20/06/2018
Medical Treatment
Trigeminal neuralgia is extremely painful but not life threatening. Thus, a goal of therapy is minimizing dangerous side effects.
Medications used to treat trigeminal neuralgia are those used for many other nerve pain syndromes-drugs originally designed to treat seizures.
These agents suppress excessive nerve tissue activity, which is the cause of the painful syndrome. As a result, they are useful in conditions such as trigeminal neuralgia.
Pain specialists use invasive therapy, including nerve blocks, nerve destruction, and nerve decompression techniques, as well as drug therapy to treat trigeminal neuralgia.
In some instances, a single injection, or a series of injections, or perhaps one decompressive procedure, will reduce or eliminate the pain and prevent your need for a long course of drug therapy.
Injection techniques also can relieve unremitting pain instantly and further confirm the diagnosis.
Using real-time X-rays, doctors can target the anatomical origin of the nerve deep in your skull. Then, with a fine needle, they can do one of the following to halt the painful syndrome:
Inject that source with anesthetic and steroid.
Inject that nerve with a drug used to destroy faulty cells.
This procedure can be performed with surprisingly little discomfort.
Doctors use 3 main drugs to treat trigeminal neuralgia-baclofen (Lioresal), carbamazepine (Tegretol), and phenytoin (Dilantin).
Baclofen is the safest of the 3, though less effective. Many doctors begin therapy with baclofen and monitor its results over a week's time.
For years, carbamazepine had been the mainstay for treating this disorder. In fact, many experts believe that if you get no relief from 2 days of carbamazepine treatment, doctors must reconsider the diagnosis of trigeminal neuralgia.
The side effects of this drug include dizziness, sedation, confusion, and rash.
The doctor likely will complete a series of blood and urine tests before beginning treatment to establish a baseline of laboratory values.
Carbamazepine in unusual instances causes a rare blood disease known as aplastic anemia.
Frequent blood monitoring avoids this problem. You can expect to take consistent doses of this medicine for about 6 months before your doctor reconsiders the dosing schedule.
If doctors clearly determine the cause of the disorder to be compression of an artery on the trigeminal nerve deep in your skull, a neurosurgeon can perform a microvascular decompression.
The surgeon moves the compressing artery to a location away from the compressed root of the nerve.
The major disadvantage is that it requires a neurosurgical operation-with all its complications-to get access to the root of the trigeminal nerve.
Doctors do not know how to prevent trigeminal neuralgia, to predict who will get it, or determine who will respond to a particular treatment until it is tried.
Clearly, though, the overwhelming majority responds to at least one of the treatments and can obtain excellent benefit from it.
More and more people find substantial relief from invasive treatment, either anesthetic injections or decompressive therapy. It is very rare that someone with trigeminal neuralgia does not obtain long-standing relief.
