Share on Facebook Share on Twitter Email
Answers.com

trigeminal neuralgia

 
Medical Encyclopedia: Trigeminal Neuralgia
Home > Library > Health > Medical Encyclopedia

Definition

Trigeminal neuralgia is a disorder of the trigeminal nerve (the fifth cranial nerve) that causes episodes of sharp, stabbing pain in the cheek, lips, gums, or chin on one side of the face.

Description

The trigeminal nerve, which is divided into three branches, is responsible for chewing, for producing saliva and tears, and for sending facial sensations to the brain. When this nerve breaks down for some reason, it can trigger brief but agonizing sizzles of pain on one side of the face.

This condition is unusual in those under age 50 and more often occurs after 70. Women are three times more likely to have the condition than are men. When trigeminal neuralgia does occur in younger people, it is often associated with multiple sclerosis.

The pain, while brief, is so severe that the sufferer often can't do anything else while the attack lasts. People with this pain often wince or twitch, which is where trigeminal neuralgia gets its French nickname tic douloureux, meaning "painful twitch."

— Carol A. Turkington


Search unanswered questions...

Enter a question here...
Search: All sources Community Q&A Reference topics

Dictionary: trigeminal neuralgia
Top
Home > Library > Literature & Language > Dictionary

n.
Paroxysmal shooting pains of the facial area around one or more branches of the trigeminal nerve, of unknown cause, but often precipitated by irritation of the affected area. Also called tic douloureux.


Neurological Disorder:

Trigeminal neuralgia

Top
Home > Library > Health > Neurological Encyclopedia

Definition

Trigeminal neuralgia is a disorder of the trigeminal nerve that causes severe facial pain. It is also known as tic douloureux, Fothergill syndrome, or Fothergill's syndrome.

Description

Trigeminal neuralgia is a rare disorder of the sensory fibers of the trigeminal nerve (fifth cranial nerve), which innervate the face and jaw. The neuralgia is accompanied by severe, stabbing pains in the jaw or face, usually on one side of the jaw or cheek, which usually last for some seconds. The pain before treatment is severe; however, trigeminal neuralgia as such is not a life-threatening condition. As there are actually two trigeminal nerves, one for each side of the face, trigeminal neuralgia often affects only one side of the face, depending on which of the two trigeminal nerves is affected.

Demographics

There have been no systematic studies of the prevalence of trigeminal neuralgia, but one widely quoted estimate published in 1968 states that its prevalence is approximately 15.5 per 100,000 persons in the United States. Other sources state that the annual incidence is four to five per 100,000 persons, which would imply a higher prevalence (prevalence is the number of cases in a population at a given time; incidence is the number of new cases per year). In any case, the disorder is rare. Onset is after the age of 40 in 90% of patients. Trigeminal neuralgia is slightly more common among women than men.

Causes and symptoms

A number of theories have been advanced to explain trigeminal neuralgia, but none explains all the features of the disorder. The trigeminal nerve is made up of a set of branches radiating from a bulblike ganglion (nerve center) just above the joint of the jaw. These branches divide and subdivide to innervate the jaw, nose, cheek, eye, and forehead. Sensation is conveyed from the surfaces of these parts to the upper spinal cord and then to the brain; motor commands are conveyed along parallel fibers from the brain to the muscles of the jaw. The sensory fibers of the trigeminal nerve are specialized for the conveyance of cutaneous (skin) sensation, including pain.

In trigeminal neuralgia, the pain-conducting fibers of the trigeminal nerve are somehow stimulated, perhaps self-stimulated, to send a flood of impulses to the brain. Many physicians assume that compression of the trigeminal nerve near the spinal cord by an enlarged loop of the carotid artery or a nearby vein triggers this flood of impulses. Compression is thought to cause trigeminal neuralgia when it occurs at the root entry zone, a. 19–.39 in (0.5–1.0 cm) length of nerve where the type of myelination changes over from peripheral to central. Pressure on this area may cause demyelination, which in turn may cause abnormal, spontaneous electrical impulses (pain).

Compression is apparently the cause in some cases of trigeminal neuralgia, but not in others. Other theories focus on complex feedback mechanisms involving the subnucleus caudalis in the brain. Multiple sclerosis, which demyelinates nerve fibers, is associated with a higher rate of trigeminal neuralgia. Brain tumors can also be correlated with the occurrence of trigeminal neuralgia. Ultimately, however, the exact mechanisms of trigeminal neuralgia remain a mystery.

Trigeminal neuralgia was first described by the Arab physician Jurjani in the eleventh century. Jurjani was also the first physician to advance the vascular compression theory of trigeminal neuralgia. French physician Nicolaus André gave a thorough description of trigeminal neuralgia in 1756 and coined the term tic douloureux. English physician John Fothergill also described the syndrome in the middle 1700s, and the disorder has sometimes been called after him. Knowledge of trigeminal neuralgia slowly grew during the twentieth century. In the 1960s, effective treatment with drugs and surgery began to be available.

The pains of trigeminal neuralgia have several distinct characteristics, including:

  • They are paroxysmal, pains that start and end suddenly, with painless intervals between.
  • They are usually extremely intense.
  • They are restricted to areas innervated by the trigeminal nerve.
  • As seen on autopsy, nothing is visibly wrong with the trigeminal nerve.
  • About 50% of patients have trigger zones, areas where slight stimulation or irritation can bring on an episode of pain. Painful stimulation of the trigger zones is actually less effective than light stimulation in triggering an attack.
  • The disorder comes and goes in an unpredictable way; some patients show a correlation of attack frequency or severity with stress or menstrual cycle.

Stimulation of the face, lips, or gums, such as talking, eating, shaving, tooth-brushing, touch, or even a current of air, may trigger the severe knifelike or shocklike pain of trigeminal neuralgia, often described as excruciating. Trigger zones may be a few square millimeters in size, or large and diffuse. The pain usually starts in the trigger zone, but may start elsewhere. Approximately 17% of patients experience dull, aching pain for days to years before the onset of paroxysmal pain; this has been termed pretrigeminal neuralgia.

The pain of trigeminal neuralgia is severe enough that patients often modify their behaviors to avoid it. They may suffer severe weight loss from inability to eat, become unwilling to talk or smile, and cease to practice oral hygiene. Trigeminal neuralgia tends to worsen with time, so that a patient whose pain is initially well-controlled with medication may eventually require surgery.

Diagnosis

Trigeminal neuralgia is a possible diagnosis for any patient presenting with severe, stabbing, paroxysmal pain in the jaw or face. However, the most common causes of facial pain are dental problems and diseases of the mouth. Trigeminal neuralgia must also be differentiated from migraine headaches and from other cranial neuralgias (i.e., neuralgias affecting cranial nerves other than the trigeminal). Many persons with trigeminal neuralgia see multiple physicians before getting a correct diagnosis, and may have multiple dental procedures performed in an effort to relieve the pain.

There is no definitive, single test for trigeminal neuralgia. Imaging studies such as computed tomography (CT) scans or magnetic resonance imaging (MRI) may help to rule out other possible causes of pain and to indicate trigeminal neuralgia. High-definition MRI angiography of the trigeminal nerve and brain stem is often able to spot compression of the trigeminal nerve by an artery or vein. Trial and error also has its place in the diagnostic process; the physician may initially give the patient carbamazepine (an anticonvulsant) to see if this diminishes the pain. If so, this is positive evidence for the diagnosis of trigeminal neuralgia.

Treatment team

Many different sorts of health care professionals may be consulted by patients with trigeminal neuralgia, including dentists, neurologists, neurosurgeons, oral surgeons, and ear, nose, and throat surgeons. A referral to a neurologist should always be sought, as trigeminal neuralgia is essentially a neurological problem.

Treatment

Treatment is primarily with drugs or surgery. Drugs are often preferred because of their lower risk, but may have intolerable side effects such as nausea or ataxia (loss of muscle coordination). The two most effective drugs are carbamazepine (an anticonvulsant often used in treating epilepsy), used for trigeminal neuralgia since 1962, and gabapentin. Drugs are prescribed initially in low doses and increased until an effective level is found. Other drugs in use for trigeminal neuralgia are phenytoin, baclofen, clonazepam, lamotrigine topiramate, and trileptal.

Carbamazepine, which inhibits the activity of sodium channels in the cell membranes of neurons (thereby reducing their excitability), is deemed the most effective medication for trigeminal neuralgia. Unfortunately, it has many side effects, including vertigo (dizziness), ataxia, and sedation (mental dullness). This may make it harder to treat elderly patients, who are more likely to have trigeminal neuralgia. Carbamazepine provides complete or partial relief for as many as 70% of patients. Phenytoin is also a sodium channel blocker, and also has adverse side effects, including hirsutism (increased facial hair), coarsening of facial features, and ataxia.

For patients whose pain does not respond adequately to medication, or who cannot tolerate the medication itself due to side effects, surgery is considered. Approximately 50% of trigeminal neuralgia patients eventually undergo surgery of some kind for their condition. The most common procedure is microvascular decompression, also known as the Jannetta procedure after its inventor. This involves surgery to separate the vein or artery compressing the trigeminal nerve. Teflon or polivinyl alcohol foam is inserted to cushion the trigeminal nerve against the vein or artery. This procedure is often effective, but some physicians argue that since other procedures that disturb or injure the trigeminal nerve are also effective, the benefit of microvascular decompression surgery is not relief of compression but disturbance of the trigeminal nerve, causing nonspecific nerve injury that leads to a change in neural activity.

Other surgical procedures are performed, some of which focus on destroying the pain-carrying fibers of the trigeminal nerve. The most high-tech and least invasive procedure is gamma-ray knife surgery, which uses approximately 200 convergent beams of gamma rays to deliver a high (and highly localized) radiation dose to the trigeminal nerve root. Almost 80% of patients undergoing this procedure experience significant relief with this procedure, although about 10% develop facial paresthesias (odd, non-painful sensations not triggered by any external stimulus).

Clinical trials

As of mid-2004, one clinical trial related to trigeminal neuralgia was recruiting patients. This study, titled "Randomized Study of L-Baclofen in Patients with Refractory Trigeminal Neuralgia," was being carried out at the University of Pennsylvania, Pittsburgh, and was sponsored by the FDA Office of Orphan Products Development (dedicated to promoting the development of treatments for diseases too rare to be considered profitable by pharmaceutical companies). Its goal is to test the effectiveness and safety of the drug L-baclofen in patients with refractory (treatment-resistant) trigeminal neuralgia. The contact is Michael J. Soso at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 15261, telephone (412) 648-1239. Forms of baclofen have been used for the treatment of trigeminal neuralgia since 1980.

Prognosis

Trigeminal neuralgia is not life threatening. It tends, however, to worsen with time, and many patients who initially were successfully treated with medication must eventually resort to surgery. Some doctors advocate surgery such as microvascular decompression early in the course of the syndrome to forestall the demyelination damage. However, there is still much controversy and uncertainty about the causes of trigeminal neuralgia and the mechanism of benefit even in those treatments that provide relief for many patients.

Resources

BOOKS

Fromm, Gerhard H., and Barry J. Sessle, eds. Trigeminal Neuralgia: Current Concepts Regarding Pathogenesis and Treatment. Stoneham, MA: Butterworth-Heinemann, 1991.

Zakrzewska, Joanna M., and P. N. Patsalos. Trigeminal Neuralgia. London: Cambridge Press, 1995.

PERIODICALS

Brown, Cassi. "Surgical Treatment of Trigeminal Neuralgia." AORN Journal (November 1, 2003).

Mosiman, Wendy. "Taking the Sting out of Trigeminal Neuralgia." Nursing (March 1, 2001).

OTHER

Komi, Suzan, and Abraham Totah. "Understanding Trigeminal Neuralgia." eMedicine. April 30, 2004 (May 27, 2004). http://www.emedicine.com/med/topic2899.htm.

ORGANIZATIONS

Trigeminal Neuralgia Association. 2801 SW Archer Road, Gainesville, FL 32608. (352) 376-9955; Fax: (352) 376-8688. tnanational@tna-support.org. http://www.tnasupport.org/.


Larry Gilman


Dental Dictionary: trigeminal neuralgia
Top
Home > Library > Health > Dental Dictionary

n

A neurologic condition of the trigeminal nerve characterized by paroxysms of flashing, stablike, unilateral pain radiating along the course of a branch of the nerve. Any or all of the three branches may be affected. The attacks are initiated by stimuli, such as a light touch of the skin, chewing, washing the face, or brushing the teeth. In some individuals the attacks may be initiated by painless physical stimulation of specific areas that are located on the same side of the face as the pain. Also called tic douloureux.

Wikipedia: Trigeminal neuralgia
Top
Home > Library > Miscellaneous > Wikipedia

See also: Atypical trigeminal neuralgia

Question book-new.svg
 This article needs additional citations for verification.
Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (September 2008)
Trigeminal neuralgia
Classification and external resources

Detailed view of trigeminal nerve, shown in yellow.
ICD-10 G50.0, G44.847
ICD-9 350.1
DiseasesDB 13363
eMedicine emerg/617
MeSH D014277

Trigeminal neuralgia (TN), tic douloureux[1] (also known as prosopalgia) is a neuropathic disorder of one or both of the facial trigeminal nerves. It causes episodes of intense pain in any or all of the following: the ear, eye, lips, nose, scalp, forehead, teeth or jaw on one side of the face.[2] It is estimated that 1 in 15,000 people suffer from trigeminal neuralgia, although the actual figure may be significantly higher due to frequent misdiagnosis. TN usually develops after the age of 50, more commonly in females, although there have been cases with patients being as young as three years of age [3].

TN brings about stabbing, mind-numbing, electric shock-like pain from just a finger's glance of the cheek or spontaneously without any stimulation by the patient.

Contents

Pathophysiology, causes, and differential diagnosis

Unfortunately, the symptoms of trigeminal neuralgia are often falsely attributed to a pathology of dental origin. "Rarely do patients come to the surgeon without having removed many, and not infrequently all, teeth on the affected side or both sides." [4] Extractions do not help. The pain is originating in the trigeminal nerve itself - often in its roots - and not in an individual nerve of a tooth but real tooth pain may be referred to the same areas of the face as that of trigeminal neuralgia. Because of this difficulty, many patients go untreated unless a correct diagnosis is made.

The trigeminal nerve is the fifth cranial nerve, a mixed cranial nerve responsible for sensory data such as tactition (pressure), thermoception (temperature), and nociception (pain) originating from the face above the jawline; it is also responsible for the motor function of the muscles of mastication, the muscles involved in chewing but not facial expression.

Several theories exist to explain the possible causes of this pain syndrome. Leading research indicates that it is a blood vessel - possibly the superior cerebellar artery - compressing the microvasculature of the trigeminal nerve near its connection with the pons. Such a compression can injure the nerve's protective myelin sheath and cause erratic and hyperactive functioning of the nerve. This can lead to pain attacks at the slightest stimulation of any area served by the nerve as well as hinder the nerve's ability to shut off the pain signals after the stimulation ends. This type of injury may rarely be caused by an aneurysm (an outpouching of a blood vessel); by a tumor; by an arachnoid cyst in the cerebellopontine angle[5]; or by a traumatic event such as a car accident or even a tongue piercing.[6]

Two to four percent of patients with TN,[citation needed] usually younger,[citation needed] have evidence of multiple sclerosis, which may damage either the trigeminal nerve or other related parts of the brain. It has been theorized that this is due to damage to the spinal trigeminal complex.[7] Trigeminal pain has a similar presentation in patients with and without MS.[8]

When there is no structural cause, the syndrome is called idiopathic. Postherpetic Neuralgia, which occurs after shingles, may cause similar symptoms if the trigeminal nerve is affected.

Symptoms

The disorder is characterised by episodes of intense facial pain that usually last from a few seconds to several minutes or hours. The episodes of intense pain may occur paroxysmally. To describe the pain sensation, patients may describe a trigger area on the face, so sensitive that touching or even air currents can trigger an episode. To say the least it affects lifestyle as it can be triggered by common activities in a patient's daily life, such as eating, talking, shaving and toothbrushing. The attacks are said to feel like stabbing electric shocks, burning, pressing, crushing, exploding or shooting pain that becomes intractable. Because the trigeminal nerve terminates in the brain stem the pain generated by the disorder is of a dangerous or fatal intensity.

Individual attacks affect one side of the face at a time, last several seconds, hours or longer and repeat up to hundreds of times throughout the day. The pain also tends to occur in cycles with complete remissions lasting months or even years. 10-12% of cases are bilateral, or occurring on both sides. This normally indicates problems with both trigeminal nerves since one serves strictly the left side of the face and the other serves the right side. Pain attacks typically worsen in frequency or severity over time. Many patients develop the pain in one branch, then over years the pain will travel through the other nerve branches.

Outwardly visible signs of TN can sometimes be seen in males who may deliberately miss an area of their face when shaving, in order to avoid triggering an episode. Successive recurrences are incapacitating and the dread of provoking an attack may make sufferers unable to engage in normal daily activities. Sufferers may ultimately have a heart attack or stroke because of the intense pain.

There is also a variant of trigeminal neuralgia called atypical trigeminal neuralgia. In some cases of atypical trigeminal neuralgia the sufferer experiences a severe, relentless underlying pain similar to a migraine in addition to the stabbing shock-like pains. This variant is often called "trigeminal neuralgia, type 2"[9], based on a recent classification of facial pain[10]. In other cases, the pain is stabbing and intense but may feel like burning or prickling, rather than a shock. Sometimes the pain is a combination of shock-like sensations, migraine-like pain and burning or prickling pain. It can also feel as if a boring piercing pain is unrelenting. Some recent studies suggest that ATN may be an early development of Trigeminal Neuralgia.

Common hurdles to receiving treatment

Owing to the rarity of trigeminal neuralgia (TN), many physicians and dentists are unfamiliar with the affliction's symptoms. TN is often misdiagnosed, as a result. A TN sufferer will usually seek the help of numerous clinicians before a firm diagnosis is made.

Those physicians that do have experience with TN are hesitant to treat patients under the age of 30 or patients who do not show nerve compression on their MRIs as nerve compression is not the only cause of TN, it may also be caused by nerve trauma done during a dental procedure such as a root canal. Patients under the age of 30 are particularly at risk of not receiving proper medical attention, as many physicians falsely believe that one must be in the later years of life in order for pain to strike -- even though the youngest patient diagnosed with TN was three years old at the time the diagnosis was made.[citation needed]

There is evidence that points towards the need to quickly treat and diagnose trigeminal neuralgia (TN). It is thought that the longer a patient suffers from TN, the harder it may be to reverse the neural pathways associated with the pain. Therefore it is essential that physicians are made aware of the seriousness of TN and the level of pain that their patient is in.

Dentists who suspect TN should proceed in the most conservative manner possible and should ensure that all tooth structures are "truly" compromised before performing extractions or other procedures.

Because of the hurdles noted above, it is essential for patients who believe they are suffering from TN to seek the advice of a TN specialist or neurologist if they find their primary care physician to be dismissive of their pain.

Medications

  • Anticonvulsants such as carbamazepine, oxcarbazepine, topiramate, phenytoin, or gabapentin are generally the most effective medications. Anticonvulsant effects may be potentiated with moderate to high levels of adjuvant therapies such as baclofen and/or clonazepam. Baclofen may also help some patients eat more normally if jaw movement tends to aggravate the symptoms.
  • Low doses of some antidepressants such as amytriptiline are thought to be effective in treating neuropathic pain, but a tremendous amount of controversy exists on this topic, and their use is often limited to treating the depression that is associated with chronic pain, rather than the actual sensation of pain from the trigeminal nerve.
  • Botox can be injected into the nerve by a physician, and has been found helpful using the "migraine" pattern adapted to the patient's special needs.
  • Patients may also find relief by having their neurologist implant a neuro-stimulator.

Many patients cannot tolerate medications for years, and an alternative treatment is to take a drug such as gabapentin and place it in an externally applied cream base by a pharmacist who compounds drugs. Also helpful is taking a "drug holiday" when remissions occur and rotating medications if one becomes ineffective.

  • Opiates such as morphine and oxycodone can be prescribed, and there is evidence of their effectiveness on neuropathic pain, especially if combined with gabapentin. [11] [12]
  • A case report found sumatriptan effective in the management of drug-resistant Trigeminal Neuralgia [13]

Surgery

Surgery may be recommended, either to relieve the pressure on the nerve or to selectively damage it in such a way as to disrupt pain signals from getting through to the brain. In trained hands, surgery has been reported to have an initial success rate approaching 90 percent. However, some patients require follow-up procedures if a recurrence of the pain begins.

Of the five surgical options, the microvascular decompression is the only one aimed at fixing the presumed cause of the pain. In this procedure, the surgeon enters the skull through a 25-millimetre (1 in) hole behind the ear. The nerve is then explored for an offending blood vessel, and when one is found, the vessel and nerve are separated or "decompressed" with a small pad, usually made from an inert surgical material such as Gore-Tex[14][15]. When successful, MVD procedures can give permanent pain relief with little to no facial numbness.

Three other procedures use needles or catheters that enter through the face into the opening where the nerve first splits into its three divisions. Excellent success rates using a cost effective percutaneous surgical procedure known as balloon compression have been reported[16]. This technique has been helpful in treating the elderly for whom surgery may not be an option due to coexisting health conditions. Balloon compression is also the best choice for patients who have ophthalmic nerve pain or have experienced recurrent pain after microvascular decompression.

Similar success rates have been reported with glycerol injections and radiofrequency rhizotomies. Glycerol injections involve injecting an alcohol-like substance into the cavern that bathes the nerve near its junction. This liquid is corrosive to the nerve fibers and can mildly injure the nerve enough to hinder the errant pain signals. In a radiofrequency rhizotomy, the surgeon uses an electrode to heat the selected division or divisions of the nerve. Done well, this procedure can target the exact regions of the errant pain triggers and disable them with minimal numbness.

Stereotactic radiation therapy

The nerve can also be damaged to prevent pain signal transmission using Gamma Knife or a linear accelerator-based radiation therapy (e.g. Trilogy, Novalis, CyberKnife). No incisions are involved in this procedure. It uses very precisely targeted radiation to bombard the nerve root, this time targeting the selective damage at the same point where vessel compressions are often found. This option is used especially for those people who are medically unfit for a long general anaesthetic, or who are taking medications for prevention of blood clotting (e.g., warfarin, heparin, aspirin). A prospective Phase I trial performed at Marseille, France, showed that 83% of patients were pain-free at 12 months, with 58% pain-free and off all medications. Side effects were mild, with 6% experiencing mild tingling and 4% experiencing mild numbness.[17]

There has only been one prospective clinical trial for surgical therapy for trigeminal neuralgia. In a prospective cohort trial, microvacular decompression was found to be significantly superior to stereotactic radiosurgery in achieving and maintaining a pain-free status in patients with trigeminal neuralgia and provided similar early and superior longer-term patient satisfaction rates compared with those treated with stereotactic radiosurgery [18]


Social consequences of trigeminal neuralgia

Most suffers of TN do not present with any outwardly noticeable symptoms, though some will exhibit brief facial spasms during an attack. Some physicians will seek a psychological root cause rather than a physiological abnormality. This is especially true of those suffering from atypical TN, who may not have any compression of the TN and in whom the sole criterion of the diagnosis may be the complaint of severe pain (constant electric-like shocks, constant crushing or pressure sensations, or a constant severe ache) and in this case trigeminal neuralgia still exists but is not visible to physicians because it was caused by the nerve being damaged during a dental procedure such as root canals, extractions, gum surgeries or it may be a condition secondary to multiple sclerosis.

Many TN sufferers are confined to their homes or are unable to work because of the frequency of their attacks. It is important for friends and family to educate themselves on the intense severity of TN pain and to be understanding of limitations that TN places upon the sufferer. However, at the same time, the TN patient must be extremely proactive in furthering his or her rehabilitative efforts. Enrolling in a chronic pain support group, or seeking one-on-one counseling, can help to teach a TN patient how to adapt to the newfound affliction.

As with any chronic pain syndrome, TN not being the exception, clinical depression has the potential to set in, especially in younger patients who often are undertreated for chronic pain. Friends and family, as well as clinicians, must be alert to the signs of a rapid change in behavior and should take appropriate measures when necessary. It must be constantly reinforced to the sufferer of TN that treatment options do exist.

Other

In one case of trigeminal neuralgia associated with tongue-piercing, the condition resolved after the jewelry was removed.[19]

Some patients have reported a correlation between dental work and the onset of their trigeminal nerve pain.

Recently, some researchers have investigated the link between neuropathatic pain, such as TN, and coeliac disease.[citation needed]

Well-known sufferers

American radio personality and voice-over artist Dave Mitchell was diagnosed with trigeminal neuralgia after a reported dental accident in 2002. Mitchell suffers pain when he speaks for extended periods, which makes doing his job quite difficult. He is currently being treated with tegretol.

See also

References

  1. ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. 101. ISBN 1-4160-2999-0. 
  2. ^ Bayer DB, Stenger TG (1979). "Trigeminal neuralgia: an overview". Oral Surg. Oral Med. Oral Pathol. 48 (5): 393–9. doi:10.1016/0030-4220(79)90064-1. PMID 226915. 
  3. ^ Bloom, R. "Emily Garland: A young girl's painful problem took more than a year to diagnose" (PDF). http://www.tna-support.org/newlook/sgl_files/library/newsletters/middletenn/2005%20November-December%20web%20pages.pdf. 
  4. ^ Dandy, Sir Walter (1987). The Brain. The Classics of Neurology and Neurosurgery (Special ed.). Birmingham: Gryphon editions. pp. 179. 
  5. ^ Babu R, Murali R (1991). "Arachnoid cyst of the cerebellopontine angle manifesting as contralateral trigeminal neuralgia: case report". Neurosurgery 28 (6): 886–7. doi:10.1097/00006123-199106000-00018. PMID 2067614. 
  6. ^ "Tongue piercing brings on ‘suicide disease' - The Globe and Mail". http://www.theglobeandmail.com/servlet/story/RTGAM.20061017.wtongues1017/BNStory/specialScienceandHealth/home. Retrieved 2009-07-18. 
  7. ^ Cruccu G, Biasiotta A, Di Rezze S, et al. (June 2009). "Trigeminal neuralgia and pain related to multiple sclerosis". Pain 143 (3): 186–91. doi:10.1016/j.pain.2008.12.026. PMID 19171430. http://linkinghub.elsevier.com/retrieve/pii/S0304-3959(08)00760-4. 
  8. ^ De Simone R, Marano E, Brescia Morra V, et al. (May 2005). "A clinical comparison of trigeminal neuralgic pain in patients with and without underlying multiple sclerosis". Neurol. Sci. 26 Suppl 2: s150–1. doi:10.1007/s10072-005-0431-8. PMID 15926016. 
  9. ^ "Neurological Surgery - Facial Pain". Oregon Health & Science University. http://www.ohsu.edu/facialpain/facial_pain-dx.shtml. 
  10. ^ Burchiel KJ (2003). "A new classification for facial pain". Neurosurgery 53 (5): 1164–6; discussion 1166–7. doi:10.1227/01.NEU.0000088806.11659.D8. PMID 14580284. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0148-396X&volume=53&issue=5&spage=1164. 
  11. ^ http://sciencelinks.jp/j-east/article/200611/000020061106A0262339.php
  12. ^ http://www.ukmicentral.nhs.uk/headline/database/story.asp?offset=200&NewsID=4098
  13. ^ http://jmedicalcasereports.com/jmedicalcasereports/article/view/7229/3246
  14. ^ "Successful vascular decompression in an 11-year-old patient with trigeminal neuralgia" http://www.springerlink.com/content/x35447150j7wnt64/
  15. ^ Gore Vascular Products: http://www.gore.com/en_xx/products/medical/surgical/vascular/vascular.html
  16. ^ Natarajan, M (2000). "Percutaneous trigeminal ganglion balloon compression: experience in 40 patients". Neurology (Neurological Society of India) 48 (4): 330–2. PMID 11146595. 
  17. ^ Régis J, Metellus P, Hayashi M, Roussel P, Donnet A, Bille-Turc F (2006). "Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia". J. Neurosurg. 104 (6): 913–24. doi:10.3171/jns.2006.104.6.913. PMID 16776335. 
  18. ^ Linskey ME, Ratanatharathorn V, Peñagaricano J. J Neurosurg (2008). "A prospective cohort study of microvascular decompression and Gamma Knife surgery in patients with trigeminal neuralgia". Journal of neurosurgery 109 Suppl: 160–72. doi:10.3171/JNS/2008/109/12/S25 (inactive 2009-11-09). PMID 19123904. 
  19. ^ Gazzeri, R; Mercuri, S. & Galarza M. (2006). "Atypical trigeminal neuralgia associated with tongue piercing". JAMA 296 (15): 1840–1. doi:10.1001/jama.296.15.1840-b. PMID 17047213. 

External links

https://www2.xlibris.com/bookstore/bookdisplay.aspx?bookid=18435

v • d • e
Nervous system pathology, PNS, Somatic (G50-G64, 350-357)
Nerve,
nerve root,
plexus
General
Polyneuropathies/
Polyradiculoneuropathy
Other
peripheral nervous system navs: anat/histo/physio/dev, noncongen PNS somatic/autonomic/congen/neoplasia, symptoms+signs/eponymous, proc
v • d • e
CNS disease: Headache (G43-G44, 339)
Primary
Secondary
ICHD 13
Other
central nervous system navs: anat/physio/dev, noncongen/congen/neoplasia, symptoms+signs/eponymous, proc

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

 
 

 

Copyrights:

Medical Encyclopedia. © 2006 through a partnership of Answers Corporation. All rights reserved.  Read more
Dictionary. The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2007, 2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved.  Read more
Neurological Disorder. Gale Encyclopedia of Neurological Disorders. Copyright © 2005 by The Gale Group, Inc. All rights reserved.  Read more
Dental Dictionary. Mosby's Dental Dictionary. Copyright © 2004 by Elsevier, Inc. All rights reserved.  Read more
Wikipedia. This article is licensed under the Creative Commons Attribution/Share-Alike License. It uses material from the Wikipedia article "Trigeminal neuralgia".  Read more