Trigeminal Neuralgia Disease

Trigeminal Neuralgia Disease


Trigeminal neuralgia (TN, or TGN) is a severe neuropathic chronic pain disorder affecting the trigeminal nerve. TN is a disorder of the fifth cranial (trigeminal) nerve. The typical or “classic” form of the disorder (called TN1) causes extreme, sporadic, sudden burning or shock-like facial pain in the areas of the face where the branches of the nerve are distributed – lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. The pain episodes last from a few seconds to as long as two minutes. These attacks can occur in quick succession and the physical activities like biting and chewing, brushing of teeth, and exposure to wind typically trigger the pain. Evidence indicates that TN is caused by loss of myelin from the sensory fibers within the nerve root itself. The classic or typical presentation of TN is characterized by episodes of sudden, explosive severe pain along the trigeminal nerve, with periods of pain-free remission between attacks. The atypical form of TN presents with the paroxysmal pain of classic TN, but with the addition of a constant pain that fluctuates from a dull aching to an excruciating roar. Trigeminal neuralgia is considered by medical experts to be one of the most painful conditions known.
The trigeminal nerve is one of 12 pairs of nerves that are attached to the brain. The nerve has three branches that conduct sensations from the upper, middle, and lower portions of the face, as well as the oral cavity, to the brain. The ophthalmic, or upper, branch provides sensation to most of the scalp, forehead, and front of the pinnacle. The jaw, or middle, branch passes through the cheek, upper jaw, top lip, teeth and gums, and to the facet of the nose. The nerve’s jaw, or lower, branch passes through the mandible, teeth, gums, and bottom lip. over one nerve branch may be suffering from the disorder. More than one nerve branch can be affected by the disorder. Rarely, both sides of the face may be affected at different times in an individual, or even more rarely at the same time, called bilateral TN.

The trigeminal nerve is a mixed type of cranial nerve responsible for sensory functions like pressure, temperature, and pain originating from the face above the jawline and it is also responsible for the motor function of the muscles of face especially the muscles involved in chewing but not facial expression.
Demyelination of the myelin sheath of the nerve fibre due to compression, injury or due to other causes leads to the disturbance in the conduction system of the nerve is the possible causes of the pain syndrome. This can lead to pain attacks at the slightest stimulation of any area served by the nerve as well as hinder the nerve’s ability to shut off the pain signals after the stimulation ends. This type of injury may also rarely be caused by an aneurysm (an out pouching of a blood vessel); by an AVM (arteriovenous malformation) , multiple sclerosis, by a tumor; such as an arachnoid cyst or meningiomas, by a traumatic event such as an accident or even brainstem diseases from strokes, Post herpetic neuralgia, which occurs after shingles, may cause similar symptoms if the trigeminal nerve is damaged.
Short-term peripheral compression is often painless. Persistent compression results in local demyelination with no loss of axon potential continuity. Chronic nerve entrapment results in demyelination primarily, with progressive axonal degeneration subsequently.
When there is no apparent structural cause, the syndrome is called idiopathic.

Signs and Symptoms of Trigeminal Neuralgia:
This disorder is characterized by episodes of intense facial pain along the trigeminal nerve divisions. The trigeminal nerve is a cranial nerve that has three major branches:
• The ophthalmic nerve
• The maxillary nerve
• The mandibular nerve
Any one or all the three branches of the nerve may be affected at a single time. Trigeminal neuralgia most commonly involves the middle branch, the maxillary nerve and lower branch, mandibular nerve of the trigeminal nerve. TN presents as attacks of stabbing unilateral facial pain, most often on the right side of the face. The number of attacks may vary from less than 1 per day to many times per hour and up to hundreds per day.
• Trigeminal neuralgia is characterised by severe pain within the face.
• Intermittent twinges of delicate pain.
• Severe episodes of shooting type pain resembles electrical shocks experienced many times in a day.
• Spasms of pain that last from a few seconds to a few minutes.
• Pain experienced along the distribution of the nerve, together with the forehead, eyes, lips, gums, teeth, jaw and cheek.
• Attacks of pain that occur additional frequently and intensely over time.
• Tingling or numbness sometimes experienced within the face before pain develops.
Triggers of pain attacks include the following:
• Chewing, talking, or smiling
• Drinking cold or hot drinks
• Touching, shaving, brushing teeth, blowing the nose
• Encountering with cold air or breeze
Pain localization is as follows:
• Patients can localize their pain precisely
• The pain commonly runs along the line dividing either the mandibular and maxillary nerves or the mandibular and ophthalmic portions of the nerve
• In 60% of cases, the pain shoots from the corner of the mouth to the angle of the jaw
• In 30%, pain arises from the upper lip or canine teeth to the eye and eyebrow, sparing the orbit itself
• In less than 5% of cases, pain involves the ophthalmic branch of the facial nerve
The pain has the following qualities:
Characteristically severe, paroxysmal, and lancinating, with the sensation of electric shock, which usually lats upto 20-30 seconds to an excruciating discomfort, begins to fade within seconds, lacking behind a burning ache like symptoms lasting seconds to minutes.
The diagnosis of the diseases Trigeminal neuralgia often requires no special investigations or laboratory test. Some times electrophysiological, or radiological investigations are indicated on routine basis, indicated for the diagnosis of TN, as patients with a characteristic history and normal neurological examination may be treated without further workup.
Differential Diagnoses
• Cavernous Sinus Syndromes
• Cerebral Aneurysms
• Cluster Headache
• Hemi facial Spasm
• Hydrocephalus
• Intracranial Haemorrhage
• Migraine Headache
• Multiple Sclerosis
• Post herpetic Neuralgia
• Subarachnoid Hemorrhage

Management :
According to ayurveda the disease Trigeminal neuralgia is due to the vitiation of the vata dosha ( biological air). When the vata dosha get vitiated due to its causes it leads to the disturbance with the trigeminal nerve roots and its branches. Alongwith the vata dosha pitta dosha also get vitiated. Together both the doshas cause the disease and exhibits the symptoms. The Ayurvedic treatment of Trigeminal neuralgia consists of natural herbs, Ayurveda oils for restoring the imbalance of Vata. Vata is known as “Air element” as per Ayurvedic principles and the treatment is focused on restoring the balance. Ayurvedic herbal medicines also need to be given to improve the microcirculation within the nerve, so that the nerve starts functioning at an optimum level, and abnormal pain sensations are brought down to acceptable levels.Ayurvedic herbal medicines are given which act on the trigeminal nerve and reduce irritability and perception of pain.This helps to gradually reduce the pain experienced by the patient.

Thus according to ayurveda to treat the disease firstly vata has to be treated. For this ayurveda proposed two types of treatments:
1. Sodhana chikita/ Panchakarma chikitsa or purification procedures
2. Shamana chikitsa or oral medications

Panchakarma or sodhana chikitsa involves:
• Abhyanga ( herbal massages)
• Swedana ( herbal fomentation or steaming )
• Nasya karma ( administering medicines through nasal route)
• Basti chikitsa ( enema therapy)
• Raktamokshana ( blood letting, especially through leeches, rarely done but very effective therapy)

Shaman chikista includes, herbal medications and preparations that will pacify the vitiated vata and pitta dosha and finally give relief from the symptoms. Here are some preparations enlisted below:
• Mahayograj gullulu
• Yograj guggulu
• Prasarnyadi kashya tablets
• Gandharvahastyadi kada
• Bhritvata chintamani rasa
• Shootshekhar rasa
• Panchatikta ghrita guggulu
• Mahatikta ghrita
• Panchatikta ghrita
• Ksheerabala taila
• Ksheerabala 101
• Dhanwantram 101
• Brahami vati
• Sarpagandha vati

Dietary And Lifestyle recommendations
• Avoid eating very cold, hot or spicy food which may worsen the pain. Eat nutritious meal. Increase intake of mushy food or liquidise the food as some people may have difficulty in chewing.
• Drink liquid using a straw as this will avoid unnecessary contact of liquid with painful areas of mouth.
• Avoid triggers that may initiate painful attacks. If the pain is triggered by wind then wear a scarf, don’t sit near the window.
• Opt for High protein diet and low fat diet Involve saturated fats in the diet as this will permit proper growth and maintenance of nerve cell membrane and neurotransmitters. Do not over dose as the intake.
• Opt for Vitamin C and Vitamin B12 rich diet for healthy nerve functions.
• Opt for natural diet containing fresh fruits and leafy vegetables.
• Prefer more fruits like apples, papayas, peaches, pears, kiwis.
• Limit intake of tea and coffee.
• No soft drink. Only fresh juices. Not even preserved one.
• No junk, packed and fried foods.
• Do not prefer outside just have healthy diet at home.
• No noodles, pasta, maggie, biscuits of white flour etc.
• Keep yourself active and do not take any kind of mental stress.