Transcranial direct current stimulation efficacy in trigeminal neuralgia

Trigeminal neuralgia is a severe,disabling pain and its deafferentation remains a challenge for health providers.Transcranial direct current stimulation is a non-invasive stimulation technique which finds new utility in managing pain.There-fore,the introduction of alternative,non-invasive,safe,and effective methods should be considered in treating patients with trigeminal neuralgia unresponsive to conventional treatment.

Percutaneous Radiofrequency Thermocoagulation for the Treatment of Different Types of Trigeminal Neuralgia:Evaluation of Quality of Life and Outcomes

Radiofrequency thermocoagulation(RFT) of the gasserian ganglion is a routine and effective technique for the treatment of classical trigeminal neuralgia(CTN).In this study we compared its efficacy in patients with CTN and atypically symptomatic or mixed trigeminal neuralgia(MTN).Fifty-seven patients were treated with RFT for trigeminal neuralgia from June 2006 to February 2009.Thirty patients had CTN,and 27 had MTN.Outcomes were measured by using the visual analog pain scale(VAS) and patients’ reports of quality of life(QOL),medication usage,and complications over a follow-up period of up to 3 years.Our results showed that the patients with MTN were younger,tended to have bilaterial involvement of the first division,and were unresponsive to treatment.All surgeries were completed smoothly.About 86.7% CTN patients and 48.1% MTN patients responded immediately to RFT.The VAS scores were significantly higher in the CTN group than in MTN group(P<0.05).Kaplan-Meier curves showed that 1-year,2-year,and 3-year pain relief rates were 76.7%,73.3%,and 73.3% in the CTN group and 46.6%,41.4%,and 41.4% in the MTN group,respectively.The rates of pain relief for both groups leveled off at 2 years.Complications included numbness,dysesthesia,and anesthesia dolorosa.RFT did not cause any deaths and complications were low.The treatment was very effective for CTN and,to some degrees,effective for MTN.If numbness,dysesthesia,and anesthesia dolorosa are limited to the trigger area,QOL will be greatly improved.

Differences in individual susceptibility affect the development of trigeminal neuralgia

Trigeminal neuralgia is a syndrome due to dysfunctional hyperactivity of the trigeminal nerve, and is characterized by a sudden, usually unilateral, recurrent lancinating pain arising from one or more divisions of the nerve. The most accepted pathogenetic mechanism for trigeminal neuralgia is compression of the nerve at its dorsal root entry zone or in its distal course. In this paper, we report four cases with trigeminal neuralgia due to an unknown mechanism after an intracranial intervention The onset of trigeminal neuralgia after surgical interventions that are unrelated to the trigeminal nerve suggests that in patients with greater individual susceptibility, nerve contact with the vascular structure due to postoperative pressure and changes in cerebrospinal fluid flow may cause the onset of pain.

Oxcarbazepine for trigeminal neuralgia may induce lower extremity weakness: A case report

BACKGROUND Although few studies have reported hyponatremia due to carbamazepine or oxcarbazepine in patients with epilepsy,no study has investigated cases of carbamazepine-or oxcarbazepine-induced hyponatremia or unsteady gait in patients with neuropathic pain.Herein,we report a case of oxcarbazepineinduced lower leg weakness in a patient with trigeminal neuralgia and summarize the diagnosis,treatment,and changes of clinical symptoms.CASE SUMMARY A 78-year-old male with a history of lumbar spinal stenosis was admitted to the hospital after he experienced lancinating pain around his right cheek,eyes,and lip,and was diagnosed with trigeminal neuralgia at the right maxillary and mandibular branch.He was prescribed oxcarbazepine(600 mg/d),milnacipran(25 mg/d),and oxycodone/naloxone(20 mg/10 mg/d)for four years.Four years later,the patient experienced symptoms associated with spinal stenosis,including pain in the lower extremities and unsteady gait.His serum sodium level was 127 mmol/L.Assuming oxcarbazepine to be the cause of the hyponatremia,oxcarbazepine administration was put on hold and the patient was switched to topiramate.At subsequent visit,the patient’s serum sodium level had normalized to 143 mmol/L and his unsteady gait had improved.CONCLUSION Oxcarbazepine-induced hyponatremia may cause lower extremity weakness and unsteady gait,which should be differentiated from those caused by spinal stenosis.

Analgesic Effect of Diprospan in Rats with Trigeminal Neuralgia

This study examined the analgesic effect of diprospan in rats with trigeminal neuralgia.Rat model of trigeminal neuralgic pain was established by loosely ligating the left infraorbital branch of the trigeminal nerve.After allodynia developed,the rats were randomly divided into 2 groups（n=20 in each）：diprospan group,in which the rats received diprospan（7 mg/mL,0.1 mL） injected to the left infraorbital foramen area;control group,in which saline（0.1 mL） was administered as the same manner as the diprospan group.The pain threshold（PT） in the left infraorbital area was measured before and 2,6,and 8 weeks after the administration.The expression of neuropeptides [substance P,preprotachykinin A（PPTA）,calcitonin gene-related peptide（CGRP）] in the trigeminal nerve was detected at the same time points as the PT measurement by immunohistochemistry or in situ hybridization method.The results showed that in the diprospan group,the PT was 10.65±1.26,10.77±1.19 and 14.13±1.34 g 2,6,and 8 weeks after the administration respectively,significantly higher than that before the administration（PT value：0.36±0.11）（P0.05 for each）.In the saline group,the PT was 0.37±0.13,0.66±0.09,4.45±1.29 and 13.72±1.72 g before and 2,6,and 8 weeks after the administration respectively with differences being significant between before and 6,8 weeks after the administration（P0.01）.No significant difference existed in the PT between the diprospan group and the saline group at pre-administration（P0.05）.The PT in the diprospan group was significantly greater than that in the saline group 2 and 6 weeks post-administration（P0.05）.In the diprospan group,the expression levels of neuropeptides were significantly reduced as compared with those in the saline group 2 and 6 weeks post-administration（P0.05）.It was concluded that diprospan has an obvious analgesic effect on the trigeminal neuropathic pain partly by reducing the expression of neuropeptides in the trigeminal ganglia.

Computed tomography-guided percutaneous radiofrequency thermocoagulation for primary trigeminal neuralgia in older and younger patients

We evaluated the immediate and long-term clinical efficacy of computed tomography （CT）-guided radiofrequency thermocoagulation for primary trigeminal neuralgia （RTPTN） in 852 patients including 502 patients aged -〉 60 years and 350 patients aged 〈 60 years. After discharge, the incidence of complications was 1.0% and 0.9% in patients aged 〉 60 years and patients aged 〈 60 years, respectively. Over 3-year follow-up after CT-guided RTPTN, 96.8% of the patients aged 〉 60 years and 98.6% of the patients aged 〈 60 years were completely pain-free, and there was no significant difference between these two age brackets. In addition, there were no significant differences in quality of life scores and numbness scores between these two age brackets. These findings suggest that CT-guided RTPTN is a safe and effective method and is recommended for older and poor-risk patients.

Current gamma knife treatment for ophthalmic branch of primary trigeminal neuralgia

AIM: To probe into problems existing in gamma knife treatment of ophthalmic branch of primary trigeminal neuralgia (TN), and propose a safe and effective solution to the problem. METHODS: Through sorting the literature reporting gamma knife treatment of refractory TN in recent years, this article analyzed the advantages and problems of gamma knife treatment of primary TN, and proposed reasonable assessment for existing problems and the possible solution. RESULTS: Gamma knife treatment of TN has drawn increasing attention of clinicians due to its unique non-invasion, safety and effectiveness, but there are three related issue; to be considered. The first one is the uncertainty of the optimal dose (70-90GY); the second one is the difference in radiotherapy target selection (using a single isocenter or two isocenters); and the third one is the big difference of recurrent pains (specific treatment methods need to be summarized and improved). CONCLUSION: For patients with refractory TN, gamma knife treatment can be selected when the medical treatment fails or drug side effects emerge. The analysis of a large number of TN patients receiving gamma knife treatment has shown that this is a safe and effective treatment method.

TREATMENT OF 25 CASES OF TRIGEMINAL NEURALGIA WITH ABDOMINAL ACUPUNCTURE THERAPY

Trigeminal Neuralgia is often found in female between 40-60 years old, marked by sudden severe pain on the face (a feeling of knife cutting, electric shock), and it is characterized by sudden, paroxysmal and periodical attack and triggered by touch). The attack usually lasts for 1 to 2 minutes with different intervals. The patient’s life quality can be seriously affected. It is mainly treated with orally taken drugs in western internal department but without satisfactory result, and with local closing therapy in surgical department. The problem may reoccur half a year later in most patients complicated with facial paralysis, so western medicine is not likely to be accepted by the patients. The author has tried to apply abdominal acupuncture in the treatment of 25 cases of trigeminal neuralgia with good effect. The result is as follows.

Pathogenesis of trigeminal neuralgia

To the editor,I read with interest the article, ＂Dif- ferences in individual susceptibility affect the development of trigeminal neuralgia＂ by Duransoy et al. （2013）. The authors have analyzed the possible pathogenesis of trigeminal neuralgia, with illustrative case examples. They have drawn very important conclu- sions, which may have implications in management of trigeminal neuralgia.

Use of High Definition Multileaf Colimator for the Treatment of Trigeminal Neuralgia

In the present work, a treatment technique for trigeminal neuralgia (TN) using LINAC radiosurgery is shown. The technique is based on the optimization of ten static arcs in such a way as to minimize the overlapping of the treatment fields with the brainstem. We will call this technique brainstem-optimized (BO). The results are compared with another technique described in the literature known as a virtual cone (VC). The comparison of dosimetry results that have been carried out essentially shows that the doses in the brainstem V12Gy-brainstem, D0.5cm3-brainstem and D0.035 cm3-brainstem are lower in the BO versus VC technique, and with the parameters V50% (whole brain) and V12Gy-cerebrum higher in BO versus VC. Our goal is to keep the dose to the brainstem as low as possible and, if possible, at most between 12 Gy and 15 Gy. The BO technique meets our purposes and is considered clinically acceptable at our institution.

The progress in diagnosis and treatment of trigeminal neuralgia

Trigeminal neuralgia(TN)is characterized by recurrent facial acupuncture like,electric shock like,burning like pain and other common clinical cranial nerve diseases in the trigeminal nerve distribution area.Around the world,people who are 40 or more are at risk.The incidence rate of TN of female is slightly higher than that of male and most of the affecting areas are on the right side unilaterally,which affects maxillary nerve and mandibular nerve,yet seldom ophthalmic nerve.Although controversy exists in the pathogenesis of TN,the most accepted theory is microvascular compression,which forces on the demyelination of the sensory axon of the trigeminal nerve root.Additionally,slight touch,conversation and chewing may cause intolerable pain.The diagnosis of TN mainly depends on clinical manifestation.The treatment mainly includes medicine,operation,and some supplementary methods.Among them,antiepileptics and tricyclic antidepressants are the first-line treatment.Surgical treatment is mainly used for patients with TN who have failed in drug treatment or have intolerable side effects.The methods of operation include destructive or non-destructive operation.Deep brain stimulation(DBS)and motor cortex stimulation(MCS)are new therapeutic techniques emerged recently.This method is expected to alleviate the refractory TN with poor drug control or ineffective conventional surgical treatment.At present,this method has not been approved for clinical treatment.Of course,more clinical data collection processes are in progress.

Comparison of the Improvement Effect of MVD and Gamma Knife on Pain,Anxiety and Depression of Patients after Treatment of Primary Trigeminal Neuralgia

Objective:To explore the effects of microsurgical vascular decompression(MVD)and gamma knife respectively on the treatment of pain,anxiety and depression in patients with primary trigeminal neuralgia.Methods:From February 2011 to June 2017,we treated 108 patients with primary trigeminal neuralgia.According to the treatment plan of the patients,they were divided into an observation group and a control group,54 cases each.The observation group underwent microsurgical vascular decompression(MVD)for the treatment of primary trigeminal neuralgia,while the control group received gamma knife treatment.The effects of pain,improvement of anxiety and depression were compared between two groups at 1 week,3 months,and 6 months after treatment.Results:The pain,anxiety and depression scores of the observation group was significantly lower than that of the control group(P<0.05).Conclusion:MVD can relieve patients'pain,anxiety and depression symptoms,as well as improve quality of life and restore self-confidence in life.

Efficiency of Gamma Knife Radiosugery and Acupuncture Therapy on Primary Trigeminal Neuralgia

Objective:To compare the clinical effectiveness of gamma knife radiosugery combined with acupuncture therapy and microvascular decompression in the treatment of idiopathic trigeminal neuralgia.Methods:A total of 93 patients with primary trigeminal neuralgia added to Nanchang University Hospital from November 2016 to October 2018 were selected,it was divided randomly into the control group(45 cases)and the study group(48 cases).The control group was treated with microvascular decompression and the study group used gamma knife radiosurgery combined with acupuncture therapy.The study compared the immediate pain relief rate,Visual Analogue Scale(VAS)scores,completion rate,recurrence rate,hospitalization days,total treatment duration,total treatment cost and total effective rate of treatment in 2 groups.Results:Comparison of the same group after treatment:the VAS score with 24 hours of treatment in the control group was(5.33±0.49),with a significant difference from the pre-treatment VAS score(8.62±0.13);The VAS score with 24 hours of treatment in the study group was(5.96±0.58),with a significant difference from the pre-treatment VAS score(8.54±0.25).After treatment,immediate effect,parent effect,acute and chronic complements of the control group was 25,5,2 and 7 cases,and the study group was 6,25,7 and 1,respectively.There were significant differences between the two groups;The comparison of hospitalization days,total treatment duration,total treatment cost was statistically significant(P<0.05);There were no significant difference in immediate pain rate,VAS score,total incidence of complications,recurrence rate,and total effectiveness of treatment between the two groups(P>0.05).Conclusion:Both microvascular decompression and gamma knife radiosurgery combined with acupuncture therapy can safe and effective treatment idiopathic trigeminal neuralgia patients,and for patients with good health,can tolerance all-hemp surgery,there are contraindicaindications to acupuncture therapy,microvascular decompression treatment can be chosen,while patients who are weak,cannot tolerante all-hemp surgery or resist surgery,economic difficulties,and can choose gamma knife radiosurgery combined with acupuncture therapy treatment.

Long-term efficacy of microvascular decompression on trigeminal neuralgia and multi-factor research of recurrence

Objective To research the factors that affects the efficacy of 2 826 cases of of trigeminal neuralgia after microvascular decompression during follow-up more than 1 year. Methods The patients with trigeminal meuralgia were followed-up for 1-25 years ( mean 9. 8 years) after microvascular decompression from January 1984 to

Virus etiology research of trigeminal neuralgia combining arachnoids' adhesion

Objective To assess the relationship that trigeminal neuralgia combining arachnoids’adhesions and herpes simplex virus type 1. Methods There are fifty-nine patients with trigeminal neuralgia their trigeminal nerve root area combined with arachnoids’adhesion,

Neuronavigator-guided percutaneous radiofrequency thermocoagulation in the treatment of intractable trigeminal neuralgia

Background Percutaneous radiofrequency thermocoagulation of the trigeminal ganglion （PRTTG） is regarded as the first choice for most patients with trigeminal neuralgia （TN） because of its safety and feasibility. However, neuronavigator-guided PRTTG has been seldom reported. The purpose of this study was to assess the safety and efficacy of neuronavigator-guided PRTTG for the treatment of intractable TN. Methods Between January 2000 and December 2004, 54 patients with intractable TN were enrolled into this study and were randomly divided into two groups. The patients in navigation group （n=26） underwent PRTTG with frameless neuronavigation, and those in control group （n=28） received PRTTG without neuronavigation. Three months after the operation, the efficacy, side effects, and complications of the surgery were recorded. The patients in the control group were followed up for 10 to 54 months （mean, 34±5）, and those in the navigation group were followed up for 13 to 58 months （mean, 36±7）. Kaplan-Meier analyses of the pain-free survival curves were used for the censored survival data, and the log-rank test was used to compare survival curves of the two groups. Results The immediate complete pain-relief rate of the navigation group was 100%, whereas it was 95% in the control. The proportion of sustained pain-relief rates at 12, 24 and 36 months after the procedure were 85%, 77%, and 62% in the navigation group, and 54%, 40%, and 35% in the control. Recurrences in the control group were more common than that in the navigation group. Annual recurrence rate in the first and second years were 15% and 23% in the navigation group, and 46%, 60% in the control group. No side-effect and complication was noted in the navigation group except minimal facial hypesthesia. Conclusion Neuronavigator-guided PRTTG is a safe and promising method for treatment of intractable TN with better short- and long-term outcomes and lower complication rate than PRTI＇G without neuronavigation.

Percutaneous microballoon compression for trigeminal neuralgia

Background Percutaneous microballoon compression （PMC） for trigeminal neuralgia is an important therapeutic method. The aim of this study was to review the effects of PMC for trigeminal neuralgia in 276 patients. Methods From December 2000 to May 2003, 276 patients with trigeminal neuralgia were treated with PMC. The course of the disease ranged from 3 months to 38 years. Under the guidance of C-arm X-ray, 14# needle was placed into the foramen ovale using the classical Hakanson＇s technique. Fogarty balloon catheter was navigated into the Meckel＇s cave tenderly. A small amount of Omnipaque was slowly injected to inflate the balloon and compress the trigeminal ganglion for 3 to10 minutes. Results A total of 290 PMC were performed on the 276 patients. Among them, 252 had immediate relief from pain. The patients were followed up for a mean of 18.7 months （range, 4 to 32）, 14 of them had a recurrence. Of the 14 patients, 12 were re-operated with PMC, and the pain was all controlled successfully. Conclusions PMC is an effective and technically simple method for trigeminal neuralgia. For older patients with trigeminal neuralgia, it may be the first choice.

Proteomic Analysis of the Hippocampus in Mouse Models of Trigeminal Neuralgia and Inescapable Shock-Induced Depression

To investigate the behavioral and biomolecular similarity between neuralgia and depression, a trigeminal neuralgia （TN） mouse model was established by constriction of the infraorbital nerve （CION） to mimic clinical trigeminal neuropathic pain. A mouse learned helplessness （LH） model was developed to investigate inescapable footshock-induced psychiatric disorders like depression in humans. Mass spectrometry was used to assess changes in the biomolecules and signaling pathways in the hip- pocampus from TN or LH mice. TN mice developed not only significant mechanical allodynia but also depressive- like behaviors （mainly behavioral despair） at 2 weeks after CION, similar to LH mice. MS analysis demonstrated common and distinctive protein changes in the hippocampus between groups. Many protein function families （such as cell-to-cell signaling and interaction, and cell assembly and organization,） and signaling pathways （e.g., the Huntington＇s disease pathway） were involved in chronic neuralgia and depression. Together, these results demonstrated that the LH and TN models both develop depressive-like behaviors, and revealed the involvement of manypsychiatric disorder-related biomolecules/pathways in the pathogenesis of TN and LH.

Clinical Effect of Sphenopalatine Ganglion Needling in Treating Primary Trigeminal Neuralgia of Liver-Yang Upsurge Syndrome Type

Objective：To observe the efficacy and safety of sphenopalatine ganglion needling in treating patients with primary trigeminal neuralgia（PTN） of Liver（Gan）-yang upsurge syndrome（LYUS） type.Methods：Sixty-five PTN patients of LYUS type were assigned by a random number table to two groups and treated by deep-needling （33 patients,DN group） and superficial-needling（32 patients,SN group）,respectively.The main-acupoint used for both groups was Xiaguan（ST7） of affected side,on which needle was deeply inserted to reach spheno-palatine ganglion in the DN group,but was inserted conventionally in the SN group;the auxiliary acupoints used were the local points Cuanzhu（BL2）,Sibai（ST2）,Chengjiang（CV24） of affected side,as well as the remote points,bilateral Hegu（LI4） and Taichong（LR3）.The needling was implemented every other day,with electric stimulation applied to all the punctured acupoints for 30 min,10 days treatment as one therapeutic course.Each patient received 2 courses of needling with 1 week interval in between.The clinical efficacy,pain control and adverse reaction were evaluated and compared after the treatment.Results：Rank-sum test showed that the efficacy in the DN group was significantly better than that in the SN group（Z=2.30,P=0.021）;the pain was alleviated in both groups in frequency, intensity and sustained time（evaluated by visual analogue scale） significantly（P0.01）,but deep needling showed a superiority over superficial needling in reducing the frequency and intensity of episode（Z=9.55,Z=5.50,both P=0.00）.No adverse reaction occurred during the treatment course of both groups.Conclusion：Spheno-palatine ganglion needling is highly effective,safe and reliable for the treatment of PTN.