Medical Treatment and Therapy of Trigeminal Neuralgia

Carbamazepine

A. Medicamentosa
        The most effective drugs are carbamazepine (Tegretol ®) 3-4X 100-200 mg a day depending on tolerance. These drugs, an anticonvulsant, is effective in most cases but causes dizziness and nausea in some patients while other patients on skin rashes and leucopeniasehingga to be discontinued. After a few weeks or months of administration, the drug can be stopped but must be given again if the pain recurs.
      Drugs other than carbamazepine anticonvulsants can shorten the duration and severity of attacks. Medications such as this example phenitoin (300-400 mg / day), falproat acid (800-1200 mg / day), clonazepam (2-6 mg / day), and gabapentin (300-900 mg / day).

Baclofen can be used on pasienyang not tolerate carbamazepine or gabapentin, but the fact is most effectively used as an adjuvant to one of the local anticonvulsan.Capsaisin given at a trigger point or given as a topical eye tetesmata (proparakain 0.5%) is quite helpful in some patients .
       Approximately 80% of patients responded to the treatment with carbamazepine or gabapentin dosage right. Treatment should be done every day and the dose was increased significantly until the pain decreases.

B. Injection
       If the pain is limited to the distribution area of ​​the supraorbital and infraorbital nerves, alcohol or phenol injection can often provide relief which lasted for months until chronic. After that, the injection should be repeated if recurrent pain. Unfortunately, the next injection is more difficult due to cicatrix arising from the previous injection. However, injection therapy is quite useful to avoid operation for some time and at the same time familiarize the patient with the inevitable side effects that can be caused by surgery, lost its main flavor.

C. Operative
       Classical surgery for this disease aims to share the sensory ganglion of the trigeminal nerve which is located proximal to the ganglion gasseri medial fossa crania. Ganglion motor still does not receive the intervention dandengan nerve fibers leaving the upper part, patients can still feel the area innervated branch I. so that corneal sensory nerve fibers and corneal reflex remained normal. Pain and touch sensation will be lost forever in the areas innervated nerve fibers were incised. If the incision in the distal peripheral nerve ganglion gasseri, regeneration can occur so that the pain appears again. Sensory branches can also be divided in the posterior cranial fossa where the fibers join the pons. With a similar approach, descending tract of the trigeminal nerve cord can be cut in the medulla. Because of this tract contains only nerve fibers of pain, touch sensation is maintained. Tractotomy far more dangerous than the uncertain outcome cleavage sensory branches that are usually performed only on certain conditions such as if the pain is limited to supraorbitalis nerve and corneal reflexes to be maintained, or there is bilateral involvement and motor branch to ascertain survive.
      Believed that trigeminal neuralgia caused by pinching nerves when through connection and medial posterior fossa decompression surgery so nervous but without division of recurrence after surgery like this is quite high. Subsequent research showed that there is doubt decompression and that the results obtained from surgical decompression caused by injury to the nerves and not decompression, according to the theory.
     Surgery results summarized by White and Sweet. In general, with sufficient competence, rhizotomy retroGasseri has a mortality rate of <1%. The incidence of complications such as facial palsy <5%. Relief of pain was satisfactory and permanent

Resources:

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