Re: trigeminal neuralgia

Posted By ccf neuro M.D.* on September 13, 1997 at 14:45:12:

In Reply to: trigeminal neuralgia posted by peter sallmaier on September 03, 1997 at 19:24:07:








I have M.S. and trigeminal neuralgia. I'm on Tegretol and Ultram for the
pain.  Can you please tell me about the glycerol block injections that a
neurosurgeon can do, to try and alleviate the pain/problem.
-----------------------------------------------------------------------------------------------------------------
Trigeminal neuralgia is characterized by severe episodic facial pain, often set off by touching a "trigger point", and is most often caused by a small blood vessel pressing against a point in the trigeminal nerve (the nerve that brings sensation to the face) where there is a naturally occurring weakpoint or empty place where there is no MYELIN, or insulation around the nerve, as it exits the brain into the skull. In multiple sclerosis, the problem is related to ABnormal excessive demyelination of the same (trigeminal) nerve, and on occasion trigeminal neuralgia or neuralgis of one of the other cranial nerves is the first symptom (in retrospect) of multiple sclerosis. Treatment for this condition consists of medications, including Tegretol (carbemazepine), Dilantin (phenytoin), Lioresal (baclofen), and occasionally other medications. If these fail to control symptoms or cause intolerable side effects, there are a number of more aggressive surgical treatment options. One is glycerol injection into the hole or foramen where the nerve exits the skull. This, if successful generally controls or eliminates symptoms for months, but is not a permanent "cure" or treatment. Another option is radiofrequency lesioning where a probe is inserted (through the cheek) into the same foramen where the nerve exits the skull, and radiofrequency energy is used to heat and damage the nerve in such a way the the smaller nerve fibers that are believed to be responsible for generating much of the pain are selectively damaged; this approach, if succesful provides a long lasting relief of pain, but in trade for the pain relief the patient is left with some degree of permanent numbness in the parts of the face, mouth, and tongue where the nerve is lesioned. The glycerol injections do not have this effect.  A final approach which is NOT a treatment option for M.S. patients involves actual opening of the skull like for brain surgery and placing a small spong or band around the blood vessel pressing against the nerve, but as this is not the usual cause for trigeminal neuralgia in multiple sclerosis patients, this is not an option for you. If you would be interested in seeing a Cleveland Clinic neurologist or neurosurgeon to review your particular case in more detail, the number to call is 1-800-223-2273; ask for neurology or neurosurgery appointments; you might be specifically interested in seeing one of our Mellen Center physicians, as this center is one of the foremost in the world in the diagnosis and treatment of multiple sclerosis specifically, and sees many patients like yourself with M.S. and trigeminal neuralgia. Information provided in the neurology forum is intended for general medical informational purposes only. Actual treatment and diagnosis of your particular illness should be strictly in conjunction with your treating physicians. We hope you find the information useful.