The diagnosis of trigeminal neuralgia is based on the characteristic picture of the disease, as well as the fact that the neurological examination does not reveal significant deviations from the normal state.
No additional tests are required for this. However, they play an important role in eliminating the organic basis, that is, the symptomatic nature of pain.
To exclude the presence of pathologies in the central nervous system, visual examinations of the brain, including magnetic resonance, are performed.
The diagnosis of classical spontaneous neuralgia is confirmed by correct results of these tests. It is also necessary to exclude inflammation of the paranasal sinuses and dental pain.
Treatment for classic neuralgia aims to relieve pain and prevent recurrence.
Pharmacology in the fight against neuralgia
Antiepileptic drugs are the most effective in the treatment of trigeminal neuralgia.
The first-line drug is carbamazepine , and treatment is given from the smallest, gradually increasing the dose. Unfortunately, the drug cannot always be used due to its toxicity. A rare but serious complication is bone marrow depression and therefore anemia. Tolerance to this drug often develops, requiring an increase in dose.
In the case of ineffectiveness or side effects of carbamazepine , attempts are made to use other classical and new anticonvulsants, as well as drugs from other groups, for example, antidepressants (especially for chronic pain).
As an aid, drugs from the group of typical pain relievers and vitamins from the B group are added. Some may benefit from additional uses: Solux irradiation , iontopheresis , laser therapy, acupuncture, biofeedback, electrical nerve stimulation, etc.
From pills to scalpel
If pharmacotherapy is ineffective, various treatments can help. In practice, surgical procedures are often used to relieve persistent pain. These include microvascular decompression (separation of the nerve from the compressive vessel if neurovascular conflict is the cause) and techniques that involve nerve destruction, usually at the so-called Ganzer Gasser level (this is where the branches of the trigeminal nerve converge).
Thermocoagulation is very popular as it destroys painful fibers and preserves large motor fibers and can be repeated in case of relapses.
Other methods include: injection of neurotoxic chemicals, mechanical disruption with a balloon, radiosurgery (destruction of the ganglion by gamma radiation). These are minimally invasive techniques performed under local anesthesia, as opposed to vascular decompression, which requires opening the skull and longer hospitalization without damaging the nerve.
