Comprehensive Treatment of Patients With Classical Trigeminal Neuralgia

Abstract

Trigeminal neuralgia is a chronic disease characterized by short paroxysms of intense excruciating shooting pains in the innervation zone of one or more branches of the trigeminal nerve. Trigeminal neuralgia is a common disease, it occurs with a frequency of 4-5 to 30-50 cases per 100,000 population — according to reports, about 15,000 new patients are diagnosed in the United States annually. The practical social severity of trigeminal neuralgia is high — the severity of pain attacks leads to a significant disruption of the flow of the normal rhythm of life of patients. Among the conservative methods of treatment of classical trigeminal neuralgia, first-line drugs are anticonvulsants and, above all, carbamazepine, which suppresses cortical and stem foci of sensitization. In parallel with the increase in tolerance to the drug, the number of adverse events also increases. If drug therapy is ineffective, surgical methods of treatment are used. Microvascular decompression of the trigeminal nerve root is considered the “gold standard” among them. The microvascular decompression ensures the complete elimination of the pain syndrome, but the percentage of relapses of the disease varies widely. According to scientists, the relapse rate after the microvascular decompression was 28%. The mortality rate is from 0.5 to 2% and averages 1.4%. The main cause of death is a violation of blood circulation in the brain stem. In addition, damage to adjacent nerve structures occurs with varying frequency: IV, VI, VII and VIII nerves. In this regard, there was a need to develop alternative approaches to the treatment of trigeminal neuralgia with paroxysmal facial pain. The results of a clinical and instrumental study of various treatment methods are presented. The effectiveness of complex treatment for trigeminal neuralgia has been proven.