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5669, 07:57, 2008-05-21 10:00:49 Description: Physical exam by a urologist including kidney, testicular and prostate exam. From a urology website.
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295, 02:46, 2008-04-22 16:25:33 Description: "THE CREATOR" - FOR STICK "EL CREADOR" - FOR STICK FOR MORE: http://www.soyelcreador.com.ar http://www.historietayanimacion.com "Animé" redirects here. For the (More) "THE CREATOR" - FOR STICK "EL CREADOR" - FOR STICK FOR MORE: http://www.soyelcreador.com.ar http://www.historietayanimacion.com "Animé" redirects here. For the oleo-resin, see Animé (oleo-resin). Anime (アニメ, Anime? IPA pronunciation: /ɑnime/ listen (help·info) in Japanese, but typically /ˈænɪˌme(ɪ)/ or /ˈænɪmə/ in English) (pl. anime) is an abbreviation of the word "animation". Outside Japan, the term most popularly refers to animation originating in Japan. To the West, not all animation is considered anime; and anime is considered a subset of animation. While some anime is hand drawn, computer assisted animation techniques have become quite common in recent years. Like any entertainment medium, the story lines represent most major genres of fiction. Anime is broadcast on television, distributed on media such as DVD and VHS, and included in video games. Additionally, some are produced as full length motion pictures. Anime often draws influence from manga, light novels, and other cultures. Some anime storylines have been adapted into live action films and television series. History Main article: History of anime The history of anime begins at the start of the 20th century, when Japanese filmmakers experimented with the animation techniques that were being explored in France, Germany, the United States, and Russia.[citation needed] Animation became notable in Japan as it provided an alternative format of storytelling compared to the underdeveloped live-action industry in Japan. Unlike America, where live-action shows and films have generous budgets, the live-action industry in Japan is a small market and suffered from budgeting, location, and casting restrictions. The lack of Western-looking actors, for example, made it next to impossible to shoot films set in Europe, America, or fantasy worlds that do not naturally involve Japan. The varied use of animation allowed artists to create any characters and settings.[1] During the 1970s, there was a surge of growth in the popularity of manga— which were often later animated — especially those of Osamu Tezuka, who has been called a "legend"[2] and the "god of manga".[3][4] As a result of his work and that of other pioneers in the field, anime developed characteristics and genres that are fundamental elements of the art today. The giant robot genre (known as "mecha" outside Japan), for instance, took shape under Tezuka, developed under Go Nagai and others, and was revolutionized at the end of the decade by Yoshiyuki Tomino. Robot anime like Gundam and Macross became instant classics in the 80s, and the robot genre of anime is still one of the most heard of in Japan and worldwide today. In the 1980s, anime was accepted in the mainstream in Japan, and experienced a boom in production (It should be noticed that, manga has significantly more mainstream exposure than anime in Japan). The mid-to-late '90s, on into the 2000s, saw an increased acceptance of anime in overseas markets. Terminology Etymology and pronunciation Note: This page or section contains IPA phonetic symbols in Unicode. See IPA chart for English for a pronunciation key. The Japanese term for animation is アニメーション (animēshon, pronounced /ɑnime:ɕoɴ/), written in katakana. It is borrowed from the French word for animation, "l'animé" (it's lacking the article--both are pronounced similarly). Both the words "animation" and "l'animé" come from the Latin word "anima" which means to move. [5] The Japanese term is spelled アニメ (anime, pronounced /ɑnime/). Both the original and abbreviated forms are valid and interchangeable in Japanese, but as could be expected the shorter form is more commonly used. The pronunciation of anime in English differs significantly from Japanese. The first vowel is further forward in English than Japanese: /æ/ is more likely than /ɑ/. As English stresses words differently than Japanese, the second vowel is likely to emerge as an unstressed schwa /ə/ or /I/ in English, whereas in Japanese each mora carries equal stress. As with a few other Japanese words such as Pokémon and Kobo Abé, anime is sometimes spelled as animé in English with an acute accent over the final e to cue the reader that the letter is pronounced as a Japanese /e/. However, this accent does not appear in any commonly used system of romanized Japanese, and English native speakers may produce /eI/. Definition An example of an anime drawing styleLinguistically, the anime definition is subject to interpretation. In Japan, the term does not specify an animation's nation of origin or style; instead, it is used as a blanket term to refer to all forms of animation from around the world.[6] In English, main dictionary sources define anime as "a Japanese style of motion-picture animation" or "a style of animation developed in Japan".[7] Thus, non-Japanese works are sometimes called anime-influenced animation if they borrow stylistically from Japanese animation. In western countries the word is used usually only to refer to animated programming of Japanese origin, with the term "cartoon" or "animated series" used for most other visual styles. The online anime database AniDB generally defines anime (in the singular form) as "an animated, professionally produced, feature film created by a Japanese company for the Japanese market".[6] However, some anime are co-productions with non-Japanese companies like the Cartoon Network. Thus, anime is no longer specific to the Japanese market. Syntax and morphology Anime can be used as a common noun, "Do you watch anime?" or as a suppletive adjective, "The anime Guyver is different from the movie Guyver." It may also be used as a mass noun, as in "How much anime have you collected?" and therefore is never pluralized "animes" (nouns are never pluralized in Japanese). However, in other languages where anime has been adopted as a loan word, it is sometimes used as a count noun in singular and in plural as in Danish "Jeg tror, jeg vil se en anime" ("I think I'll watch an anime") and "Hvor mange anime'er har du nu?" ("How many animes do you have now?"). Synonyms Anime is sometimes referred to as Japanimation, but this term has fallen into disuse. Japanimation saw the most usage during the 1970s and 1980s, which broadly comprise the first and second waves of anime fandom, and had continued use up until before the mid-1990s anime resurgence. In general, the term now only appears in nostalgic contexts. The term is much more commonly used within Japan to refer to domestic animation. Since anime or animēshon is used to describe all forms of animation, Japanimation is used to distinguish Japanese work from that of the rest of the world. In more recent years, anime has also frequently been referred to as manga in European countries, a practice that may stem from the Japanese usage: In Japan, manga can refer to both animation and comics (although the use of manga to refer to animation is mostly restricted to non-fans). Among English speakers, manga usually has the stricter meaning of "Japanese comics". An alternate explanation is that it is due to the prominence of Manga Entertainment, a distributor of anime to the US and UK markets. Because Manga Entertainment originated in the UK the use of the term is common outside of Japan. The portmanteau "animanga" has been used to collectively refer to anime and manga, though it is also a term used to describe comics produced from animation cels. Characteristics Dragon Ball Z (1989) is a popular shōnen anime based on the original manga series which spanned 291 episodes and 13 movies.Anime features a wide variety of artistic styles. They vary from artist to artist or by studio to studio. They are generally characterized by detailed backgrounds and stylized characters in a variety of different settings and storylines, aimed at a wide range of audiences. It is usually coloured and designed to look as realistic as possible. Unlike Manga, which uses slightly exaggerated colours and designs. But, anime fantasy creatures, (e.g witches, spirits etc.) can have exaggerated facial and physical features. But, they will always be designed to look as realistic as possible, and bright colours would be rarely used unless needed to. Genres Anime has many genres typically found in any mass media form. Such genres include action, adventure, children's stories, comedy, drama, erotica (hentai), medieval fantasy, occult/horror, romance, and science fiction. Most anime includes content from several different genres, as well as a variety of thematic elements. Thus, some series may be categorized under multiple genres. For example, Neon Genesis Evangelion might be considered to fall into the genres of post-apocalyptic, mecha, drama, and shonen-ai. A show may have a seemingly simple surface plot, but at the same time may feature a far more complex, deeper storyline and character development. It is not uncommon for an action themed anime to also involve humor, romance, and even social commentary. The same can be applied to a romance themed anime in that it may involve an action element, or in some cases brutal violence. The following is a list of the major genres and designations that are specific to anime and manga.[8] For other possible genres, see film genre. Genres with Western Counterparts: Action/Adventure: Anime that primarily focuses on martial arts, sword fighting, or other action oriented material. Examples: Ninja Scroll. Horror: Anime or manga which contains darker themes or science-fictional characters. Examples: Vampire Hunter D series or Wicked City. Progressive: "Art films" or extremely stylized anime. Examples: Voices of a Distant Star or Byōsoku 5 Centimetre. Demographic Genres: Shōjo: Japanese for 'young lady' or 'little girl'. Refers to anime or manga targeted at girls. Examples: Fruits Basket or Mermaid Melody Pichi Pichi Pitch. Shōnen: Japanese for 'young boy'. Refers to anime or manga targeted at younger boys. Examples: Dragon Ball Z or Digimon. Seinen: Japanese for 'young man'. Anime or manga targeted at teenage or young male adults. Examples: Oh My Goddess!, Outlaw Star or Cowboy Bebop. Josei: Japanese for 'young woman'. Anime or manga that is aimed at young women. Examples: Gokusen. Kodomo: Japanese for 'child'. Anime or manga that is aimed at young children. Examples: Doraemon, Hello Kitty, Keroppi, Pokémon or Panda-Z. Thematic Genres Bishōjo: Japanese for 'beautiful girl'. A blanket term that can be used to describe any anime that features pretty girl characters. Examples: Magic Knight Rayearth. Bishōnen: Japanese for 'beautiful boy'. A blanket term that can be used to describe any anime that features "pretty" and elegant boys and men. Examples: Fushigi Yūgi or most CLAMP shows. Sentai: Literally "fighting team" in Japanese. Refers to any show that involves a superhero team. Examples: Cyborg 009. Robot/Mecha: Anime or manga featuring super robots. Examples: Mobile Suit Gundam or Mazinger Z. Post-Apocalyptic: Anime dealing with a post-apocalyptic world. Examples: Neon Genesis Evangelion, Trigun, Akira, Wolf's Rain, or Nausicaä of the Valley of the Wind Mahō shōjo: Subgenre of shōjo known for 'Magical Girl' stories. Examples: Sailor Moon. Mahō shōnen: Male equivalent of Mahō Shōjo. Examples: D.N.Angel. Moe: Anime or manga featuring characters that are extremely perky or cute. Examples: A Little Snow Fairy Sugar. Expertise: Anime that deals with a specific topic in depth, such as Eyeshield 21 and football, Hikaru no Go and the game Go, Yakitate! Japan and bread-making, etc. Romantic Genres Harem: A genre where several girl characters are attracted to a single boy character (or sometimes to multiple boy characters). It is more often than not a Shonen Anime and may be considered a sub-genre. Examples: Ranma ½ or Love Hina. Reverse Harem: As a Harem anime, but where several boy characters are attracted to a single girl character (or sometimes to multiple girl characters). It is more often than not a Shojo Anime and may be considered a sub-genre. Examples: Ouran Host Club or Fruits Basket. Ecchi: Japanese for 'indecent sexuality', derived from the pronunciation of the letter 'H', (the origin of the term is not well known, even in Japan. See main article for more information.) Contains sexual humor, and some fan service. Examples: Love Hina, Oruchuban Ebichu or He Is My Master. Hentai: Japanese for 'abnormal' or 'perverted'. While Western audiences may use the term to refer to pornographic anime or erotica, in Japan the term used to refer to the same material is typically Poruno or Ero. Examples: La Blue Girl or "Bible Black". Shōjo-ai/Yuri: Japanese for 'girl-love'. Refers to anime or manga that focus on love and romance between female characters. It is often being replaced by the term "Girls Love" (GL). Yuri is like Shōjo-ai, but sometimes involves older characters or explicit sexual activity. Examples: Revolutionary Girl Utena or Kannazuki no Miko. Shōnen-ai: Japanese for 'boy-love'. Refers to anime or manga that focus on love and romance between male characters. The term "Shōnen-ai" is being phased out in Japan due to its other meaning of pederasty, and is being replaced by the term "Boys Love" (BL). Examples: Loveless, Gravitation Yaoi: Like "Shōnen-ai" but often involving older characters and explicit sexual activity. Examples: "Sensitive Pornograph" Some anime titles are written for a very specific audience, even narrower than those described above. For example, Initial D, Wangan Midnight and éX-Driver concern street racing and car tuning. Ashita No Joe, Hajime no Ippo were about boxing. Hanaukyo Maid Team is based on the French maid fantasy. Style While different titles and different artists have their own artistic styles, many stylistic elements have become so common such that they are described as being definitive of anime in general. These elements have been given names of their own. The anime drawing style can be learned, particularly with the aid of books such as How to Draw Manga. Such books come complete with information and instructions on the styles used in anime. A common approach is the large eyes style drawn on many anime and manga characters, credited to the influence of Osamu Tezuka, who was inspired by the exaggerated features of American cartoon characters such as Betty Boop and Mickey Mouse and from Disney's Bambi. Tezuka found that large eyes style allowed his characters to show emotions distinctly. Cultural anthropologist Matt Thorn argues that Japanese animators and audiences do not perceive such stylized eyes as inherently more or less foreign.[1] When Tezuka began drawing Ribbon no Kishi, the first manga specifically targeted at young girls, Tezuka further exaggerated the size of the characters' eyes. Indeed, through Ribbon no Kishi, Tezuka set a stylistic template that later shōjo artists tended to follow. Another variation of this style is "super deformed"; which usually feature huge eyes, an enlarged head, and small body. Other stylistic elements are common as well; often in comedic anime, characters that are shocked or surprised will perform a "face fault", in which they display an extremely exaggerated expression. Angry characters may exhibit a "vein" or "stressmark" effect, where lines representing bulging veins will appear on their forehead. Angry women will sometimes summon a mallet from nowhere and strike someone with it, leading to the concept of Hammerspace and cartoon physics. Male characters will develop a bloody nose around their female love interests (typically to indicate arousal, based on an old wives' tale).[9] Embarrassed characters will invariably produce a massive sweat-drop, which has become one of the most widely recognized stereotype motifs of anime. The degree of stylization varies from title to title. Some titles make extensive use of common stylization: FLCL, for example, is known for its wild, exaggerated stylization. In contrast, titles such as Only Yesterday, a film by Isao Takahata, take a much more realistic approach, and feature few stylistic exaggerations. Distribution Licensing Main article: Anime licensing Anime is available outside of Japan in localized form. Licensed anime is modified by distributors through dubbing into the language of the country. The anime may also be edited to alter cultural references that may not be understood by a non-Japanese person and certain companies may remove what may be perceived as objectionable content. This process was far more common in the past (e.g. One Piece), when anime was largely unheard of in the west, but its use has declined in recent years because of the demand for anime in its original form. This "light touch" approach to localization has proved popular with fans as well as viewers formerly unfamiliar with anime. The popularity of such methods is evident by the success of Naruto, Dragon Ball Z, and Cartoon Network's Adult Swim programming block, both of which employ minor edits. The "light touch" approach also applies to DVD releases as they often include both the dubbed audio and the original Japanese audio with subtitles, are typically unedited. Anime edited for television is usually released on DVD "uncut," with all scenes intact. Anime has also been a commercial success in Asia, Europe and Latin America, where anime has become even more mainstream than in the United States. For example, the Saint Seiya video game was released in Europe due to the popularity of the show even years after the series has been off-air. Fansubs Main article: Fansub Although it is a violation of copyright laws in many countries, some fans watch fansubs, recordings of anime series that have been subtitled by fans. Watching subtitled Japanese versions, though not necessarily downloaded fansubs, is seen by many enthusiasts as the preferred method of watching anime. The ethical implications of producing, distributing, or watching fansubs are topics of much controversy even when fansub groups do not profit from their activities and cease distribution of their work once the series has been licensed outside of Japan. Television TV networks regularly broadcast anime programming. Cable channels such as Cartoon Network, Disney, Sci-Fi, and others dedicate some of their time slots for anime. Then the Anime Network specifically shows anime. In Japan, major national TV networks broadcast anime regularly. Anime beyond Japan Early anime in the United States The United States saw its first exposure to anime in June of 1961, when Shônen Sarutobi Sasuke (Magic Boy) was released by MGM, followed a few weeks later by Hakuja den (Panda and the Magic Serpent, or The Tale of the White Serpent). Anime then got its running jump in September of 1963, when NBC syndicated a dubbed version of the Japanese series Astro Boy. Not counting such Japanese/American co-productions as The King Kong Show and Johnny Cypher in Dimension Zero[1], only seven more anime TV series were released in the United States in the 1960s. These were 8 Man (1965), Gigantor (1966), Kimba the White Lion (1966), Prince Planet (1966), Marine Boy (1966), The Amazing 3 (1967) and Speed Racer (1967). Speed Racer would be the last anime series released in the United States until 1978 when the 1972 series Kagaku ninja tai Gatchaman was adapted for American audiences as Battle of the Planets.[10] Many anime series that made it to American television from the 1960s through the 1980s tended to be science fiction or action-oriented, such as Star Blazers (the English dub of Space Battleship Yamato) and Robotech and Voltron (both Americanized amalgamations of unrelated anime series cobbled together into a single story). As the 1980s wore on, more anime series and films targeted at very young children also found their way to U.S. TV screens, often on cable television channels or in syndication. Nickelodeon broadcast many mostly Canadian-made English dubs of anime films during its early years, including TV series such as Mysterious Cities of Gold, Adventures of the Little Koala, Belle and Sebastian, The Adventures of the Little Prince, Noozles, Maya the Bee, Grimm's Fairy Tale Classics, and The Littl' Bits, many of which were aired on "Nick Jr.", the network's block of programming for very young viewers. The Disney Channel broadcast both of the feature-length anime films starring Osamu Tezuka's famous unicorn character Unico, and CBN redubbed and broadcast its Bible-based anime TV series co-produced with Tatsunoko, Superbook and The Flying House. HBO also showed juvenile-targeted anime on occasion, including TV series such as Tales of Little Women, The Adventures of Tom Sawyer, The Wonderful Wizard of Oz, and Saban's Adventures of Pinocchio and feature films such as Gisaburo Sugii's 1974 Jack and the Beanstalk. A great many anime films and feature-length TV series compilations were also released direct-to-video in the U.S., and were often available for rental at mainstream video stores. Some titles which were distributed in the U.S. in this fashion included Candy Candy, Captain Future, Angel, Serendipity the Pink Dragon, Taro the Dragon Boy, Robby the Rascal (Cybot Robotchi), and Ninja the Wonder Boy (Manga Sarutobi Sasuke). For the most part, though, these TV series and films were not actively promoted as being of Japanese origin; in fact, many of them went so far as to remove most or all Japanese names from the credits except for credits to the animation studios. In the series themselves, character names were often changed and Japanese cultural references removed to make them more accessible to English-speaking audiences, such as Genshi being changed to Flint in Space-Time Detective Genshi-kun. In the late 1990s and early 2000s, this trend began to change as more openly Japanese works, such as Sailor Moon, Gundam Wing, Pokémon, Dragon Ball Z, Digimon, and Yu-Gi-Oh! achieved mainstream popularity on American television. Although many of these shows did undergo some kind of "Americanization" in the form of character name changes and edits for violence, language, and the occasional nudity, viewers were more aware of the shows' country of origin, which might perhaps pique their curiosity to seek out other works in a similar style. Current reception in the United States AnimeNation's John Oppliger had this to say on the matter: The support for anime among American anime fans is very strong. The availability of anime in America is truly impressive, especially within the anime fan community. Awareness of Japanese animation in America is at an all time high. However, mainstream acceptance of anime in America lags far behind the advances anime has made in other respects. A close examination of the support for anime on American television may provide a revealing and realistic gauge of the actual penetration of anime into America and American culture. Anime may seem like it's tremendously successful in America because its high profile, but the facts tell another story. According to AC Nielsen, Pixar's The Incredibles sold 16 million copies on DVD in America last year. Shark Tale sold nearly 10 million copies. Even the DVD release of Bambi sold 6 million copies in 2005. In comparison, all four Inuyasha movies combined have sold just over 1 million copies in the past year and a half. Evidently, the success of anime in America is very relative. American anime fans are very devoted. Through underground means hardcore American fans now have access to brand new Japanese anime before even many Japanese residents do. America's anime fan community is influential because it's affluent, intelligent, and motivated; but it's not very large.[11] Despite assessments like that, and its rare and limited release in American theaters, anime's legitimacy and respect in North America has grown well enough to garner major native artistic awards such as the Academy Award for Best Animated Feature in 2002 for Spirited Away by Hayao Miyazaki. Anime has a dedicated fan following in English speaking countries, particularly active on the internet, and at conventions regularly held throughout the US and UK. Commercial appeal Anime has become commercially profitable in western countries as early commercially successful western adaptations of anime, such as Astro Boy, have revealed.[12] The phenomenal success of Nintendo's multi-billion dollar Pokémon franchise[13] was helped greatly by the spin-off anime series that, first broadcast in the late 1990s, is still running worldwide to this day. Influence on Western culture Western Animation Main article: Anime-influenced animation Anime-influenced animation refers to non-Japanese works of animation that emulate the visual style of anime. Though most of these works are created by and primarily shown in the United States, many also involve production studios from Europe and non-Japanese Asia. These generally adapted anime stylizations and anime methods described in anime physics into their own. Such examples exist in Totally Spies!, The Boondocks, W.I.T.C.H. and Megas XLR. In addition, works such as Avatar: The Last Airbender features Asian themes. While these examples are not considered anime by the fanbase majority, they are best noted for being "influenced by anime". Conventions Main article: Anime convention Fan-based conventions have long existed. Conventions for anime began to appear in the early 1990's, starting with Anime Expo, Animethon, Otakon, and JACON. Eventually, anime conventions are held annually in various cities across the United States, Canada, and Europe. http://en.wikipedia.org/wiki/Anime (Less)
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34, 00:38, 2008-04-22 10:14:06 Description: A 30 YEAR WOMEN WITH INTRACTABLE BILIARY COLIC CASE REPORT: This 30 year women developed severe pain right upper quadrant for last 10 days. She sought many consultations and was given intravenous (More) A 30 YEAR WOMEN WITH INTRACTABLE BILIARY COLIC CASE REPORT: This 30 year women developed severe pain right upper quadrant for last 10 days. She sought many consultations and was given intravenous analgesics both (nonnarcortic and narcotic). Pain did not subside and she sought my consultation. Examination revealed her to be in agony with severe upper abdominal pain. General physical examination was otherwise unremarkable. Abdominal examination revealed mild tenderness in right hypochondrium with doubtful Murphy's sign. Urgent abdominal ultrasound showed a linear structure in bile ducts making slow writhing movements. The structure had an anechoic tube (alimentary canal) inside suggestive of a large Ascarid. Urgent ERCP was performed and bile duct and pancreatic duct cannulated selectively. Pancreatic duct was normal. Bile ducts contained a long linear filling defect extending from lower end of common bile duct to right intrahepatic duct (see image gallery for ERCP plate). A basket was introduced in the duct (see video clip) and the linear structure was engaged with soft closure and extracted out of the bile duct. Accompanying the basket was a 25 cm thick highly motile Ascarid. To recover the worm, endoscope was withdrawn along with the basket and the friendly catch. While the endoscope was being withdrawn and the basket was in the duodenum with the worm out of bile duct, patient indicated of relief of abdominal pain. A relook cholangiogram showed no more structures in the duct. She was given antihelmintic therapy and passed hundreds of worms with the feces. The worms recovered form stools were both male and female population and varied in length and size. However the lone worm recovered form bile ducts was the longest and the thickest male worm. The phenomenal behavior of this ubiquitous infection remains unexplained. (Source Records from Dr. Khuroo's Medical Clinic. Review prepared by Mehnaaz Sultan Khuroo Host website www.drkhuroo.org , E-mail: mkhuroo@yahoo.com ). (Less)
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38, 02:12, 2008-04-22 09:04:04 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 6-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 6-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com Important words found on this site. Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From NelsonIdeas.com Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites http:/./www.NelsonIdeas.com Click Dental Education Trigeminal Neuralgia Extreme Facial Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html Click Trigeminal Neuralgia Patient Painful-Stories http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html Click My Story on TN Brian N http://www.PartyTentCity.com/trigeminal-neuralgia-tn-tmj-my-story/directory.html Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Medical Data Base Medical Costs More Expensive Due to Non Use of Technology http://www.briannelsonconsulting.com/medical-data-base/faq-info.html Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click-Trigeminal Neuralgia Assn Page 1 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain.html Click-Trigeminal Neuralgia Assn Page 2 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain-2.html Click What is Trigeminal Neuragia? Portland,OR Slide Show http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia National Conference http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 1. Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 2 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info2.html Click Page 3 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info3.htm Click Page 4 Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info4.html Click MyTrigeminal Neuralgia Stories Directory http://www.MyTrigeminalNeuralgiaStory.com/Index.html Click Brian's TN Story Quck Version http://www.MyTrigeminalNeuralgiaStory.com/BrianNelson/TN1.html Click Shirley's Story Trigeminal Neuralgia http://www.MyTrigeminalNeuralgiaStory.com/ShirleyH/TN3.html Click Sand's Story TN WHAT IS TRIGEMINAL NEURALGIA? TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears. It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html What is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. Is there any treatment? Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves. What is the prognosis? The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal. What research is being done? Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research. An Alternate Strategy Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages: • Avoid years of medication and intermittent pain • Avoid facing surgery when old or infirm • If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression) How To Find Out If You Have a Vascular Loop The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners. Surgical Options: Non-Destructive Procedures The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures. Surgical Options: Destructive Procedures There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery. Comments Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use. Recommendations Based on the data currently available, and in an effort to maximize quality of life, we recommend the following: Patients with less than 10 year life expectancy Refer for destructive procedure if pain not controlled medically without significant side effects Patients with more than 10 but less than 20 year life expectancy Consider destructive procedure May abolish need for continued increasing medications Will make medical therapy easier even if fails Patients with more than 20 year life expectancy Perform thin cut MRI with 3-D Volume Acquisition If vessel present recommend MVD 25 ARTICLE SECTIONS From the Mayo Clinic. Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 Introduction Signs and symptoms Causes When to seek medical advice Screening and diagnosis Treatment Coping skills Introduction Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery. Signs and symptoms An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia. People who have experienced severe trigeminal neuralgia have described the pain as: Lightning-like or electric-shock-like Shooting Jabbing Like having live wires in your face Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time. Causes Branches of the trigeminal nerve CLICK TO ENLARGE The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux. The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia. After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face: The first branch controls sensation in your eye, upper eyelid and forehead. The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing. You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include: Compression by a tumor Multiple sclerosis A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system A variety of triggers, many subtle, may set off the pain. These triggers may include: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases. When to seek medical advice Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth. If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor. Screening and diagnosis If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain. If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head. Treatment Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you. Medications Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea. Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness. Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness. Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision. Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin). Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option. Surgery The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve: Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure. Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling. http://www.MyTrigeminalNeuralgiaStory.com Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew. http://www.MyTrigeminalNeuralgiaStory.com Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root. An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years. Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve. Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead. Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known. • Coping skills Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. Frequency: Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons. Mortality/Morbidity: No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired. In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome. Sex: Male-to-female ratio is 2:3. Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis. Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age. Symptomatic or secondary TN tends to occur in younger patients. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. http://www.MyTrigeminalNeuralgiaStory.com (Less)
Channel: youtubeTags: Association BrianNelson123 douloureux Electric Facial Jannetta Nerve Pain Painful Shocks. Suicide Teflon Tic TN TNA
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115, 05:34, 2008-04-22 09:04:03 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 3-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 3-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com Important words found on this site. Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From NelsonIdeas.com Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites http:/./www.NelsonIdeas.com Click Dental Education Trigeminal Neuralgia Extreme Facial Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html Click Trigeminal Neuralgia Patient Painful-Stories http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html Click My Story on TN Brian N http://www.PartyTentCity.com/trigeminal-neuralgia-tn-tmj-my-story/directory.html Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Medical Data Base Medical Costs More Expensive Due to Non Use of Technology http://www.briannelsonconsulting.com/medical-data-base/faq-info.html Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click-Trigeminal Neuralgia Assn Page 1 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain.html Click-Trigeminal Neuralgia Assn Page 2 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain-2.html Click What is Trigeminal Neuragia? Portland,OR Slide Show http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia National Conference http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 1. Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 2 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info2.html Click Page 3 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info3.htm Click Page 4 Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info4.html Click MyTrigeminal Neuralgia Stories Directory http://www.MyTrigeminalNeuralgiaStory.com/Index.html Click Brian's TN Story Quck Version http://www.MyTrigeminalNeuralgiaStory.com/BrianNelson/TN1.html Click Shirley's Story Trigeminal Neuralgia http://www.MyTrigeminalNeuralgiaStory.com/ShirleyH/TN3.html Click Sand's Story TN WHAT IS TRIGEMINAL NEURALGIA? TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears. It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html What is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. Is there any treatment? Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves. What is the prognosis? The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal. What research is being done? Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research. An Alternate Strategy Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages: • Avoid years of medication and intermittent pain • Avoid facing surgery when old or infirm • If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression) How To Find Out If You Have a Vascular Loop The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners. Surgical Options: Non-Destructive Procedures The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures. Surgical Options: Destructive Procedures There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery. Comments Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use. Recommendations Based on the data currently available, and in an effort to maximize quality of life, we recommend the following: Patients with less than 10 year life expectancy Refer for destructive procedure if pain not controlled medically without significant side effects Patients with more than 10 but less than 20 year life expectancy Consider destructive procedure May abolish need for continued increasing medications Will make medical therapy easier even if fails Patients with more than 20 year life expectancy Perform thin cut MRI with 3-D Volume Acquisition If vessel present recommend MVD 25 ARTICLE SECTIONS From the Mayo Clinic. Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 Introduction Signs and symptoms Causes When to seek medical advice Screening and diagnosis Treatment Coping skills Introduction Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery. Signs and symptoms An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia. People who have experienced severe trigeminal neuralgia have described the pain as: Lightning-like or electric-shock-like Shooting Jabbing Like having live wires in your face Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time. Causes Branches of the trigeminal nerve CLICK TO ENLARGE The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux. The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia. After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face: The first branch controls sensation in your eye, upper eyelid and forehead. The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing. You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include: Compression by a tumor Multiple sclerosis A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system A variety of triggers, many subtle, may set off the pain. These triggers may include: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases. When to seek medical advice Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth. If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor. Screening and diagnosis If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain. If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head. Treatment Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you. Medications Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea. Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness. Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness. Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision. Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin). Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option. Surgery The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve: Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure. Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling. http://www.MyTrigeminalNeuralgiaStory.com Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew. http://www.MyTrigeminalNeuralgiaStory.com Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root. An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years. Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve. Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead. Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known. • Coping skills Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. Frequency: Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons. Mortality/Morbidity: No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired. In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome. Sex: Male-to-female ratio is 2:3. Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis. Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age. Symptomatic or secondary TN tends to occur in younger patients. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. http://www.MyTrigeminalNeuralgiaStory.com (Less)
Channel: youtubeTags: Association BrianNelson123 douloureux Electric Facial Jannetta Nerve Pain Painful Shocks. Suicide Teflon Tic TN TNA
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56, 04:56, 2008-04-22 09:04:03 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 1-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 1-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com Important words found on this site. Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From NelsonIdeas.com Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites http:/./www.NelsonIdeas.com Click Dental Education Trigeminal Neuralgia Extreme Facial Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html Click Trigeminal Neuralgia Patient Painful-Stories http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html Click My Story on TN Brian N http://www.PartyTentCity.com/trigeminal-neuralgia-tn-tmj-my-story/directory.html Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Medical Data Base Medical Costs More Expensive Due to Non Use of Technology http://www.briannelsonconsulting.com/medical-data-base/faq-info.html Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click-Trigeminal Neuralgia Assn Page 1 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain.html Click-Trigeminal Neuralgia Assn Page 2 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain-2.html Click What is Trigeminal Neuragia? Portland,OR Slide Show http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia National Conference http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 1. Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 2 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info2.html Click Page 3 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info3.htm Click Page 4 Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info4.html Click MyTrigeminal Neuralgia Stories Directory http://www.MyTrigeminalNeuralgiaStory.com/Index.html Click Brian's TN Story Quck Version http://www.MyTrigeminalNeuralgiaStory.com/BrianNelson/TN1.html Click Shirley's Story Trigeminal Neuralgia http://www.MyTrigeminalNeuralgiaStory.com/ShirleyH/TN3.html Click Sand's Story TN WHAT IS TRIGEMINAL NEURALGIA? TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears. It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html What is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. Is there any treatment? Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves. What is the prognosis? The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal. What research is being done? Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research. An Alternate Strategy Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages: • Avoid years of medication and intermittent pain • Avoid facing surgery when old or infirm • If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression) How To Find Out If You Have a Vascular Loop The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners. Surgical Options: Non-Destructive Procedures The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures. Surgical Options: Destructive Procedures There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery. Comments Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use. Recommendations Based on the data currently available, and in an effort to maximize quality of life, we recommend the following: Patients with less than 10 year life expectancy Refer for destructive procedure if pain not controlled medically without significant side effects Patients with more than 10 but less than 20 year life expectancy Consider destructive procedure May abolish need for continued increasing medications Will make medical therapy easier even if fails Patients with more than 20 year life expectancy Perform thin cut MRI with 3-D Volume Acquisition If vessel present recommend MVD 25 ARTICLE SECTIONS From the Mayo Clinic. Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 Introduction Signs and symptoms Causes When to seek medical advice Screening and diagnosis Treatment Coping skills Introduction Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery. Signs and symptoms An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia. People who have experienced severe trigeminal neuralgia have described the pain as: Lightning-like or electric-shock-like Shooting Jabbing Like having live wires in your face Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time. Causes Branches of the trigeminal nerve CLICK TO ENLARGE The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux. The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia. After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face: The first branch controls sensation in your eye, upper eyelid and forehead. The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing. You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include: Compression by a tumor Multiple sclerosis A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system A variety of triggers, many subtle, may set off the pain. These triggers may include: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases. When to seek medical advice Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth. If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor. Screening and diagnosis If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain. If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head. Treatment Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you. Medications Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea. Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness. Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness. Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision. Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin). Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option. Surgery The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve: Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure. Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling. http://www.MyTrigeminalNeuralgiaStory.com Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew. http://www.MyTrigeminalNeuralgiaStory.com Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root. An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years. Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve. Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead. Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known. • Coping skills Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. Frequency: Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons. Mortality/Morbidity: No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired. In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome. Sex: Male-to-female ratio is 2:3. Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis. Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age. Symptomatic or secondary TN tends to occur in younger patients. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. http://www.MyTrigeminalNeuralgiaStory.com (Less)
Channel: youtubeTags: Association BrianNelson123 douloureux Electric Facial Jannetta Nerve Pain Painful Shocks. Suicide Teflon Tic TN TNA
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40, 05:03, 2008-04-22 09:04:03 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 2-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 2-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com Important words found on this site. Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From NelsonIdeas.com Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites http:/./www.NelsonIdeas.com Click Dental Education Trigeminal Neuralgia Extreme Facial Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html Click Trigeminal Neuralgia Patient Painful-Stories http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html Click My Story on TN Brian N http://www.PartyTentCity.com/trigeminal-neuralgia-tn-tmj-my-story/directory.html Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Medical Data Base Medical Costs More Expensive Due to Non Use of Technology http://www.briannelsonconsulting.com/medical-data-base/faq-info.html Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click-Trigeminal Neuralgia Assn Page 1 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain.html Click-Trigeminal Neuralgia Assn Page 2 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain-2.html Click What is Trigeminal Neuragia? Portland,OR Slide Show http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia National Conference http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 1. Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 2 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info2.html Click Page 3 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info3.htm Click Page 4 Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info4.html Click MyTrigeminal Neuralgia Stories Directory http://www.MyTrigeminalNeuralgiaStory.com/Index.html Click Brian's TN Story Quck Version http://www.MyTrigeminalNeuralgiaStory.com/BrianNelson/TN1.html Click Shirley's Story Trigeminal Neuralgia http://www.MyTrigeminalNeuralgiaStory.com/ShirleyH/TN3.html Click Sand's Story TN WHAT IS TRIGEMINAL NEURALGIA? TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears. It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html What is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. Is there any treatment? Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves. What is the prognosis? The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal. What research is being done? Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research. An Alternate Strategy Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages: • Avoid years of medication and intermittent pain • Avoid facing surgery when old or infirm • If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression) How To Find Out If You Have a Vascular Loop The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners. Surgical Options: Non-Destructive Procedures The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures. Surgical Options: Destructive Procedures There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery. Comments Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use. Recommendations Based on the data currently available, and in an effort to maximize quality of life, we recommend the following: Patients with less than 10 year life expectancy Refer for destructive procedure if pain not controlled medically without significant side effects Patients with more than 10 but less than 20 year life expectancy Consider destructive procedure May abolish need for continued increasing medications Will make medical therapy easier even if fails Patients with more than 20 year life expectancy Perform thin cut MRI with 3-D Volume Acquisition If vessel present recommend MVD 25 ARTICLE SECTIONS From the Mayo Clinic. Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 Introduction Signs and symptoms Causes When to seek medical advice Screening and diagnosis Treatment Coping skills Introduction Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery. Signs and symptoms An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia. People who have experienced severe trigeminal neuralgia have described the pain as: Lightning-like or electric-shock-like Shooting Jabbing Like having live wires in your face Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time. Causes Branches of the trigeminal nerve CLICK TO ENLARGE The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux. The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia. After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face: The first branch controls sensation in your eye, upper eyelid and forehead. The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing. You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include: Compression by a tumor Multiple sclerosis A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system A variety of triggers, many subtle, may set off the pain. These triggers may include: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases. When to seek medical advice Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth. If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor. Screening and diagnosis If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain. If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head. Treatment Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you. Medications Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea. Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness. Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness. Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision. Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin). Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option. Surgery The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve: Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure. Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling. http://www.MyTrigeminalNeuralgiaStory.com Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew. http://www.MyTrigeminalNeuralgiaStory.com Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root. An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years. Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve. Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead. Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known. • Coping skills Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. Frequency: Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons. Mortality/Morbidity: No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired. In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome. Sex: Male-to-female ratio is 2:3. Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis. Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age. Symptomatic or secondary TN tends to occur in younger patients. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. http://www.MyTrigeminalNeuralgiaStory.com (Less)
Channel: youtubeTags: Association BrianNelson123 douloureux Electric Facial Jannetta Nerve Pain Painful Shocks. Suicide Teflon Tic TN TNA
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48, 04:38, 2008-04-22 09:04:03 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 5-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 5-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com Important words found on this site. Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From NelsonIdeas.com Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites http:/./www.NelsonIdeas.com Click Dental Education Trigeminal Neuralgia Extreme Facial Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html Click Trigeminal Neuralgia Patient Painful-Stories http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html Click My Story on TN Brian N http://www.PartyTentCity.com/trigeminal-neuralgia-tn-tmj-my-story/directory.html Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Medical Data Base Medical Costs More Expensive Due to Non Use of Technology http://www.briannelsonconsulting.com/medical-data-base/faq-info.html Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click-Trigeminal Neuralgia Assn Page 1 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain.html Click-Trigeminal Neuralgia Assn Page 2 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain-2.html Click What is Trigeminal Neuragia? Portland,OR Slide Show http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia National Conference http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 1. Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 2 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info2.html Click Page 3 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info3.htm Click Page 4 Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info4.html Click MyTrigeminal Neuralgia Stories Directory http://www.MyTrigeminalNeuralgiaStory.com/Index.html Click Brian's TN Story Quck Version http://www.MyTrigeminalNeuralgiaStory.com/BrianNelson/TN1.html Click Shirley's Story Trigeminal Neuralgia http://www.MyTrigeminalNeuralgiaStory.com/ShirleyH/TN3.html Click Sand's Story TN WHAT IS TRIGEMINAL NEURALGIA? TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears. It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html What is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. Is there any treatment? Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves. What is the prognosis? The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal. What research is being done? Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research. An Alternate Strategy Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages: • Avoid years of medication and intermittent pain • Avoid facing surgery when old or infirm • If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression) How To Find Out If You Have a Vascular Loop The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners. Surgical Options: Non-Destructive Procedures The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures. Surgical Options: Destructive Procedures There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery. Comments Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use. Recommendations Based on the data currently available, and in an effort to maximize quality of life, we recommend the following: Patients with less than 10 year life expectancy Refer for destructive procedure if pain not controlled medically without significant side effects Patients with more than 10 but less than 20 year life expectancy Consider destructive procedure May abolish need for continued increasing medications Will make medical therapy easier even if fails Patients with more than 20 year life expectancy Perform thin cut MRI with 3-D Volume Acquisition If vessel present recommend MVD 25 ARTICLE SECTIONS From the Mayo Clinic. Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 Introduction Signs and symptoms Causes When to seek medical advice Screening and diagnosis Treatment Coping skills Introduction Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery. Signs and symptoms An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia. People who have experienced severe trigeminal neuralgia have described the pain as: Lightning-like or electric-shock-like Shooting Jabbing Like having live wires in your face Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time. Causes Branches of the trigeminal nerve CLICK TO ENLARGE The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux. The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia. After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face: The first branch controls sensation in your eye, upper eyelid and forehead. The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing. You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include: Compression by a tumor Multiple sclerosis A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system A variety of triggers, many subtle, may set off the pain. These triggers may include: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases. When to seek medical advice Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth. If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor. Screening and diagnosis If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain. If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head. Treatment Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you. Medications Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea. Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness. Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness. Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision. Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin). Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option. Surgery The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve: Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure. Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling. http://www.MyTrigeminalNeuralgiaStory.com Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew. http://www.MyTrigeminalNeuralgiaStory.com Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root. An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years. Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve. Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead. Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known. • Coping skills Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. Frequency: Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons. Mortality/Morbidity: No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired. In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome. Sex: Male-to-female ratio is 2:3. Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis. Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age. Symptomatic or secondary TN tends to occur in younger patients. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. http://www.MyTrigeminalNeuralgiaStory.com (Less)
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42, 05:07, 2008-04-22 09:04:03 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 4-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 4-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com Important words found on this site. Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From NelsonIdeas.com Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites http:/./www.NelsonIdeas.com Click Dental Education Trigeminal Neuralgia Extreme Facial Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html Click Trigeminal Neuralgia Patient Painful-Stories http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html Click My Story on TN Brian N http://www.PartyTentCity.com/trigeminal-neuralgia-tn-tmj-my-story/directory.html Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Medical Data Base Medical Costs More Expensive Due to Non Use of Technology http://www.briannelsonconsulting.com/medical-data-base/faq-info.html Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click-Trigeminal Neuralgia Assn Page 1 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain.html Click-Trigeminal Neuralgia Assn Page 2 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain-2.html Click What is Trigeminal Neuragia? Portland,OR Slide Show http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia National Conference http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 1. Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 2 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info2.html Click Page 3 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info3.htm Click Page 4 Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info4.html Click MyTrigeminal Neuralgia Stories Directory http://www.MyTrigeminalNeuralgiaStory.com/Index.html Click Brian's TN Story Quck Version http://www.MyTrigeminalNeuralgiaStory.com/BrianNelson/TN1.html Click Shirley's Story Trigeminal Neuralgia http://www.MyTrigeminalNeuralgiaStory.com/ShirleyH/TN3.html Click Sand's Story TN WHAT IS TRIGEMINAL NEURALGIA? TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears. It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html What is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. Is there any treatment? Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves. What is the prognosis? The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal. What research is being done? Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research. An Alternate Strategy Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages: • Avoid years of medication and intermittent pain • Avoid facing surgery when old or infirm • If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression) How To Find Out If You Have a Vascular Loop The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners. Surgical Options: Non-Destructive Procedures The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures. Surgical Options: Destructive Procedures There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery. Comments Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use. Recommendations Based on the data currently available, and in an effort to maximize quality of life, we recommend the following: Patients with less than 10 year life expectancy Refer for destructive procedure if pain not controlled medically without significant side effects Patients with more than 10 but less than 20 year life expectancy Consider destructive procedure May abolish need for continued increasing medications Will make medical therapy easier even if fails Patients with more than 20 year life expectancy Perform thin cut MRI with 3-D Volume Acquisition If vessel present recommend MVD 25 ARTICLE SECTIONS From the Mayo Clinic. Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 Introduction Signs and symptoms Causes When to seek medical advice Screening and diagnosis Treatment Coping skills Introduction Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery. Signs and symptoms An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia. People who have experienced severe trigeminal neuralgia have described the pain as: Lightning-like or electric-shock-like Shooting Jabbing Like having live wires in your face Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time. Causes Branches of the trigeminal nerve CLICK TO ENLARGE The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux. The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia. After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face: The first branch controls sensation in your eye, upper eyelid and forehead. The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing. You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include: Compression by a tumor Multiple sclerosis A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system A variety of triggers, many subtle, may set off the pain. These triggers may include: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases. When to seek medical advice Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth. If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor. Screening and diagnosis If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain. If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head. Treatment Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you. Medications Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea. Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness. Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness. Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision. Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin). Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option. Surgery The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve: Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure. Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling. http://www.MyTrigeminalNeuralgiaStory.com Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew. http://www.MyTrigeminalNeuralgiaStory.com Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root. An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years. Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve. Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead. Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known. • Coping skills Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. Frequency: Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons. Mortality/Morbidity: No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired. In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome. Sex: Male-to-female ratio is 2:3. Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis. Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age. Symptomatic or secondary TN tends to occur in younger patients. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. http://www.MyTrigeminalNeuralgiaStory.com (Less)
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32, 05:34, 2007-08-07 04:05:28 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 3-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 3-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve
THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com
Important words found on this site.
Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz
Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From
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Click Dental Education Trigeminal Neuralgia Extreme Facial Pain
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Click-Trigeminal Neuralgia Assn Page 1
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Click Sand's Story TN
WHAT IS TRIGEMINAL NEURALGIA?
TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears.
It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve.
TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation.
http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html
What is Trigeminal Neuralgia?
Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening.
The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves.
Is there any treatment?
Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves.
What is the prognosis?
The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal.
What research is being done?
Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research.
An Alternate Strategy
Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages:
• Avoid years of medication and intermittent pain
• Avoid facing surgery when old or infirm
• If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression)
How To Find Out If You Have a Vascular Loop
The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners.
Surgical Options: Non-Destructive Procedures
The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures.
Surgical Options: Destructive Procedures
There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery.
Comments
Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use.
Recommendations
Based on the data currently available, and in an effort to maximize quality of life, we recommend the following:
Patients with less than 10 year life expectancy
Refer for destructive procedure if pain not controlled medically without significant side effects
Patients with more than 10 but less than 20 year life expectancy
Consider destructive procedure
May abolish need for continued increasing medications
Will make medical therapy easier even if fails
Patients with more than 20 year life expectancy
Perform thin cut MRI with 3-D Volume Acquisition
If vessel present recommend MVD
25 ARTICLE SECTIONS From the Mayo Clinic.
Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446
Introduction
Signs and symptoms
Causes
When to seek medical advice
Screening and diagnosis
Treatment
Coping skills
Introduction
Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable.
You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area.
Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery.
Signs and symptoms
An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia.
People who have experienced severe trigeminal neuralgia have described the pain as:
Lightning-like or electric-shock-like
Shooting
Jabbing
Like having live wires in your face
Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time.
Causes
Branches of the trigeminal nerve CLICK TO ENLARGE
The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux.
The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia.
After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face:
The first branch controls sensation in your eye, upper eyelid and forehead.
The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum.
The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing.
You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face.
Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include:
Compression by a tumor
Multiple sclerosis
A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system
A variety of triggers, many subtle, may set off the pain. These triggers may include:
Shaving
Stroking your face
Eating
Drinking
Brushing your teeth
Talking
Putting on makeup
Encountering a breeze
Smiling
Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases.
When to seek medical advice
Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth.
If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor.
Screening and diagnosis
If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain.
If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected.
Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head.
Treatment
Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you.
Medications
Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea.
Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness.
Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness.
Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision.
Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin).
Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option.
Surgery
The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve:
Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure.
Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling.
http://www.MyTrigeminalNeuralgiaStory.com
Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew.
http://www.MyTrigeminalNeuralgiaStory.com
Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root.
An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions.
PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years.
Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve.
MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people.
http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve.
Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead.
Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known.
• Coping skills
Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life.
You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area.
27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion.
Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons.
Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems.
Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks.
Frequency:
Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons.
Mortality/Morbidity:
No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired.
In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome.
Sex: Male-to-female ratio is 2:3.
Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis.
Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age.
Symptomatic or secondary TN tends to occur in younger patients.
27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion.
Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons.
Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems.
Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks.
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38, 04:38, 2007-08-07 04:02:58 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 5-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 5-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve
THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com
Important words found on this site.
Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz
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WHAT IS TRIGEMINAL NEURALGIA?
TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears.
It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve.
TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation.
http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html
What is Trigeminal Neuralgia?
Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening.
The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves.
Is there any treatment?
Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves.
What is the prognosis?
The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal.
What research is being done?
Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research.
An Alternate Strategy
Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages:
• Avoid years of medication and intermittent pain
• Avoid facing surgery when old or infirm
• If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression)
How To Find Out If You Have a Vascular Loop
The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners.
Surgical Options: Non-Destructive Procedures
The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures.
Surgical Options: Destructive Procedures
There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery.
Comments
Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use.
Recommendations
Based on the data currently available, and in an effort to maximize quality of life, we recommend the following:
Patients with less than 10 year life expectancy
Refer for destructive procedure if pain not controlled medically without significant side effects
Patients with more than 10 but less than 20 year life expectancy
Consider destructive procedure
May abolish need for continued increasing medications
Will make medical therapy easier even if fails
Patients with more than 20 year life expectancy
Perform thin cut MRI with 3-D Volume Acquisition
If vessel present recommend MVD
25 ARTICLE SECTIONS From the Mayo Clinic.
Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446
Introduction
Signs and symptoms
Causes
When to seek medical advice
Screening and diagnosis
Treatment
Coping skills
Introduction
Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable.
You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area.
Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery.
Signs and symptoms
An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia.
People who have experienced severe trigeminal neuralgia have described the pain as:
Lightning-like or electric-shock-like
Shooting
Jabbing
Like having live wires in your face
Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time.
Causes
Branches of the trigeminal nerve CLICK TO ENLARGE
The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux.
The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia.
After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face:
The first branch controls sensation in your eye, upper eyelid and forehead.
The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum.
The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing.
You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face.
Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include:
Compression by a tumor
Multiple sclerosis
A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system
A variety of triggers, many subtle, may set off the pain. These triggers may include:
Shaving
Stroking your face
Eating
Drinking
Brushing your teeth
Talking
Putting on makeup
Encountering a breeze
Smiling
Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases.
When to seek medical advice
Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth.
If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor.
Screening and diagnosis
If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain.
If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected.
Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head.
Treatment
Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you.
Medications
Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea.
Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness.
Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness.
Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision.
Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin).
Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option.
Surgery
The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve:
Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure.
Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling.
http://www.MyTrigeminalNeuralgiaStory.com
Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew.
http://www.MyTrigeminalNeuralgiaStory.com
Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root.
An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions.
PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years.
Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve.
MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people.
http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve.
Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead.
Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known.
• Coping skills
Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life.
You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area.
27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion.
Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons.
Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems.
Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks.
Frequency:
Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons.
Mortality/Morbidity:
No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired.
In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome.
Sex: Male-to-female ratio is 2:3.
Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis.
Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age.
Symptomatic or secondary TN tends to occur in younger patients.
27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion.
Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons.
Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems.
Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks.
http://www.MyTrigeminalNeuralgiaStory.com (Less)
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24, 05:03, 2007-08-06 22:21:54 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 2-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 2-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve
THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com
Important words found on this site.
Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz
Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From
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Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites
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Click Dental Education Trigeminal Neuralgia Extreme Facial Pain
http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html
Click Trigeminal Neuralgia Patient Painful-Stories
http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html
Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html
Click My Story on TN Brian N
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Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html
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Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com
Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html
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Click What is Trigeminal Neuragia? Portland,OR Slide Show
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Click Trigeminal Neuralgia National Conference
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Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer
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WHAT IS TRIGEMINAL NEURALGIA?
TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears.
It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve.
TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation.
http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html
What is Trigeminal Neuralgia?
Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening.
The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves.
Is there any treatment?
Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves.
What is the prognosis?
The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal.
What research is being done?
Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research.
An Alternate Strategy
Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages:
• Avoid years of medication and intermittent pain
• Avoid facing surgery when old or infirm
• If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression)
How To Find Out If You Have a Vascular Loop
The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners.
Surgical Options: Non-Destructive Procedures
The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures.
Surgical Options: Destructive Procedures
There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery.
Comments
Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use.
Recommendations
Based on the data currently available, and in an effort to maximize quality of life, we recommend the following:
Patients with less than 10 year life expectancy
Refer for destructive procedure if pain not controlled medically without significant side effects
Patients with more than 10 but less than 20 year life expectancy
Consider destructive procedure
May abolish need for continued increasing medications
Will make medical therapy easier even if fails
Patients with more than 20 year life expectancy
Perform thin cut MRI with 3-D Volume Acquisition
If vessel present recommend MVD
25 ARTICLE SECTIONS From the Mayo Clinic.
Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446
Introduction
Signs and symptoms
Causes
When to seek medical advice
Screening and diagnosis
Treatment
Coping skills
Introduction
Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable.
You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area.
Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery.
Signs and symptoms
An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia.
People who have experienced severe trigeminal neuralgia have described the pain as:
Lightning-like or electric-shock-like
Shooting
Jabbing
Like having live wires in your face
Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time.
Causes
Branches of the trigeminal nerve CLICK TO ENLARGE
The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux.
The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia.
After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face:
The first branch controls sensation in your eye, upper eyelid and forehead.
The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum.
The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing.
You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face.
Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include:
Compression by a tumor
Multiple sclerosis
A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system
A variety of triggers, many subtle, may set off the pain. These triggers may include:
Shaving
Stroking your face
Eating
Drinking
Brushing your teeth
Talking
Putting on makeup
Encountering a breeze
Smiling
Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases.
When to seek medical advice
Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth.
If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor.
Screening and diagnosis
If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain.
If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected.
Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head.
Treatment
Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you.
Medications
Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea.
Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness.
Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness.
Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision.
Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin).
Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option.
Surgery
The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve:
Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure.
Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling.
http://www.MyTrigeminalNeuralgiaStory.com
Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew.
http://www.MyTrigeminalNeuralgiaStory.com
Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root.
An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions.
PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years.
Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve.
MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people.
http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve.
Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead.
Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known.
• Coping skills
Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life.
You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area.
27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion.
Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons.
Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems.
Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks.
Frequency:
Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons.
Mortality/Morbidity:
No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired.
In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome.
Sex: Male-to-female ratio is 2:3.
Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis.
Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age.
Symptomatic or secondary TN tends to occur in younger patients.
27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion.
Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons.
Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems.
Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks.
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