1 Farrer Park Station Road, #08-14, Farrer Park Hospital (Connexion), Singapore 217562
Welcome to Chiropractor of Losangle !
-
Call for help: (+1800) 456 7890
-
ALLEVIATE PAIN CLINIC
We see patients with a variety of Pain-related conditions.
Trigeminal Neuralgia – The Suicide Disease
Trigeminal Neuralgia (TN), often called the "suicide disease" due to the severity of the pain it causes, is a neurological disorder that affects the trigeminal nerve, leading to intense, stabbing facial pain. While it may not be as widely recognized as other conditions, the impact of TN on those who experience it is significant, both physically and emotionally. In this article, we’ll explore the causes of Trigeminal Neuralgia and available treatment options.
When Should You Suspect Trigeminal Neuralgia?
Trigeminal Neuralgia is characterized by sudden, sharp, stabbing pain on one side of the face. The pain can be triggered by even the lightest touch, such as brushing the teeth, touching the face, or even a gentle breeze. Episodes are typically short but incredibly intense, often lasting only seconds to minutes, yet the unpredictability of the attacks makes the condition particularly distressing for those affected.
What is the Trigeminal Nerve?
The trigeminal nerve, also known as the fifth cranial nerve (CN V), is one of the twelve cranial nerves emerging directly from the brain. It is the largest of these nerves and serves two main functions: transmitting sensory information from the face to the brain and controlling the muscles responsible for chewing.
The trigeminal nerve is divided into three branches:
- V1 (Ophthalmic branch): Sensory input from the forehead, eyes, and scalp.
- V2 (Maxillary branch): Sensory input from the cheek, upper lip, and teeth.
- V3 (Mandibular branch): Sensory input from the lower lip, jaw, and teeth, as well as controlling chewing muscles.
In most cases of Trigeminal Neuralgia, pain is localized to one of these divisions. However, in some rare instances, pain can occur in two or more branches simultaneously.
What Causes Trigeminal Neuralgia?
The precise cause of Trigeminal Neuralgia remains unclear, but in many cases, the condition is associated with compression of the trigeminal nerve by a blood vessel as it exits the brainstem. This compression can irritate the nerve, leading to the sharp pain characteristic of TN. One common treatment for patients with this type of neurovascular compression is Microvascular Decompression (MVD), a surgery that involves separating the nerve from the compressing blood vessel.
However, it’s important to note that:
- Vascular compression is often seen in individuals without any symptoms of Trigeminal Neuralgia.
- Not all patients with TN show evidence of neurovascular compression.
Is There a Test for Trigeminal Neuralgia?
An MRI is commonly used in patients presenting with facial pain to rule out other serious conditions, such as tumors, and to identify any vessels that might be compressing the trigeminal nerve. However, it’s important to understand that neurovascular compression, while observed in some cases, is not necessary for diagnosing Trigeminal Neuralgia, and the MRI is not conclusive in confirming the condition. The diagnosis is primarily made based on a thorough medical history and clinical examination.
Several other conditions can also cause facial pain, so a careful differential diagnosis is crucial.
Treatment for Trigeminal Neuralgia
While Trigeminal Neuralgia can be debilitating, many patients can find relief with medications. The most commonly prescribed drugs are Carbamazepine and Oxcarbazepine, anticonvulsants that work by reducing nerve excitability and preventing painful episodes.
However, if medication doesn’t provide sufficient relief or causes undesirable side effects, more invasive treatment options may be considered:
1. Minimally Invasive Procedures:
- Radiofrequency Ablation (RFA): A procedure that uses heat to disrupt pain signals along the trigeminal nerve.
- Balloon Compression: A method that involves inflating a balloon near the nerve to compress and disrupt pain pathways.
- Glycerol Injection: A technique that involves injecting glycerol to damage the nerve and alleviate pain.
2. Surgery:
- Microvascular Decompression (MVD): A surgical procedure aimed at relieving nerve compression by repositioning or padding the offending blood vessel.
3. Radiation:
- Gamma Knife Radiosurgery: A non-invasive method that uses focused gamma radiation to treat areas of the brain associated with the trigeminal nerve, providing targeted relief from pain.
What is Microvascular Decompression?
Microvascular Decompression (MVD) is a surgical technique designed to relieve pressure on the trigeminal nerve caused by nearby blood vessels. In this procedure, a small incision is made in the skull, and the blood vessel that is compressing the nerve is either repositioned or cushioned with a soft material to reduce the pressure. The goal of MVD is to eliminate or significantly reduce the painful episodes associated with Trigeminal Neuralgia.
What is Radiofrequency Ablation?
Gasserian Ganglion Radiofrequency Ablation (RFA) is a minimally invasive procedure that targets the nerve junction responsible for facial pain. Under sedation, a needle is inserted near the Gasserian Ganglion (a key nerve cluster) using imaging guidance such as X-ray or CT scans. Radiofrequency energy is then delivered through the needle to disrupt the nerve's ability to transmit pain signals, providing relief from the intense discomfort associated with TN.
