Trigeminal Neuralgia
I believe that Trigeminal Neuralgia or tic douloureux is very rare in MS patients, but it can occur. Trigeminal Neuralgia is an intense neurological pain that affects areas of the face. I have not experienced TN and for this, given that it is widely accepted as the most painful affliction known to medical practice, I am extremely grateful.
The trigeminal nerve is one of the main Cranial Nerves. It splits into three main branches that serve different areas of the face:
- Opthalmic Branch: eye, eyebrows, forehead and frontal portion of the scalp.
- Maxillary Branch: upper lip, upper teeth, upper gum, cheek lower eyelid and side of the nose.
- Mandibular Branch: lower lip, lower teeth, lower gum and side of the tongue. Also covers a narrow area that extends from the lower jaw in front of the ear to the side of the head.
The most common cause of Trigeminal Neuralgia, in non-MS cases, is pressure exerted on the nerve by an enlarged looping artery or vein where it emerges from the brain stem at the base of the brain. Multiple Sclerosis is a possible cause as is a brain tumour.
Trigeminal Neuralgia usually has it's onset in individuals over the age of fifty. It is common for TN to start gradually and may begin as a dull ache or burning sensation. It may escalate to intense stabbing, electric shock-like pains. Each episode may last anywhere from a few seconds to two minutes.
Individual episodes may be triggered by vibration or exposure to heat or cold. The pain of Trigeminal Neuralgia can be completely mentally debilitating and gives rise to the term "suicide disease" for obvious reasons.
Treatments
The most effective drug treatments are carbamazepine (Tegretol®) and gabapentin (Neurontin®). Treatment should begin with a low-dose regime, increasing as required.
Microvascular Decompression (MVD) is the only non-destructive surgical procedure, involving coagulation, moving or padding of the blood vessels that are pressing on the nerve. This is not appropriate to MS caused TN.
Glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression are all based on interrupting the pain by partial damage to the Trigeminal nerve fibres. As well as stopping the pain, the patient also loses sensation in the parts of the face served by the nerve.
References:
Trigeminal Neuralgia - DefinitionTrigeminal Neuralgia UCSD, San Diego
National Institute of Neurological Disorders and Stroke
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