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Createdon: 29 Mar 2023
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Author: Khoa Tran
Published Mar 29, 2023
Updated Apr 07, 2023

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Trigeminal Neuralgia (tic Douloureux)

Etymology and Pronunciation

Trigeminal (try-JEM-uh-nuhl)
Refers to the trigeminal nerve, which is the fifth cranial nerve responsible for sensation in the face.
The trigeminal nerve has three branches, hence the name "tri-geminal".

Neuralgia (noo-ral-juh)
neuron - Greek for "nerve"
algos - Greek for "pain"

History

Trigeminal neuralgia, also known as tic douloureux, is a nerve disorder that causes sudden, severe facial pain. 

The Persian physician Rhazes, who lived in the 9th century, was one of the earliest medical practitioners to describe Trigeminal Neuralgia. He referred to it as "shakhsiyah" which translates to "personal" or "individual" pain. Rhazes described the pain as a sharp, stabbing sensation that occurred in the face, particularly around the eyes, nose, and lips. Rhazes also noted that the pain tended to be triggered by touch or movement, such as talking, chewing, or brushing one's teeth. He believed that the condition was caused by an inflammation of the nerves, which resulted in increased sensitivity and pain.

Between 1811 and 1821, Scottish surgeon Sir Charles Bell published a series of papers detailing his extensive research on the trigeminal nerve. This nerve is responsible for transmitting sensation from the face to the brain. Bell's research played a pivotal role in improving our understanding of the trigeminal nerve and the underlying mechanism of trigeminal neuralgia, a condition caused by compression or irritation of the trigeminal nerve.

Bell's research was based on meticulous anatomical dissections of both human and animal nerves. Through this, he was able to identify and describe the various branches and functions of the trigeminal nerve. Additionally, he relied on careful clinical observations of patients experiencing facial pain and other neurological symptoms to further refine his understanding of the trigeminal nerve and its associated disorders, including trigeminal neuralgia.

Since Bell's research, there have been advancements in technology that have allowed for even more detailed and accurate mapping of the trigeminal nerve, such as magnetic resonance imaging (MRI) and computerized tomography (CT) scans. These advancements have improved the diagnosis and treatment of trigeminal neuralgia and other related conditions.

Modern Understanding

Trigeminal neuralgia, also known as tic douloureux, is a type of chronic pain condition that affects the trigeminal nerve, which is responsible for sensation in the face. This condition causes sudden, severe, and often excruciating pain in the face that can be triggered by even the slightest touch, such as brushing teeth, washing the face, or even a gentle breeze.

The pain is typically described as sharp, shooting, or electric shock-like, and can last anywhere from a few seconds to a couple of minutes. The pain-like electric shock is often unilateral (on one side of the face) and can be so intense that it can significantly affect a person's quality of life. Trigeminal neuralgia can occur at any age, but is most common in individuals over the age of 50.

Causes

The exact cause of trigeminal neuralgia is not well understood, but it is believed to be caused by compression or irritation of the trigeminal nerve, which is responsible for sensation in the face. This compression or irritation can be caused by various factors, including:

- A blood vessel pressing against the nerve: This is the most common cause of trigeminal neuralgia. The blood vessel can press against the nerve and cause it to malfunction, leading to pain.
- A tumor or other abnormality in the brain or skull: In rare cases, a tumor or other abnormality in the brain or skull can cause trigeminal neuralgia by putting pressure on the trigeminal nerve.
- Multiple sclerosis or other demyelinating diseases: Demyelinating diseases, such as multiple sclerosis, can cause damage to the myelin sheath that surrounds the trigeminal nerve, leading to pain.
- Trauma or injury to the face: Trauma or injury to the face can damage the trigeminal nerve and cause pain.

In some cases, the cause of trigeminal neuralgia may be unknown, which is called idiopathic trigeminal neuralgia.

Treatments

The treatment for trigeminal neuralgia depends on the severity of the symptoms and the underlying cause. The goal of treatment is to relieve pain and improve quality of life. Here are some of the treatment options:

- Medications: Anticonvulsant drugs such as carbamazepine, oxcarbazepine, and gabapentin are often used to treat trigeminal neuralgia. These medications can help reduce nerve sensitivity and provide pain relief.
- Surgery: If medication does not relieve the pain, surgery may be an option. Microvascular decompression surgery is a common procedure used to treat trigeminal neuralgia. In this surgery, a surgeon will move any blood vessels that may be compressing the trigeminal nerve.
- Gamma Knife radiosurgery: This is a non-invasive procedure that uses radiation to target and destroy the trigeminal nerve. It is often used when medication and surgery do not provide relief.
- Nerve blocks: Local anesthesia is injected into the area around the trigeminal nerve to provide pain relief. This is a temporary solution that may be used in conjunction with other treatments.
- Complementary therapies: Acupuncture, biofeedback, and relaxation techniques may help reduce stress and manage pain.

It is important to consult with a healthcare provider to determine the best treatment plan for trigeminal neuralgia.

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