Trigeminal Neuralgia is a chronic condition in which functioning of the Trigeminal nerve is disrupted, resulting in intense facial pain. The most common known cause of this malfunction is a “neurovascular conflict”. In simple terms, a blood vessel in the brain starts putting pressure on the Trigeminal nerve which is responsible for carrying sensation between the face to the brain. This compression damages the nerve’s protective cover (Myelin Sheath), thereby causing episodes of intense and excruciating pain affecting cheeks, jaw, gums, and lips.
However, it may also occur around the eyes and the forehead area. The pain can be easily set off by triggers like smiling, drinking, chewing, speaking, yawning, shaving, touching or washing the face, brushing the teeth, and even cold winds. The sensation is often described by patients as shooting, jabbing, prickling, explosive, stabbing, piercing, burning, shock-like, or a combination of them. The pain may resolve completely between attacks and does not occur during sleep. TN is known to affect the right side of the face more often than the left.
TN is also called “tic douloureux” due to the uncontrollable painful twitching that it causes to the patient. It is known to be one of the most painful conditions to affect any individual as it has a considerably disruptive impact on their day to day functioning and quality of life.
Based on the pain pattern experienced by the patient, there are two types of TN cases: Type I is characterized by intermittent pain which may last from several seconds to a couple of minutes, with pain-free intervals in between attacks.
Type II is identified by a constant background pain. Some patients progress from Type I to Type II over time. In either case, the intensity of pain can feel incapacitating, both physically and mentally. This can make the state of the patient quite miserable, especially if the issue is left undiagnosed or is misdiagnosed.
TN has been observed to occur majorly in the elderly population over the age of 60, with incidences increasing with advancing age. It is uncommon among people younger than 40 and is slightly more common in women than in men.
Due to various socio-economic factors, the elderly segment of the Indian population fails to receive adequate medical attention. There is a significant lack of awareness about Trigeminal Neuralgia in our country – not only amongst the masses but also amongst our dental colleagues and perhaps even many non-neurological medical practitioners. This is major because of the rarity of the disease.
Treatment of Trigeminal Neuralgia primarily depends on anticonvulsant medication like Carbamazepine. No other group of anti-epileptic drugs is as effective. However, the effect of this drug has been found to wane over time. In about a couple of years, the side effects of drug dosage propel patients to seek alternative treatments.
Microvascular Decompression (MVD) is the surgical procedure of choice for TN. It is aimed at separating the offending artery from the Trigeminal nerve. Some other elegant procedures presenting varying efficacy and recurrence rates are Gamma Knife Radiosurgery, Percutaneous Balloon Compression, and Radio-Frequency Ablation of Gasserian Ganglion.
Given the complexities of the origin and development of the disease, the treatment of TN is a challenge for neurologists and neurosurgeons. However, advances in MRI diagnostics and the introduction of new-age surgical technologies like endoscope and neuronavigation in recent years have been beneficial in the investigation & management of this debilitating condition.