Stilbamidine isethionate therapy of tic douloureux.

Abstract

LASSICAL tic douloureux is a disease of unknown origin characterized, among other attributes, by periods of spontaneous remission. Any proposed medical therapy must therefore be scrutinized with specific attention to this factor. Previous attempts at medical relief, such as that assigned to the intake of massive doses of ferrous carbonate 9,1~ or to the injection of B121,11 have failed to alter substantially the natural course of this disease. The inhalation of trichloroethylene offers at best the momentary relief obtained by a short-acting analgesic agent. ~9 The severe pain of tic douloureux is relieved permanently only by complete section of the sensory root of the trigeminal nerve. The time-tested procedures of sensory root section by the temporal route of Spiller-Frazier 25 or the cerebellar approach of Dandy 7 carry virtually no mortality in experienced hands and scant morbidity. Following sensory root section there remain, however, permanent analgesia and anesthesia over the sensory domain of the fifth nerve, including the cornea. The procedure is scarcely applicable to cases of bilateral or alternating tic douloureux and can be applied to the younger age group of patients only with extreme reluctance. More peripherally placed nerve sections or alcohol injections are effective measures only for the temporary relief of the pain of tic douloureux. More recently, decompression of the ganglion and sensory root of the fifth nerve has been proposed by Taarnhoj 27 as a means of relieving tic pain and at the same time avoiding the subjective distress of sensory loss over the face and the potential danger of the loss of corneal sensitivity. The operation of ganglionlysis is a variation on this theme. 21,26 Whether based upon sound premises or not, the procedure is not unlike the partial section once advocated by Frazier 12 and by Dandy s and the recurrence rate of these newer procedures has also been high. 17,2s In 194~, Napier and Sen Gupta is described a late chronic neuropathy confined largely to the distribution of the fifth nerve which occurred as an unexpected sequel to the administration of 4:4'-diamidino-diphenyl-ethylene to patients with kala-azar. The observation was extended by Sen Gupta 22 and others 2,5,6,2~ in patients treated for kala-azar, trypanosomiasis and blastomycosis. The majority of such patients treated with therapeutic doses of stil