diseases

TRIGEMINAL NEURALGIA


Introduction
Neuralgia means severe pain along the course of the nerve. Trigeminal nerve is responsible for the sensation of the skin of the face and the anterior portion of the head; through three of its branches: Ophthalmic, Maxillary and Mandibular.

It is also responsible for the functioning of the various muscles of the face.

The mean age of onset of trigeminal neuralgia is seen in the 5th or 6th decade; occurs most frequently in persons over 40 years of age. It is more commonly seen in males than in females.


Definition:
It is a disease of the trigeminal nerve marked by brief attacks of severe, lightening like pain along the distribution of one or more of the branches of the trigeminal nerve.

Causes and risk factors:
. Depending on the age of onset, it can be of two types: The symptomatic form, if it appears before 40 years of age and the idiopathic form, if it appears after 50 years of age.
. Most of the cases, where the onset is after 50 years of age, no cause can be determined. They are idiopathic.
. The most common cause of the symptomatic form is due to the pressure of some lesions on the nerve.
. The following lesions may be the cause:
1. Pontine neoplasm (a tumor of a part of the brain stem), multiple sclerosis (a disease characterized by destruction of the neurons in various regions of the brain),
2. Cholesteatoma (a tumor filled with fat like debris in the middle ear, central nervous system etc), granulomas (a tumor due to inflammatory reaction of the body, seen in many conditions).etc.

. The pressure of the blood vessels on the nerve root may also be the probable cause.
. Rarely, it may occur with herpes zoster.
. Certain precipitating factors are also recognized, like: cold water, washing the face, chewing food, swallowing, talking, shaving etc.
. Certain 'trigger points' are present over the face, teeth and buccal mucosa, stimulation of which by any of the above factors may initiate the attack.

Screening and diagnosis:
. The adequate stimulus for precipitating an attack is the tactile one (a tickle) rather than any other thermal/noxious stimuli.
. There is a sharp, excruciating pain felt in the lips, cheek, chin, gums without any loss of sensation.
. The pain doesn't last for more than a minute or two, but it is so severe that, it makes the patient wince.
. Each attack is usually followed by a dull 'after pain', which may spread to the remaining half of the face.
. These attacks may recur frequently, for many weeks.
. There is a tendency for the condition to recur and relapse over many years.
. In such long standing cases, the hair of the affected side may become coarse and bleached.

Diagnosis:
. It can be made on strict clinical criteria.
. It usually has no sensory loss in the idiopathic cases. But, in the symptomatic cases, sensory loss can be demonstrated.
. It is important to diagnose whether it is the symptomatic form or the idiopathic form.
. The presence of sensory loss at a younger age indicates symptomatic form.
. Certain confirmatory tests may support the diagnosis.CT scan or MRI may help to identify the symptomatic forms.

Homoeopathic treatment:
. Homoeopathic remedies aim at reducing the intensity of the attacks, decreasing the frequency between two attacks and finally leading to remission.
. The nature of the attack is considered in its minutest details with respect to its triggering factors, type of pain, exact location etc.
. We will also take into consideration other aspects about you like; your health status in the past, any kind of stressors in your life, your lifestyle etc. before prescribing you a perfect remedy.
. As this is a chronic disease, an individualistic remedy thus prescribed, will act at a very deeper level and heal the disease from its core.

Patient care:
. The characteristic of each attack are observed and recorded.
. Patient should be advised to maintain a very good oral hygiene.
. He should avoid sudden jerky movements of the neck.
. Eating hard food substances should be avoided.
. Any kind of stress or anxiety should be avoided.

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