Monmouth’s Facial Pain Center on CBS News!

Click here to find out more about one of the patients featured in this story.

Find out more about headache and facial pain, and treatment options for trigeminal neuralgia, including surgical treatment.

Come to one of our trigeminal neuralgia support group meetings – check the Neuroscience Events Panel on the right side of the page.

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Another Gamma Knife Facial Pain Success Story

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Click here to find out more about gamma knife radiosurgery at Monmouth Neuroscience Institute.

Comparing treatment options for trigeminal neuralgia

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First line of treatment for patients with trigeminal neuralgia TGN should always be medical, usually the anticonvulsant carbamazepine (Tegretol®), which provides at least partial pain relief for 80% to 90% of patients.  Common side effects include dizziness, drowsiness, forgetfulness, unsteady gait, and nausea. However, carbamazepine and other drugs prescribed do not always remain effective over time, requiring higher and higher doses or a greater number of medications taken concurrently, causing many patients to experience side effects serious enough to warrant discontinuation.

A study from the 1980s followed 143 TGN patients treated with carbamazepine (CBZ) over a 16-year period.  The drug was effective initially with few mild side effects in 99 patients (69%). Of these, 19 developed resistance between 2 months and 10 years after commencing treatment, and required alternative measures. Of the remaining 80 (56%), the drug was effective in 49 for 1-4 years and in 31 for 5-16 years. Thirty-six patients (25%) failed to respond to CBZ initially and required alternative measures, as did 8 (6%) who were intolerant of the drug.

Surgical treatment of TGN is reserved for people who still experience debilitating pain despite best medical management. Surgical options include gamma knife “radiosurgery” (GKS) and the more invasive microvascular decompresion (MVD).

Another study from 2008 compared outcomes for 80 consecutive TGN patients treated surgically with either MVD (36 patients) or GKS (44 patients) over 4-8 years:

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TGN KMG

In sum, MVD was more likely than GKS to achieve and maintain pain-free status in TGN,but  both procedures provided similar early patient satisfaction rates.  MVD is therefore preferred for younger healthy patients, while GKS is preferred for older patients with co-morbidies or contraindications, but neither should be considered unless medical therapy has already been tried and failed.

2nd Trigeminal Neuralgia Support Group Meeting at MMC

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** Location Change **

Moved to the Conference Room

Breast Center, at MMC

 

Please contact Shirley Lew to register, either call her at 732-923-6551 or click here to email.

Find out more about facial pain and headache, and surgical treatment of trigeminal neuralgia.

Surgical options for trigeminal neuralgia

Trigeminal Neuralgia

Trigeminal neuralgia is characterized by recurrent short episodes of one-sided zapping, shooting, or excruciating spasms of facial pain. The pain may be so severe that the patient may cry out or visibly wince. The affected area of the face may become super-sensitive, with such minor stimulation as a light breeze, cold temperature, water from a shower, washing the face, shaving, or even eating can set off attacks of pain.

Medical Treatment of Trigeminal Neuralgia
The anticonvulsant carbamazepine is usually first line treatment.
Second line medications include baclofen, lamotrigine, oxcarbazepine, phenytoin, gabapentin, pregabalin, and antidepressants such as amitriptyline.
However these medications are not always effective and can cause side effects such as confusion and unsteady gait.

Surgical Treatment of Trigeminal Neuralgia
Surgical treatment, known as microvascular decompression, involves sub occipital craniotomy, mobilizing the offending blood vessel off the nerve, and insertion of a sponge to separate these structures.

Partial lesioning of the trigeminal nerve, either by radiofrequency ablation using a percutaneous needle or gamma knife radiosurgery is less invasive and can also be very effective:

Gamma knife for trigeminal neuralgia patient story:
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