to identify an infection that can later become the cause of the disease.
• Atherosclerosis (the occurrence of plaques in the vessels of the body, the brain is no exception), to which people of the older age group are more susceptible, is ranked among a number of causes of trigeminal neuralgia.

Any disease is easier to prevent than to cure, so the emphasis should be on the prevention of trigeminal neuralgia in order to avoid its consequences. If it happens that the disease has taken over, do not self-medicate, do not prescribe painkillers for yourself that relieve pain for a couple of hours, but contact an experienced specialist for a rational and complete course of treatment.

Forecast

Neuralgias do not pose a direct threat to life. Trigeminal neuralgia is no exception. However, the human psyche can be greatly affected by this disease. Frequent and very intense pain syndromes quickly drive the patient into a state of depression. He begins to avoid communication, begins to lead an asocial lifestyle. The development of a wide variety of mental pathologies can begin.

Timely treatment will minimize the damage to a person's mental health. Even in the most difficult situations, you shouldn't endure pain. It is better to decide on an operation, since the disease lends itself to effective treatment even in the most difficult situations.

The trigeminal nerve belongs to the 5th pair of cranial nerves and has branches - the ophthalmic, located in the upper jaw and located in the lower jaw. With the development of an inflammatory process in the area of ​​this nerve, they speak of neuralgia.

What it is?
Trigeminal neuralgia is a chronic disease in which the branches of the nerve are affected, as a result of which the patient suffers from constant paroxysmal pain in the area of ​​their innervation. With this pathology, pain occurs more often in one half of the face.

Common causes of facial trigeminal neuralgia are:

1. Hypothermia of the body;
2. Foci of chronic infection in the body (carious teeth, sinusitis, tonsillitis, t, frontal sinusitis);
3. Tumor formations in the brain;
4. Aneurysm of cerebral blood vessels;
5. Compression of the nerve by the bones of the skull;
6. Osteochondrosis in the cervical spine;
7. Head injuries received;
8. Herpetic infection;
9. Polio;
10. Previous surgical interventions in the oral cavity.

At risk are people:

• Over 45 years old;
• Susceptible to constant stress;
• Those suffering from vitamin deficiencies;
• Allergy sufferers;
• Persons with;
• Suffering from disorders of the organs of the endocrine system (, hypo and hyperthyroidism).

The main clinical symptom of trigeminal neuralgia is pain, usually localized on one side of the face. The attack occurs suddenly, with the slightest irritation of the affected nerve. The patient complains of shooting pain, which is often equated with electric shocks.

The pain does not last long, usually no more than a few minutes. After this, a period of remission begins, which can last up to several weeks or months, but as the disease progresses, pains occur more often, and the intervals between them become shorter.

With neuralgia of 1 branch of the trigeminal nerve, pain is localized in the wing of the nose, eyes, eyebrows, temples, crown.

Another attack of pain is provoked by simple actions of the patient:

• Smile, laugh, yawn;
• Hygiene procedures and a simple touch on the face, etc.;
• Food intake and chewing movements;
• Stay in the cold or draft.

In addition to pain, before effective treatment begins, the following conditions are the symptoms of trigeminal neuralgia:

1. Lachrymation from the side of the lesion;
2. There may be profuse clear nasal discharge;
3. Redness of the lower eyelids and mucous membranes of the eyes;
4. Twitching of the facial muscles - the affected half contracts convulsively;
5. Disorders of the patient's psyche - so any actions (laughter, eating, yawning, etc.) can provoke another attack of pain, the patient becomes irritable, withdrawn, refuses to eat, is afraid to fall asleep. In addition, in severe cases, suicidal thoughts are possible;
6. Violation of the sensitivity of half of the face - the patient complains of facial numbness in the affected area, a feeling of creeping under the skin;
7. Muscle atrophy of the affected half of the face - develops as a result of impaired blood supply and lymph drainage. Under the influence of such changes on the affected half of the face, eyelashes, eyebrows, teeth fall out, wrinkles appear, the corner of the lips rises and the eyelid drops, and chewing ability worsens.

Diagnosis of neuralgia

Diagnosis of trigeminal neuralgia begins with a visit to a neurologist. The doctor examines the patient during remission and after exposure to pain points, the influence on which can provoke an attack of pain, collects an anamnesis of life and illness, prescribes additional studies:

• Electroneurography;
• Computed tomography, MRI;
• Electroencephalography;
• Blood biochemistry;
• Puncture of the spinal cord, if necessary - if suspected;
• Consultation with an otolaryngologist, dentist, neurosurgeon.

The therapy of the disease is carried out in a comprehensive manner, the main steps in the treatment of trigeminal neuralgia are as follows:

• Prevention of factors that can trigger the development of neuralgia;
• Normalization of the central nervous system - prevention of stress, reduction of hyperexcitability;
• Physiotherapy procedures - electrophoresis, acupuncture, massage.

To stop an attack of trigeminal neuralgia and prevent pain in the future, the patient is prescribed Finlepsin. This drug belongs to the group of anticonvulsants and helps to reduce the excitability of nerve fibers and inhibit the production of neurotransmitters.

This remedy can be taken strictly according to the indications of a doctor and in an individually indicated dosage, since the tablets have a number of serious contraindications.

In addition to finlepsin, the patient is prescribed:

• B vitamins - have a beneficial effect on the work of the central nervous system;
• Sedatives - Valerian;
• Glycine or Glycesed - amino acids that take part in the transmission of nerve impulses;
• Antihistamines;
• Muscle relaxants;
• Antidepressants.

During stable remission, physiotherapy and spa treatment are indicated.

Surgical treatment of trigeminal neuralgia

If conservative methods of treatment are not effective, the patient is prescribed a surgical intervention. The main indications are brain tumors, the presence of narrowed areas in the canal of the nerve exit from the skull, pinching of the nerve branches ,.

In modern surgery, an operation to eliminate trigeminal neuralgia is performed with a laser. This intervention is minimally invasive and well tolerated by the patient.

Forecast

When seeking medical help on time and correctly prescribed treatment, the prognosis of the disease is generally favorable. Following simple preventive recommendations allows you to achieve a stable remission or completely get rid of the problem.

Trigeminal neuralgia or trigeminal neuralgia is a chronic neurological disease characterized by attacks of excruciating pain in the innervation zone of the branches of the trigeminal nerve (temple, eye socket and forehead, upper or lower jaw). The disease is quite common, occurs in 1 case per 15 thousand of the population, women are most susceptible to neuralgia after 50 years.

Causes of trigeminal neuralgia

The trigeminal nerves, the largest pair of the 12 cranial nerves, provide sensitivity and motor function to various parts of the face.

Neuralgia usually occurs due to acute or chronic compression of the nerve, which leads to demyelination, as a result of which the conduction of nerve signals is impaired. The main causes of trigeminal neuralgia are:

mechanical compression by blood vessels, tumor, sclerotic plaque (with multiple sclerosis)

damage to the trigeminal nerve itself due to trauma

consequences of trauma or pathological development of the jaw

inflammatory processes along the nerve

infectious diseases

Allocate primary trigeminal neuralgia and secondary (symptomatic), as a consequence of another disease: infections, multiple sclerosis, tumor diseases. Also known is the typical (paroxysmal) and atypical course of the disease, when the pain is constant and covers most of the face.

Symptoms of trigeminal neuralgia

The main manifestation of the disease is acute shooting or burning pain along the affected branch of the nerve. Most often, the second branch suffers (often in combination with the third), then the third (lower), less often the first (about 5% of all cases). Usually, only one side of the paired nerve is affected. Pain syndrome is rarely accompanied by sensory disorders, but muscle tics and spasms may occur.

Absolutely any daily action in which the trigger zone (hypersensitivity zone) is involved can provoke an attack. Usually this is the area of ​​the nasolabial triangle, but it can be the temple or forehead. A bout of pain may occur

during a conversation (articulation)

with a smile and other facial expressions

in the process of washing, shaving, brushing teeth

due to the presence of makeup

when touched or hit on the nose

from touching the trigger zone (even a breath of wind)

Hypothermia, acute respiratory viral infections (especially rhinitis or sinusitis), tooth extraction surgery, the use of spicy, smoked, fatty and highly spicy foods, alcohol can also serve as a provoking factor. Also, an attack of trigeminal neuralgia can be caused by a migraine attack, and vice versa.

The pain syndrome is so acute that it completely knocks a person out of the usual rhythm of life. At the time of the attack, the patient freezes, fearing any movement to increase the pain. His attention is focused only on her, and therefore he is not able to perform any work activity, only actions aimed at alleviating the condition.

Diagnostics of the trigeminal neuralgia

In the diagnosis of a pathology such as trigeminal neuralgia, an important role is played by a neurological examination, in which the doctor assesses the pain syndrome. The doctor determines the type of pain syndrome, its location and triggers causing the pain attack. The doctor palpates the face to determine the area of ​​the trigeminal nerve lesion, in particular, to find out which of its branches is affected, determines the violation of sensitivity, motor function of the innervated muscles, conducts a general examination to exclude concomitant pathology. The diagnosis is established on the basis of a set of data: patient complaints, neurological examination, the results of additional examinations. In order to formulate the correct diagnosis, identify the cause of the pathology and select the tactics for treating neurology, the Aksimed clinic recommends the following examination plan: complete blood count, biochemical blood test, consultation with a maxillofacial surgeon, otolaryngologist, magnetic resonance imaging of the brain.

Treatment of trigeminal neuralgia

To date, it is possible to completely cure trigeminal neuralgia only by mechanical compression, removing the irritating factor. In other cases, treatment is aimed at stopping the attack and reducing the intensity of pain, as well as reducing the sensitivity of the trigger zones. For these purposes, drug therapy (anticonvulsants, pain relievers, anesthetics), physiotherapy procedures are used.

If conservative treatment of trigeminal neuralgia does not bring the desired result, surgery is indicated: dissection of the nerve roots, removal of the gasser's node, blockade of the nerve branches. In some cases, it may be necessary to remove any of the branches or the entire trigeminal nerve. However, the consequences of such an operation: loss of sensitivity of the zone for which the removed nerve was responsible, impaired facial expressions and motor function of the lower jaw.

Prevention of trigeminal neuralgia does not exist, however, full treatment of ARVI, sanitation of the oral cavity, avoidance of hypothermia and proper nutrition reduce the risk of its development.

Update: December 2018

Before describing the symptoms of trigeminal neuralgia, let's try to explain what the trigeminal nerve is. As you know, there are 12 pairs of cranial nerves in the human body. The trigeminal nerve is a representative of the fifth pair. It consists of three branches - ocular, mandibular and maxillary. Thus, if the ophthalmic branch of the nerve is affected, the pain will be localized in the forehead, temple, and brow arch.

With the defeat of the 2nd branch, the pain manifests itself in the area of ​​the nose, upper jaw, facial muscles. The defeat of the 3rd branch is characterized by pain localized in the area of ​​the lower jaw, chin, neck. Often, with the defeat of the second and third branches, severe toothache occurs.

Types of neuralgia

Conventionally, all types of trigeminal neuralgia can be divided into primary (true) and secondary neuralgia.

• Primary (true) neuralgia is considered a separate pathology arising from compression of a nerve or a violation of blood supply in this area.
• Secondary neuralgia is the result of other pathologies. These include tumor processes, severe infectious diseases.

Neuralgia can affect both all nerve branches at once, and manifest itself as inflammation of one or two branches.

Causes of neuralgia

In order to choose an adequate treatment for trigeminal neuralgia, one must be well versed in the causes of the onset of the disease. And there are a lot of them:

• Compression of all or one branch of the trigeminal nerve;
• Inflammatory diseases of the paranasal sinuses
• Diseases of the teeth;
• Chronic infectious diseases - tuberculosis, brucellosis, malaria;
• Metabolic disorders - diabetes mellitus, gout
• Brain tumors (see)

Signs of the disease

Trigeminal neuralgia symptoms are quite vivid, so the diagnosis of the disease does not cause difficulties. The disease is characterized by the appearance of a sharp, burning pain in the face that occurs suddenly. The painful attack does not last long, for a maximum of 2 minutes or seconds (10-20), after which it goes away on its own. As we wrote above, pain occurs in the area where one of the three branches of the nerve is affected. Most affected are patients who have all three branches of the trigeminal nerve affected.

The pain always occurs on one side of the face. Sometimes it can be transitional - to affect one branch of the nerve, then another. The pains are given to the eye, ear, neck, occipital region, patients call such pain shooting, they compare it with an electric discharge.

An attack of neuralgia is accompanied by convulsive contractions of the facial (mimic, chewing) muscles, while the patient does not cry, does not cry, but tries to minimize movements. Patients have increased salivation, lacrimation, sweating (see). The skin turns red, signs of rhinitis may appear.

The pain occurs both for no apparent reason, and with additional irritations: talking, shaving, chewing. In the periods between painful attacks, no signs of the disease can be detected. Mild soreness is sometimes noted if pressure is applied to the exit points of the facial nerve.

Usually, the location of pain remains unchanged for several years. Since patients with similar neuralgia often chew food on the healthy side, over time, muscle compaction, dystrophy of the masticatory muscles, and a decrease in sensitivity may occur on the diseased part of the face.

The disease is characterized by excruciating pain. When taking anamnesis and examining, doctors note that patients talk with horror about the pain they have suffered, trying not to touch the area of ​​the face where the attack occurred. Patients are usually tense, anxious in anticipation of an exacerbation of neuralgia. This must be taken into account when choosing a method for treating trigeminal neuralgia - it is very important to reassure the patient, instill in him confidence that the treatment will be effective and the pain will not return.

Which doctor should I go to? Having experienced an attack of severe facial pain, especially if it manifests itself in the jaw and teeth, most patients associate its occurrence with dental pathologies. This is not true. Your road lies to a doctor - a neurologist.

How is trigeminal neuralgia treated?

For the treatment of this disease, medication, physiotherapy and surgery are used.

Drug treatment

The main drug for the treatment of trigeminal neuralgia is carbamazepine. It develops inhibitory processes in nerve cells that are prone to paroxysmal activity (painful excitement). The dosage of the drug is selected by the doctor, so we will not dwell on the drug regimens used. Let's just say that carbamazepine is taken for a long time, up to 8 weeks.

In addition, the drug is quite toxic. Affects the liver, urinary, bronchial system. Among the side effects from taking carbamazepine, various mental disorders, memory impairment, and drowsiness were noted.

Carbamazepine is contraindicated in pregnant women. The drug has a teratogenic effect - it has a toxic effect on the embryo. Also, carbamazepine should not be taken by people with glaucoma, heart block, blood diseases.

Interesting! It is known that when taking carbamazepine, grapefruit juice should not be consumed - it enhances the toxic effect of the drug.

We hope we have convinced you not to take carbamazepine without a doctor's prescription. Against the background of taking this drug for trigeminal neuralgia, the symptoms stop after 1-2 days, its analgesic effect is felt, the duration of which is 3-4 hours.

• Similar drugs - antconvulsants can also be used in the complex treatment of trigeminal neuralgia. These are Phenibut, Pantogam, Baclofen.
• To relieve a painful attack, ambulance specialists can use intravenous sodium oxybutyrate. However, the effect of such injections is short-lived, the pain is relieved for several hours.
• can enhance the therapeutic effect of carbamazepine (Pipolfen, Diphenhydramine).
• Tranquilizers (Tazepam, Diazepam) and antipsychotics (Pimozide) are prescribed, as an additional drug, neurologists can use a well-known long course.
• With diseases of the cerebral vessels, vasotonics can be prescribed for - Cavinton, Trental, Nicotinic acid, etc.
• Vitamin therapy, especially vitamin C and vitamins of group B. The latter are often prescribed in the form of injections in the acute period of the disease.
• Non-steroidal anti-inflammatory drugs - see.

Physiotherapy treatment

In combination with medication, physiotherapy is prescribed. The following methods are used:

• Acupuncture;
• Ultrasound;
• Laser therapy;

Radical treatment

In the absence of the effect of the ongoing conservative treatment, the patient can be offered a solution to the problem by surgery. Currently, there are several types of radical treatment. Let's dwell on these methods in more detail:

• Rhizotomy

Through a cutaneous incision behind the ear, a rupture of the trigeminal nerve is carried out, which achieves the therapeutic effect.

• Microvascular decompression

The operation is performed by neurosurgeons. This operation removes or removes blood vessels that come in contact with the nerve roots. The efficiency of such an operation reaches 80%.

• Radiofrequency ablation

Exposure to the nerve node with high temperature. Treatment is carried out with local anesthesia. Hospitalization is optional. The pains do not stop immediately, the final recovery occurs after a month.

• Glycerin injections

They are carried out with the help of a long thin needle, with the help of which the doctor penetrates into the branching area of ​​the trigeminal nerve. Injections help well, but sometimes relapses of the disease are noted at a later date.

New developments

The most modern and effective methods of treating trigeminal neuralgia are radiosurgery with the Cyber ​​Knife. This device uses a photon flux for treatment, which penetrates precisely into the area of ​​inflammation and eliminates it. Cyber ​​Knife treatment provides high precision of radiation doses, comfortable and fast healing. Moreover, the procedure is absolutely safe for the patient.

Modern treatment with Cyber ​​Knife can be considered the most effective. This technique is used not only abroad, but also in the vastness of the former USSR: in Russia, Ukraine, Belarus. For your information, treatment in Moscow will cost 180,000 rubles.

Scientists call this disease Trousseau's tic pain and Fosergil's disease and is known to patients as trigeminal neuralgia. You can independently determine the pathology by paroxysmal, extremely intense pain in the eyes, forehead, and jaw. If you find this distinctive feature, you should immediately contact a medical institution, even a single symptom that has arisen is a reason to start treatment of trigeminal neuralgia as soon as possible.

Anatomical structure

The fifth pair of cranial nerves is called the trigeminal nerves, they are located symmetrically: on the right and left sides of the face. The function of the trigeminal nerve is the innervation of a number of facial muscles. It consists of three main branches, including many smaller branches. The path of the branches to the innervated areas passes through channels in the bones of the skull, where nerve fibers can be compressed.

Causes of trigeminal neuralgia

Revealing the origin of neuralgia allows you to objectively assess the clinical picture and cure the patient quickly and with minimal stress on the body. Doctors consider the most common causes of trigeminal neuralgia:

• vascular pathologies, including changes and abnormalities in the development of blood vessels or their location;
• deterioration of blood flow due to hypothermia of the face area;
• inflammatory processes in the branching zone, which can be caused by otorhinolaryngological, eye and dental problems;
• trauma to the face and skull;
• violation of metabolic processes in the body;
• chronic viral diseases;
• congenital narrowness of the canals along the branches;
• any tumors localized to the trigeminal nerve zone;
• multiple sclerosis;
• allergic inflammation;
• stem stroke;
• psychogenic factors.

Risk group and features of the course of the disease

Trigeminal neuralgia is a very common reason for visiting a neurologist. This is due to the large number of factors provoking the development of the disease, painful attacks of extremely high intensity and long-term therapy of neglected cases. The number of people at risk for trigeminal neuralgia is quite large.

Middle-aged people are more often susceptible to neuritis, mainly the disease manifests itself between the ages of 40 and 50. The percentage of patients with trigeminal neuralgia among women is significantly higher than among the male part. An important determining factor is the presence of chronic diseases contributing to the development of neuralgia in the patient's history.

In seventy percent of cases, the right side is affected, both sides are rarely affected by the disease. The course of the pathology is cyclical: the acute period is replaced by remission. Peaks of exacerbations occur in autumn and spring.

Symptoms of facial trigeminal neuralgia

Fosergil's disease has clear symptoms that are obvious even to a layman. However, how to effectively treat trigeminal neuralgia can only be determined by a doctor who takes into account the entire clinical picture.

Symptoms of Trousseau's pain tic are divided into three groups, which manifest themselves in stages: at first, only pain is disturbed, then motor and reflex, and then vegetative-trophic disorders. At the third stage, not only the symptomatology undergoes changes, but also the medical prognosis for complete healing significantly worsens.

The nature of the pain

The first sign of Trousseau's pain tic is intense pain attacks in the innervation zone of the affected branch. The pain is burning and excruciating, characterized by extreme intensity, it is paroxysmal, arises very sharply.

Patients compare a painful attack with neuralgia with a lumbago and the passage of an electric current. Paroxysm lasts from several seconds to several minutes. At the time of exacerbation, the frequency of attacks is very high.

According to a scientific article devoted to the study of the disease, a painful attack with neuralgia can occur up to three hundred times per day.

Localization of pain

The pain can be localized both in the innervation zone of the entire nerve, and in one of its branches. A characteristic feature is that the pain spreads from one branch to another, and over time, the entire affected half of the face is involved. The longer the illness lasts without medical intervention, the more likely it becomes to damage the entire nerve. and the spread of the pathological process to other branches.

With lesions of the ocular branch, the pain is concentrated in the forehead and eye. With a disease of the maxillary branch, the pain spreads to the upper and middle part of the face. Lesions of the mandibular nerve can provoke the onset of pain in the masticatory muscles, the lower jaw and the wings of the nose. Sometimes echoes of pain are felt in the neck, temple and occiput.

It happens that the pain is clearly concentrated in the area of ​​a particular tooth, which is why the dentist often becomes the first specialist for an appointment with which a patient with neuralgia is scheduled. When examining the tooth, the cause of the pain is not revealed, but if the treatment is still carried out, this does not bring any effect or relief. The main task of a dentist in such a situation is to refer the patient to a consultation with a neurologist.

Pain provocation

Painful paroxysm can be triggered by touching or pressing on the exit points of nerve branches in the face and trigger zones. Daily activities, such as chewing and brushing teeth, washing, shaving, even a breath of wind, speaking and laughing, can also induce an attack of pain. At the moment when an attack occurs, the patient often freezes, afraid to make the slightest movement, and lightly rubs the pain zone.

Movement and Reflex Disorders

• Facial muscle spasm. At the moment of paroxysm, the muscles of the face contract involuntarily. Reflex disorders begin with blepharospasm or trismus, with the course of the disease, spasms can be transmitted to the entire half of the face.
• Degradation of the superciliary, corneal and mandibular reflexes. The disorder is revealed when examined by a neurologist.

Vegetative trophic symptoms

At the initial stage of the disease, vegetative-trophic symptoms are practically absent, or symptoms appear exclusively during an attack. Only the occurrence of painful paroxysm, local redness or pallor of the skin is characteristic. The secretion of the glands changes, a runny nose, lacrimation and salivation may appear.

With the progression of the disease, the vegetative-trophic symptoms of trigeminal neuralgia also intensify, and therefore treatment requires a longer and more extensive one.

Symptoms of an advanced case of neuralgia

In advanced cases, a number of symptoms are added. Elimination of the cause of the disease leads to recovery in more than a hundred percent of cases; complex methods of treatment are required.

Signs of advanced trigeminal neuralgia are:

• Swelling of the face, loss of eyelashes, change in the secretion of the skin glands.
• The spread of pain to other parts of the face.
• The appearance of pain from the slightest pressure on any part of the face from the affected side.
• The onset of pain to any stimulus, up to a loud sound or bright light, may even be a reminder of a previous attack.
• Permanent nature of pain.
• Changes in the localization and duration of pain attacks.
• Strengthening vegetative-trophic symptoms.

Diagnostics

Correct treatment of trigeminal neuralgia requires the identification of all symptoms, they will help determine the stage and specificity of the course of the disease. Anamnesis and questioning of the patient are of paramount importance in making a diagnosis. Examination helps to determine the localization of a decrease and increase in skin sensitivity on the face, to identify possible degradation of muscle reflexes.

During the period of remission of the disease, if it is at an early stage, the pathology is not always noticeable on examination. To detect the cause of neuritis, an MRI scan may be recommended to the patient, however, even the most modern tomography performed in Moscow does not always show pathology. Patients with symptoms of neuralgia are advised to see a neurologist immediately.

Fosergil's disease treatment methods

Treatment of trigeminal neuralgia is performed by the following methods, mainly used in combination:

• physiotherapy;
• prescribing drugs;
• surgical intervention.

Attempts to cure all kinds of folk remedies are not only ineffective for neuralgia, but also very dangerous. The main risk is that time will be lost and qualified assistance will not be provided on time.

Treatment with medications

Prescribing drug treatment is justified when the cause of trigeminal neuralgia is vascular pathology or a tumor. The therapy involves:

• Antiepileptic drugs.
• Pain relievers or injections.
• Muscle relaxants.
• Antiviral agents.

The main drug in most cases is an anticonvulsant drug based on carbamazepine. Vitamin-based adjuvant therapy has proven itself well. In addition, they are used for treatment.

• Valproic acid.
• Pregabalin.
• Baclofen
• Gabapentin.
• Lamotrigine.

The doctor selects the optimal medicines and dosages individually. The main tasks of therapy are to relieve pain attacks, eliminate the causes of the disease, and prevent complications. Treatment of trigeminal neuralgia with medications takes about six months with a gradual decrease in medicinal doses.

Surgery

It is better to carry out the operation in the early stages of the disease, this increases the likelihood of complete healing. Today, two main groups of operations are used to treat neuralgia. One is effective in cases where it is necessary to correct the position of the artery, or if neuralgia is provoked by compression of the nerve branch by some anatomical formation. The second is used if neuralgia was treated with conservative methods, and the therapy did not give positive results.

The type of surgical intervention differs depending on the pathology that caused the neuralgia:

• If the cause of the compression is vascular disease, microvascular decompression is used. This is a microsurgical operation during which a nerve and a vessel are separated. The effectiveness of the method is very high, but it must be taken into account that the operation is traumatic.
• If the reason is the development of a tumor process, the tumor is removed first, and after that, treatment is prescribed.
• If it is necessary to remove painful impulses along the nerve fiber, percutaneous balloon compression is performed.

In some cases, the destruction of the nerve is necessary. For this, the following methods are used:

• Non-invasive ionizing radiation. Used only in the early stages of the disease.
• Stereotactic percutaneous rhizotomy. The nerve root is destroyed under the influence of an electric current, which is supplied to the damaged area using the thinnest electrode.
• Radiofrequency ablation, in which nerve fibers are destroyed by heat.
• Glycerin injections at the sites of nerve branching.

Physiotherapy treatment

For the early removal of pain symptoms and complete healing in tandem with drug therapy, physiotherapy procedures are prescribed. After the start of treatment, surgical or physiotherapy, the pain does not immediately disappear. The period of complete disappearance of paroxysm is individual and due to the vastness of the process, the duration of the disease, therefore, in addition, the doctor prescribes pain relievers.

The most effective treatments for Trusso's pain tic are shown by the following procedures:

• laser therapy;
• diadynamic currents;
• electrophoresis using novocaine;
• acupuncture;
• phonophoresis with hydrocortisone.

Preventive measures

It is impossible to avoid all potentially dangerous factors, especially considering that some of the reasons are congenital: narrowness of the channels, pathology in the structure and location of blood vessels. However, you can reduce the risk of the disease by eliminating several provoking factors. As a primary prophylaxis, one should:

• avoid hypothermia of the face and head;
• timely treat diseases that can give rise to trigeminal neuralgia;
• avoid head injuries.

Doctors consider the only timely treatment of diseases of the trigeminal nerve to be a full-fledged secondary prevention, therefore, at the first symptoms of pathology, you should immediately contact the clinic.

Possible complications

It is impossible to start trigeminal neuralgia, Fosergil's disease causes complications:

• paresis of the facial muscles;
• hearing loss;
• irreversible damage to the nervous system, up to inflammation in the brain.

It is categorically impossible to relieve pain with analgesics and hopes that neuralgia will go away by itself. This is a serious neuralgic disorder that only a doctor should treat. The sooner the patient seeks help, the more successful and shorter the therapy will be.