TRIGEMINAL NEURALGIA

AMITHBABU.C.B
MScD-ENDO
 INTRODUCTION
• It is the most debilitating form of
neuralgia that affects the sensory
branches of the Vth cranial nerve.
• It is a disorder of the peripheral or
central fibres of the trigeminal nerve in
which the dominant symptom is pain in
the anterior half of the head.
 DEFINITION
• It is defined as sudden, usually unilateral,
severe, brief, stabbing, lancinating, recurring
pain in the distribution of one or more
branches of the Vth cranial nerve.
 TIC DOULOUREUX

• Tic douloureux painful jerking

It is a truly agonizing condition, in which the
patient may clunch the hand over the face &
experience severe, lancinating pain associated
with spasmodic contractions of the facial muscles
during attacks

– a feature that led to use of this term

 ETIOLOGY
• Usually idiopathic
• Demyelination of the nerve
• Petrous ridge compression
• Post traumatic neuralgia
• Intra cranial tumors
• Intra cranial vascular abnormalities
• Viral etiology
PATHOGENESIS
 GENERAL FEATURES
• Incidence- 8 in 1,00,000
• Age- 5th- decade of life
• Sex- female> male 1.6>1.0
• Affliction for side- right > left
• Division of trigeminal
nerve involvement - V3 >V2>V1
 CLINICAL FEATURES
• Manifests as a sudden, unilateral, intermittent
paroxysmal, sharp, shooting, lancinating,
shock like pain, elicited by slight touching
superficial ‘trigger points’ which radiates from
that point, across the distribution of one or
more branches of the trigeminal nerve.
• Pain is usually confined to one part of one
division of trigeminal nerve
 CLINICAL FEATURES

•Pain rarely crosses the midline.

•Attacks do not occur during sleep.
• Pain is of short duration, but may recur with
variable frequency.
•In extreme cases, the patient will have a
motionless face – the ‘frozen or mask like face’.
 COMMON TRIGGER POINTS
CUTANEOUS INTRA ORAL

• Corner of the lips

• Cheek •Teeth
• Ala of the nose •Gingivae
• •Tongue
Lateral brow
 DIAGNOSIS
• From well taken history
• CT – scan
• MRI
• Diagnostic nerve block
 TREATMENT MODALITIES

MEDICAL SURGICAL
PHARMACOLOGIC: ANTIEPILEPTIC
DRUGS (AED)
• Carbamazepine
• Phenytoin
• Gabapentin
• Pregabalin
• Clonazepam
• Sodium Valproate/Divalproex
• Lamotrigine
• Oxcarbazepine
 PHARMACOLOGIC: NON-
ANTIEPILEPTIC DRUGS
• Baclofen
• Tocainide
• Pimozide
• Chloripramine
• Amitriptyline
• Tizanidine
• Proparacaine
 CONCLUSION…….
• No sufficient evidence certifies the efficacy of
non-antiepileptic drugs for use in TN
• Baclofen, pimozide, tocainide and
chlorimipramine has the most potential for use
in TN but…
• No evidence to recommend use of these non-
antiepileptic drugs as routine therapeutics for TN
•
 TRICYCLINE ANTIDEPRESSANTS:

• Amitriptyline 10 – 300 mg/day

• Doxepin 10 – 300 mg/day
• Nortriptyline 10 – 150 mg/day
• Imipramine 10 – 300 mg/day
 SURGICAL
• Peripheral Neurectomy
• supraorbital, infraorbital and mental nerves
• Intracranial trigeminal rhizotomy
• portio major
• Glycerol gasserian gangliolysis
• Microvascular decompression
• Stereotactic radiosurgery
• Radiofrequency rhizotomy
THANK YOU