Trigeminal neuralgia

Trigeminal neuralgia is the distribution of the trigeminal nerve (face, eye) of a sudden onset of pain, it was called the best in all the la

Content

Trigeminal neuralgia is the distribution of the trigeminal nerve (face, eye) of a sudden onset of pain, it was called the best in all the land of pain, the disease is more common in the elderly over the age of 50, male to female ratio is about 1:1.6.

The dominant area of the trigeminal nerve is shown below

Trigeminal neuralgia is divided into primary and secondary two classes, secondary trigeminal neuralgia refers to trigeminal neuralgia secondary to tumor and demyelination lesions clearly, in patients with trigeminal neuralgia, about 1%~5% was found to have brain tumors, the most common acoustic neuroma. The majority of patients are primary trigeminal neuralgia, and there is no satisfactory explanation.

[clinical features]

1 episodes of "lightning" or "electric shock" type of pain, every few seconds to several minutes.

2 trigger points in the face, especially the mouth of the mild tactile stimulation can induce trigeminal neuralgia. Speaking, chewing, brushing, etc. can be induced.

3 during the period of intermittent attack, there were several months of intermittent periods. With the development of the disease, the intermittent period became shorter and shorter.

4 unilateral unilateral trigeminal neuralgia occurred in almost all cases.

5 C Masi Bing and nerve block treatment effect is good.

[treatment]

(a) drug treatment

1 C Masi Bing preferred medicine, after meals, 100mg daily start of the 2, after the daily increase of 100mg, until the pain relief or disappear (can be increased to 200~400mg, daily 3 times), maintain 2~3 weeks, and then gradually reduced. Side effects: dizziness, drug eruption, long-term use of bone marrow suppression and liver function damage.

2 gabapentin starting dose of 300mg/ day, gradually increased to the pain control, the general dosage is 1200mg/ days, 2400mg/ days.

(two) nerve block

For patients with poor drug control, nerve block therapy. Mandibular nerve distribution area pain in patients with mandibular nerve block; maxillary nerve pain in patients with the distribution of nerve block.

(three) surgical treatment

The surgical treatment of classic methods mainly have two kinds, one is the trigeminal ganglion radiofrequency ablation is minimally invasive, simple to understand is the human peripheral trigeminal nerve block pain signals to the central transmission, resulting in less pain, curative effect, very little damage to the human body. The other is open microvascular decompression, the effect is relatively accurate, mainly for patients with vascular compression or tumor oppression, are open surgery, there is a certain risk.

The following is the schematic diagram of trigeminal nerve radiofrequency

The treatment of Xuanwu Hospital of Department of pain in the trigeminal neuralgia, accumulated a lot of clinical experience, with follow-up data of semilunar ganglion radiofrequency thermocoagulation for the treatment of the world's largest amount of samples (about 2000 cases), has been recognized by experts at home and abroad, there are a large number of articles published on the high level of foreign periodicals.

 

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