Trigeminal Neuralgia - Medical Malpractice Lawyers

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Trigeminal Neuralgia - Medical Malpractice

Trigeminal neuralgia is also called tic douloureux. It is also known as prosopalgia. It is an intensely painful disease of the trigeminal nerve of the face. There are three branches to the trigeminal nerve and one, two or all three branches can be affected at any given time. The first branch of the trigeminal nerve is the branch that goes to the forehead and down to the eye. The second branch of the trigeminal nerve regulates the cheek, nose and down to the upper lip. The third branch of the trigeminal nerve regulates the nerve fibres of the chin and below the level of the lower lip.

The pain of trigeminal neuralgia can be felt in the lips, eye, ear, nose, forehead, scalp, cheeks, jaw or teeth. In rare cases, pain may be felt in the left index finger. It is not an easy disease to control once it comes on but there are medications and treatments that can help the disease get better faster. About one in 15,000 individuals suffer from trigeminal neuralgia although it is a frequently misdiagnosed condition. Most people with trigeminal neuralgia suffer from it after the age of fifty years of age; however, a few cases have been seen in children.

The main symptom of trigeminal neuralgia is intense facial pain that can hurt at rest or only with movement. It can last several seconds or several hours at a time and may be paroxysmal. Cold air or eating certain foods can trigger the onset of the pain and people have trouble brushing their teeth, shaving, talking and eating. Certain loud noises or a brisk wind can trigger the onset of pain, which feels like electric shocks are going down your face. The pain is often intractable and causes a person to have great distress.

Usually one side of the face is affected at one time and you can get hundreds of jolts of pain throughout the day. Ten to twelve cases of trigeminal neuralgia are bilateral so that pain occurs on both sides. If someone has trigeminal neuralgia, the attacks tend to worsen over time and be more severe. Usually, if a case is recurrent, it affects the same branch of the trigeminal nerve each time. It can travel to other branches of the trigeminal nerve, however. It can spread to all branches of the trigeminal nerve on one side and be extremely painful. Those with multiple sclerosis or an expanding cranial tumour can present with trigeminal neuralgia. Some patients report continuous pain during the day that is not a come-and-go type of pain.

The trigeminal nerve is also known as the fifth cranial nerve and is sensitive to pressure, pain and temperature. It innervates the entire half of the face on either side just above the jaw line. It also involves the motor function of the eating muscles so that eating is problematic when you have the disease. It is believed that the superior cerebellar artery, which travels near the trigeminal nerve, swells and crushes the nerve, causing trigeminal neuralgia. Rarely, you can get the same thing with an aneurysm of the artery. It is common in patients who have multiple sclerosis. This occurs in about one to four percent of those who have trigeminal neuralgia.

Treatment of trigeminal neuralgia can be difficult. It is diagnosed primarily via clinical examination and history of present illness. Some doctors provide corticosteroids like prednisone in order to block the inflammation of the nerve. Pain medications using hydrocodone or codeine are often prescribed because this is a very severe type of pain. Anticonvulsants are common treatments for trigeminal neuralgia. These can include carbamazepine, baclofen (which is a muscle relaxant), lamotrigine, oxycarbazepine, phenytoin and gabapentin. Sodium valproate is a second line agent. Clonazepam and lidocaine are sometimes successful.

The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here