Trigeminal Neuralgia Flashcards
Define trigeminal neuralgia
Sudden, unilateral, severe, brief stabbing, recurrent pain in the distribution of one or more branches of the 5th cranial nerve
Trigeminal neuralgia epidemiology?
Point prevalence 0.001 Incidence approx 3-5 per 100,000 of the population Women>men Age 50yrs plus Unilateral
Idiopathic
Secondary
Presentation of trigeminal neuralgia?
Unilateral, sharp shooting pain, severity 10/10
- Lightening
- Knife being twisted
- Electric shock
Triggered - eating, talking, washing
Paroxysms
Day>night
Remission
Depression
Suicidal
Isolated
Pathophysiology of trigeminal neuralgia?
Local demyelination of the trigeminal root
Management of trigeminal neuralgia?
Medical Surgical - Microvascular decompression - Ganglion procedures - Stereotactic radiosurgery - Cryoanalgesia
Management medication for trigeminal neuralgia?
Carbamazepine, oxcarbazepine, lamotrigine = sodium channel blockers
Gabapentin/pregabalin
Baclofen
Valproate
Phenytoin
Carbamazepine (tegretol) dosage?
2x daily
Increase dose gradually
Carbamazepine (tegretol) side effects?
Rash 8%
Ataxia and somnolence
Dyscrasia (rare)
Drug interactions - warfarin etc
Surgical management of trigeminal neuralgia?
Microvascular decompression
Ganglion procedures
Stereotactic radiosurgery
Cryoanalgesia
How to manage microvascular decompression?
> 80% complete pain relief - often life long
Morbidity - CSF leaks, meningitis, cranial nerve deficits
Management ganglion procedure?
Needle inserted through foramen ovale into the ganglion
- Compression ballon
- Glycerol injection
- Thermocoagulation
GA
Sensory deficit
Management cryoanalgesia?
Recovery and recurrence of pain
Fibrosis
Sensory deficit
Stereostatic radiosurgery - does it work?
Most patients very satisfied BUT Delay in pain relief Failure of tx 20-30% of pts get some paraesthesia Recurrence of pain
