Trigeminal Neuralgia (TN)

Introduction

• Also known as Fothergill disease, tic douloureux, or trifacial neuralgia.
• A chronic pain disorder affecting the trigeminal nerve, responsible for facial sensation and motor functions like biting and chewing.
• It is a form of neuropathic pain.
• Two main types: Typical and Atypical trigeminal neuralgia.

Trigeminal Nerve

• A major cranial nerve with three branches:
  • Ophthalmic nerve (V1)
  • Maxillary nerve (V2)
  • Mandibular nerve (V3)
• TN commonly affects the maxillary and mandibular branches.

Symptoms

• Typical TN: Severe, sudden, shock-like facial pain lasting from seconds to minutes, often triggered by facial contact.
• Atypical TN: Constant burning pain, less severe.
• Pain may lead to depression and anxiety.

Causes

• Believed to be due to issues with myelin of the trigeminal nerve.
• Common causes: Nerve compression, multiple sclerosis, stroke, trauma, tumors, or arteriovenous malformations.

Diagnosis

• Based on symptoms; might involve ruling out other causes (e.g., postherpetic neuralgia).
• Sometimes requires neurological and physical tests, medical history review.
• MRI used to detect vascular compression.

Treatment

• Medications:
  • First-line: Carbamazepine, oxcarbazepine.
  • Alternatives: Lamotrigine, baclofen, gabapentin, amitriptyline, pimozide.
• Surgery: Considered if medication is ineffective. Options include:
  • Microvascular decompression
  • Percutaneous techniques (balloon compression, glycerol injection, radiofrequency thermocoagulation)
  • Stereotactic radiosurgery
• Psychological and social support is important.

Prognosis

• About 80% improve with initial treatment.
• Affects 1 in 8,000 people annually, more common in females (3:1 ratio).

Epidemiology

• Usually starts in individuals over 50, but can occur at any age.
• Described in detail by John Fothergill in 1773.

Notable Cases

• Famous individuals with TN include William Gladstone, Melissa Seymour, Salman Khan, and others.

Important Notes

• TN pain severely impacts daily activities and quality of life, leading to significant emotional distress.
• It’s referred to as the "suicide disease" due to its intensity and impact on mental health.
• More research and awareness are needed for better management and understanding of TN.