Q: What are the causes, consequences, treatment and prognosis of trigeminal neuralgia?

A:Trigeminal neuralgia means pain in the distribution of the trigeminal nerve which carries sensation from one side of the face to the lower part of the brain. Thus, there are two such nerves, one each on the right and left side, which convey all sensation from the skin over the face to the brain. When this nerve is swollen or irritated, it causes pangs of severe pain over the area of face that it supplies. This pain can be very severe and disturbing, and may be precipitated or exaggerated by chewing, cold or hot food, cold climate and stress. The pain caused may be very severe and prevent patient from talking or eating at times. It is short lived, and there may be fluctuations with the patient having pain-free periods without any medicines.

Many a times we cannot find a cause why the nerve is swollen or irritated, it is presumed to be due to damage caused by some viral infections or due to destruction of the coating of nerve fibres (myelin). In some cases, a blood vessel may loop around this nerve, and by pulling it, cause this pain. In very rare instances, tumors or diseases like Multiple Sclerosis may cause similar damage to the nerve and cause trigeminal neuralgia.

The medical management consists of some drugs like carbamazepine, phenytoin etc, which may significantly reduce or stop the pain. If a blood vessel loop is seen pulling the nerve, or a tumor compressing it, surgical decompression can be done. Some patients also benefit with injections that directly numb the nerve. Newer techniques like radiosurgery minimise the discomfort and hospital stay. The decision for surgery should be taken by a team of experienced neurologist and neurosurgeon.