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12 results

  • Chapter 13 - Trigeminal Neuralgia

  • from Part III - Chronic Pain Conditions Head and Neck
  • Edited by Omar Viswanath, Creighton University, Omaha, Ivan Urits, Southcoast Brain & Spine Center, Wareham
  • Book:
    Cambridge Handbook of Pain Medicine
    Published online:
    01 December 2023
    Print publication:
    14 December 2023, pp 81-85

  • Summary

    Trigeminal neuralgia (TN), or tic douloureux, is characterized by recurrent attacks of lancinating, neuropathic facial pain in the dermatomal distribution of the trigeminal nerve. It was first described as early as in the first century, but accurate descriptions were not documented until the 1700s. Tic douloureux refers to the distinctive facial muscle spasms associated with condition. In patients with TN, minimal stimulation (e.g., light touch, tooth brushing, chewing, talking, wind) causes debilitating pain. Mainstays of treatment include medication, surgery, and complementary approaches. Surgical management is indicated for those who have failed medical treatment with three or more medications, suffer from intolerable side effects, or have intractable symptoms.

  • Chapter 30 - Use of Botulinum Neurotoxin in Neuropathic Pain

  • Edited by Daniel Truong, University of California, Riverside, Dirk Dressler, Hannover Medical School, Mark Hallett, National Institutes of Health (NIH), Christopher Zachary, University of California, Irvine, Mayank Pathak, Truong Neuroscience Institute
  • Book:
    Manual of Botulinum Toxin Therapy
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 245-251

  • Summary

    Neuropathic pain refers to pain caused by a lesion or disease of the somatosensory nervous system. Diabetic neuropathy, postherpetic neuralgia, radiculopathy pain, trigeminal neuralgia and complex regional pain syndrome are all neuropathic pain syndromes.

    Local administration of botulinum neurotoxin (BoNT)) has proven significant effects on the treatment of neuropathic pain. Abnormal muscle contractions contribute to chronic pain. Botulinum neurotoxin serotype A (BoNT-A) is well known to have an effect on inhibition of muscle contraction and this may partially explain its effect on chronic pain. In preclinical models, BoNT-A was found to effectively block the release of several pain-related neurotransmitters, including norepinephrine, substance P, glutamate and calcitonin gene-related peptide, from afferent nerve terminals and dorsal root ganglia. These pain-related neurotransmitters can stimulate depolarization of C fibers, which are responsible for propagation of chronic pain. BoNT-A also decreases local inflammation around the nerve terminal.

    This chapter offers clinical description and pictorial illustration for injection of BoNT for the particular conditions of diabetic neuropathy, postherpetic neuralgia and trigeminal neuralgia.

  • Chapter 8 - Musculoskeletal and Neurogenic Pain

  • from Section 2 - Common Neurologic Presentations: A Symptom-Based Approach
  • Edited by Thomas P. Campbell, Allegheny Health Network, Pittsburgh, Kevin M. Kelly, Allegheny Health Network, Pittsburgh
  • Book:
    Handbook of Emergency Neurology
    Published online:
    10 January 2024
    Print publication:
    17 August 2023, pp 94-107

  • Summary

    Pain is one of the most common presenting complaints in the emergency department (ED), both acute pain and exacerbation of chronic pain syndromes. Acute pain is accompanied by anxiety and sympathetic hyperactivity, whereas chronic pain is often associated with affective symptoms of depression. Nociceptive (musculoskeletal, inflammatory, or somatic) pain involves activation of the peripheral receptors secondary to tissue damage from trauma or heat. Neuropathic pain involves direct activation of either sensory nerves or ganglia by nerve injury or disease. Differentiation between nociceptive and neuropathic pain in the ED can be difficult, but should be considered for successful management of the pain.

  • Repeat CyberKnife Radiosurgery for Trigeminal Neuralgia: Outcomes and Complications

  • Albert Guillemette, David Roberge, Sami Heymann, Cynthia Ménard, Jean-Paul Bahary, Marie-Pierre Fournier-Gosselin
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 51 / Issue 2 / March 2024
    Published online by Cambridge University Press:
    08 May 2023, pp. 272-277
    • Article
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  • Background:

    CyberKnife radiosurgery (RS), as an initial first treatment, is recognized as an efficient and safe modality for trigeminal neuralgia (TN). However, knowledge on repeat CyberKnife RS in refractory cases is limited. The objective was to evaluate the clinical outcomes of repeat CyberKnife RS for TN.

    Methods:

    A retrospective review of 33 patients with refractory TN treated a second time with CyberKnife RS from 2009 to 2021. The median follow-up period after the second RS was 26.0 months (range 0.3–115.8). The median dose for the repeat RS was 60 Gy (range 60.0–70.0). Pain relief after the intervention was assessed using the Barrow Neurological Institute scale for pain (I–V). Scores I to IIIb were classified as an adequate pain relief and scores IV–V were classified as a treatment failure

    Results:

    After the second RS, initial adequate pain relief was achieved in 87.9% of cases. The actuarial probabilities of maintaining an adequate pain relief at 6, 12, 24, and 36 months were 92.1%, 74.0%, 58.2%, and 58.2%, respectively. Regarding sustained pain relief, there was no significant difference between the first and the second RS. Sensory toxicity after the first RS was predictive of a better outcome following the second RS. The onset of hypesthesia rate was the same after the first or the second RS (21%).

    Conclusion:

    Repeat RS is an effective and safe method for the treatment of refractory TN.

  • Trigeminal Neuralgia and Multiple Sclerosis: A Historical Perspective

  • David B. Burkholder, Peter J. Koehler, Christopher J. Boes
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 44 / Issue 5 / September 2017
    Published online by Cambridge University Press:
    19 July 2017, pp. 589-593
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  • Trigeminal neuralgia (TN) associated with multiple sclerosis (MS) was first described in Lehrbuch der Nervenkrankheiten für Ärzte und Studirende in 1894 by Hermann Oppenheim, including a pathologic description of trigeminal root entry zone demyelination. Early English-language translations in 1900 and 1904 did not so explicitly state this association compared with the German editions. The 1911 English-language translation described a more direct association. Other later descriptions were clinical with few pathologic reports, often referencing Oppenheim but citing the 1905 German or 1911 English editions of Lehrbuch. This discrepancy in part may be due to the translation differences of the original text.

  • Altered Autonomic Nervous System Reactivity to Pain in Trigeminal Neuralgia

  • Guillaume Léonard, Philippe Chalaye, Philippe Goffaux, David Mathieu, Isabelle Gaumond, Serge Marchand
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 42 / Issue 2 / March 2015
    Published online by Cambridge University Press:
    25 March 2015, pp. 125-131
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  • Background: In the past two decades, there has been increasing evidence to suggest that trigeminal neuralgia (TN) may be linked to a dysfunction of the autonomic nervous system (ANS). The aim of the present study was to formally test this hypothesis by comparing the reactivity of the ANS to experimental pain in a population of TN patients and healthy controls. Methods: Twelve patients diagnosed with classical TN and 12 healthy controls participated in the study. Cardiac activity was assessed while participants were instructed to rest and again during a cold pressor test (CPT). Heart rate variability analyses were performed off-line to obtain parasympathetic (high-frequency) and sympathetic (low-frequency) indices. Results: At baseline, ANS measures did not differ between healthy controls and TN patients, and both groups showed a similar increase in heart rate during the CPT (all p values >0.05). However, TN patients showed a greater increase in cardiac sympathetic activity and a greater decrease in cardiac parasympathetic activity during CPT compared with healthy controls (all p values <0.05). Importantly, changes in sympathetic reactivity, from baseline to CPT, were negatively associated with the number of pain paroxysms experienced each day by TN patients in the preceding week (r=−.58, p<0.05). Conclusions: These results suggest that TN, like many other short-lasting, unilateral facial pain conditions, is linked to ANS alterations. Future studies are required to determine if the altered ANS response observed in TN patients is a cause or a consequence of TN pain

  • Patulous eustachian tube after percutaneous balloon microcompression for trigeminal neuralgia: case report

  • M Cresswell, J Buckland, P West, O Sparrow
  • Journal:
    The Journal of Laryngology & Otology / Volume 128 / Issue 5 / May 2014
    Published online by Cambridge University Press:
    12 May 2014, pp. 478-480
    Print publication:
    May 2014
  • Objective:

    To report a case of patulous eustachian tube which occurred after percutaneous balloon microcompression of the Gasserian ganglion.

    Method:

    Retrospective case review.

    Results:

    A 41-year-old man was referred to our audiovestibular medicine department following episodes of autophony. These symptoms appeared two weeks after percutaneous balloon microcompression performed to treat severe trigeminal neuralgia secondary to multiple sclerosis. A diagnosis of patulous eustachian tube was indicated by clinical examination and tympanometry. The symptoms were present for less than six months and improved without any specific treatment.

    Conclusion:

    Percutaneous balloon microcompression is a procedure used for refractory trigeminal neuralgia that can cause transient sensory and motor deficits of any of the trigeminal nerve branches. It is proposed that injury to the mandibular division in this case caused temporary tensor veli palatini dysfunction with consequent patulous eustachian tube.

  • Chapter 23 - Spinal cord stimulation and other neuromodulation

  • from Section 6 - The Management of Neuropathic Pain
  • Edited by Cory Toth, Dwight E. Moulin
  • Book:
    Neuropathic Pain
    Published online:
    05 December 2013
    Print publication:
    07 November 2013, pp 273-289

  • Summary

    Multiple sclerosis (MS) can lead to numerous types of pain through the processes of inflammation and degeneration. The common types of pain seen in MS include dysesthetic/extremity pain, trigeminal neuralgia (TN), spasticity, L'hermitte's phenomenon, painful tonic spasms (PTS), musculoskeletal, headache, optic neuritis, and treatment related pain. This chapter focuses on the first five, with a particular focus on dysesthetic pain. The acute onset of dysesthetic pain in the setting of a relapse in a relapsing-remitting MS (RRMS) patient is clearly due to an inflammatory lesion. The inciting pathology of TN in MS is a lesion which affects the primary afferents of the trigeminal nerve after they enter the pons, distal to the trigeminal nuclear complex, in the root entry zone (REZ). Considering that people with MS are already predisposed to poor sleep, depression, and a poor quality of life, the presence of pain is particularly debilitating.

  • Venous haemangioma of the mandibular division of the trigeminal nerve

  • B McMonagle, S Connor, M Gleeson
  • Journal:
    The Journal of Laryngology & Otology / Volume 125 / Issue 6 / June 2011
    Published online by Cambridge University Press:
    28 February 2011, pp. 649-650
    Print publication:
    June 2011
  • Objectives:

    To present a rare cause of facial pain, and the differential diagnosis of a lesion of the mandibular division of the trigeminal nerve.

    Case report:

    A 19-year-old woman presented to a tertiary referral skull base centre with right periorbital pain and a progressive, right-sided deficit of the mandibular division of the trigeminal nerve. Clinical examination revealed right-sided hypoaesthesia in the mandibular division of the trigeminal nerve dermatome, mild trismus and some wasting of the right masseter muscle. Computed tomography and magnetic resonance imaging scans revealed a small area of mildly enhancing soft tissue centred within the foramen ovale, with concentric enlargement. Surgery was undertaken via an infratemporal fossa (Fisch) type D approach. A vascular lesion was found filling the foramen ovale, with no obvious nerve separate from the lesion. The lesion was removed en bloc. Histopathological analysis demonstrated a venous haemangioma within the nerve.

    Conclusion:

    Facial pain is common, and may be wrongly attributed to trigeminal neuralgia. A thorough clinical examination must be performed to identify subtle neurological abnormalities, and appropriate imaging undertaken to exclude rare causes, such as this venous haemangioma of the mandibular division of the trigeminal nerve.

  • Case 17 - Deephypothermic circulatory arrest for intracranial aneurysm clipping

  • from Section I - Neuroanesthesia
  • Edited by George A. Mashour, Ehab Farag
  • Book:
    Case Studies in Neuroanesthesia and Neurocritical Care
    Published online:
    03 May 2011
    Print publication:
    03 February 2011, pp 55-58

  • Summary

    Trigeminal neuralgia is multifactorial in etiology: it may be due to vascular compression, tumor, demyelination, or idiopathic causes. The treatment options are either medical (carbamazepine, oxacarbazepine, lamotrigine, neurontin, clonazepam, pregabalin, phenytoin, and baclofen) or surgical. Surgical management includes microsurgical exploration/decompression, percutaneous procedures (rhizotomies) on the Gasserian ganglion (radiofrequency lesioning, glycerol injection, and balloon compression), radiosurgery, and neurectomy. Bradycardia and even asystole as a result of the trigemino cardiac reflex can complicate this procedure. The noxious stimulus on the trigeminal nerve during needle insertion and balloon inflation is thought to induce the reflex. This reflex can also be activated without surgery; the mere pain of trigeminal neuralgia has reportedly resulted in bradycardia that was severe enough to cause syncope and in other instances degenerated to complete cardiac arrest. Events such as these demonstrate the potentially debilitating nature of trigeminal neuralgias.

  • Chapter 12 - Paroxysmal memory loss

  • Edited by Bettina Schmitz, Barbara Tettenborn, Johannes Gutenberg Universität Mainz, Germany, Donald L. Schomer, Harvard University, Massachusetts
  • Book:
    The Paroxysmal Disorders
    Published online:
    06 December 2010
    Print publication:
    09 September 2010, pp 158-163

  • Summary

    According to the criteria of the International Headache Society (IHS), a migraine is defined as a disease with periodic occurring headache episodes, typically associated with autonomic symptoms. The release of neuropeptides explains the actual origin of pain but not how and why the attack begins so abruptly in humans. Triptans improves the typical additional symptoms like nausea or vomiting, photo- and photophobia, and improves the ability to return to work. During a migraine attack, most patients suffer from gastrointestinal symptoms. The aim of migraine prophylaxis is a reduction of frequency, severity and duration of migraine attacks and the prevention of medication overuse headache. Effective for preventive migraine therapy are the non-selective beta-blocker propranolol and the beta-1-selective beta-blocker metoprolol. Most psychological treatments used in migraine therapy are behavior therapies. Paroxysmal pain of short duration located in a region of one of the trigeminus nerves is very characteristic for the trigeminal neuralgia.