Today, October 7 is celebrated as Trigeminal Neuralgia Day with the aim of raising awareness of this rare disease of the Peripheral Nervous System.
To learn more about this pathology, Dr. José María Torres Campa-Santamarina, specialist in Neurosurgery and coordinator of the Neurosurgery Service of the Asturias Medical Center, answers some questions about trigeminal neuralgia, one of the most unbearable pains a human being can have.
What is the trigeminal nerve?
The trigeminal is the nerve that gives us the sensitivity to the face and has three parts:
- In the upper part in the forehead and in the upper part of the eye.
- A middle part that takes us to the cheek.
- A lower part that takes us the branch of the jaw.
It is an eminently sensitive nerve.
What is a neuralgia?
A neuralgia is a pain in those areas indicated and it is a lancinating pain, which lasts one or two seconds, but it is so intense that if we are not able to control it, cases of suicides have been described.
It is a pain that is usually controlled with medication.
What causes this pain?
The cause of this pain is not known with certainty. What is known is that it usually affects older people and is due to nerve wear. Although there are other people that if we analyze the brain we see that in the nerve, in the posterior part, there is a contact between an artery and the nerve, in an area that the nerve is very sensitive, in that area the beating of the artery would be constantly hitting the nerve and would cause an alteration of the nerve signals. In such a way that a minimal and normal stimulus such as drinking, brushing teeth or talking is identified as a painful stimulus. In fact, there are patients who cannot speak, cannot brush their teeth or cannot eat, which is extremely disabling.
How is Trigeminal Neuralgia treated?
It is usually treated with pills, it has been used for a very long time and also, as the pain is not continuous, that is, it does not occur all the time the same, but there are a series of outbreaks. They are usually more noticeable in spring and autumn, so when the patient has the pain he takes the medication and then he does not have to take it again.
The medication in small doses can usually be controlled, but there are some patients who do not tolerate it because it has important side effects.
In the case that the pain is more intense and is not controlled with medication, two types of surgeries can be performed:
The first option consists of looking for the nerve through the cheek with a needle, in the operating room, and what is done is to stimulate the nerve; the part of the nerve that causes the pain is seen and an electric current is passed to make a small lesion in that nerve, which is injured, so that it stops hurting. Normally the efficacy is 85-90% of the cases, although in some cases there are repetitions of the picture after two or three years.
If the previous surgery does not work or if the patient is very young, what can be done is to separate the artery and the nerve through a very simple surgery: an incision is made in the back of the head, a hole is made in the skull about the size of a euro coin, and what is done is to separate the artery and the nerve and something is placed in the middle that does not transmit, such as Teflon or some substance that allows them to be separated.
This surgery allows an efficiency rate of 85-90% of the cases. Although it is also true that it is a surgery that has some more complications than puncture and it is more indicated in young people, although lately it is being seen that in older patients the risks are perfectly acceptable and superimposable.