Trigem­i­nal neu­ral­gia: the facts

Friday - - Living -

What is it?

The trigem­i­nal nerve, which should trans­mit ap­pro­pri­ate pain mes­sages, has three branches on each side of the face: one above the eyes and across the fore­head; an­other through the cheek, up­per jaw, teeth, gums and side of the nose; and the third through the lower jaw, teeth and gums. Mal­func­tion­ing pain mes­sages most of­ten come from the mid­dle and lower branches.

Dr Mo­tasem Aly­a­coub, con­sul­tant neu­rol­o­gist, Amer­i­can Hos­pi­tal, says he’s treated around 300 pa­tients with the con­di­tion over the past 20 years. It’s an un­com­mon ill­ness that usu­ally af­fects the el­derly, be­cause as peo­ple age, blood ves­sels lengthen and can rest on and pulsate against a nerve.

“More than 80 per cent of the pa­tients I have seen were over the age of 60, fewer than 5 per cent of pa­tients were un­der the age of 40 and the rest were be­tween 40 and 60 years,” says Dr Aly­a­coub.

What causes it?

It’s un­clear what causes most cases of trigem­i­nal neu­ral­gia. Most likely is dam­age to the myelin sheath around the nerve, which can hap­pen through pres­sure from ar­ter­ies or blood ves­sels, some­times from tu­mours or mul­ti­ple scle­ro­sis.

Con­di­tions be­lieved to lead to trigem­i­nal neu­ral­gia in­clude a blood ves­sel com­press­ing the nerve, vi­ral in­fec­tion, den­tal pro­ce­dures and be­nign tu­mours, Dr Aly­a­coub says.

What are the symp­toms?

Sud­den pain of­ten de­scribed as elec­tric shocks, or stab­bing and burn­ing, most of­ten on the right side of the face.

How is it treated?

An­ti­con­vul­sant drugs are usu­ally tried first to soothe the ner­vous sys­tem. Some­times an­tide­pres­sants may help qui­eten the ner­vous sys­tem. Nor­mal painkillers of­ten prove in­ef­fec­tive. In­jec­tions of glyc­erol through the cheek, or ra­di­a­tion, may be tried to dam­age the nerve and stop it send­ing pain mes­sages to the brain.

In­va­sive surgery, MVD, in­volves open­ing the skull, mov­ing of­fend­ing blood ves­sels away and ei­ther re­mov­ing them or insert­ing a sponge to act as a buf­fer.

Liv­ing with trigem­i­nal neu­ral­gia

Trigem­i­nal neu­ral­gia is not fa­tal, but it can be de­bil­i­tat­ing be­cause pain can be trig­gered by ev­ery­day ac­tiv­i­ties like con­tact with the cheek when shav­ing, wash­ing the face, brush­ing teeth, eat­ing, drink­ing or talk­ing. To avoid pain, Dr Aly­a­coub ad­vises us­ing a soft tooth­brush and avoid­ing hot and cold foods or drinks, and chewy foods.

Dam­age to the myelin sheath around the nerves can be a cause of trigem­i­nal neu­ral­gia

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