Trigeminal neuralgia
Trigeminal neuralgia (TN or TGN), also called Fothergill disease, tic douloureux, trifacial neuralgia, or suicide disease is a long-term pain disorder that affects the trigeminal nerve, the nerve responsible for sensation in the face and motor functions such as biting and chewing. It is a form of neuropathic pain. There are two main types: typical and atypical trigeminal neuralgia. The typical form results in episodes of severe, sudden, shock-like pain in one side of the face that lasts for seconds to a few minutes. Groups of these episodes can occur over a few hours. The atypical form results in a constant burning pain that is less severe. Episodes may be triggered by any touch to the face. Both forms may occur in the same person. It is regarded as one of the most painful disorders known to medicine, and often results in depression and suicide.
| Trigeminal neuralgia | |
|---|---|
| Other names | Tic douloureux, prosopalgia, Fothergill's disease, suicide disease |
| The trigeminal nerve and its three major divisions (shown in yellow): the ophthalmic nerve (V1), the maxillary nerve (V2), and the mandibular nerve (V3) | |
| Specialty | Neurology |
| Symptoms | Typical: episodes of severe, sudden, shock-like pain in one side of the face that lasts for seconds to minutes Atypical: constant burning pain |
| Complications | Depression |
| Usual onset | > 50 years old |
| Types | Typical and atypical trigeminal neuralgia |
| Causes | Believed to be due to problems with myelin of trigeminal nerve |
| Diagnostic method | Based on symptoms |
| Differential diagnosis | Postherpetic neuralgia |
| Treatment | Medication, surgery |
| Medication | Carbamazepine, oxcarbazepine |
| Prognosis | 80% improve with initial treatment |
| Frequency | 1 in 8,000 people per year |
The exact cause is unknown, but believed to involve loss of the myelin of the trigeminal nerve. This might occur due to compression from a blood vessel as the nerve exits the brain stem, multiple sclerosis, stroke, or trauma. Less common causes include a tumor or arteriovenous malformation. It is a type of nerve pain. Diagnosis is typically based on the symptoms, after ruling out other possible causes such as postherpetic neuralgia.
Treatment includes medication or surgery. The anticonvulsant carbamazepine or oxcarbazepine is usually the initial treatment, and is effective in about 90% of people. Side effects are frequently experienced that necessitate drug withdrawal in as many as 23% of patients. Other options include lamotrigine, baclofen, gabapentin, amitriptyline and pimozide. Opioids are not usually effective in the typical form. In those who do not improve or become resistant to other measures, a number of types of surgery may be tried.
It is estimated that trigeminal neuralgia affects around 0.03% to 0.3% of people around the world with a female over-representation around a 3:1 ratio between women and men. It usually begins in people over 50 years old, but can occur at any age. The condition was first described in detail in 1773 by John Fothergill.