Radiosurgery for trigeminal neuralgia

Trigeminal neuralgia is a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve. It has been described as among the most painful conditions known to mankind. It is estimated that 1 in 15,000 people suffer from TN, although the actual figure may be significantly higher due to frequent misdiagnosis.

Radiosurgery for trigeminal neuralgia

Postby » Wed, 20 Nov 2013, 10:44 pm

I came across this on the MS Research website. It confirns the presence of serious jaw problems that MSers suffer from!:

We obviously disagree with the diagnosis and the treatment modality. There are far simpler ways to treat this problem with orthopaedic appliances

Posted: 20 Nov 2013 12:57 AM PST

Gamma knife radiosurgery for MS-related trigeminal neuralgia

"Pain is one of the most disabling symptoms MSers suffer from; it prevents normal functioning and stops MSers living normal lives. Pain can also make depression worse and frequently results in poor sleep that then exacerbates fatigue. All of this frequently triggers a downward spiral. MSers who have, or have had, trigeminal neuralgia know what I am talking about. Some of them describe it as the worst pain they have ever experienced and some contemplate suicide as a result of the pain. Due to its severity I personally treat MS-related trigeminal neuralgia as a medical emergency and do everything I possibly can to get the pain under control. It is most often due to a demyelinating plaque or lesion in the root entry zone, i.e. the area were the trigeminal nerve enters the brain stem. It usually responds, partially or completely, to drugs that block rapid firing of nerves in the demyelinated segment. The drugs we use belong to a class of agents called sodium channel blockers, for example carbamazepine, oxcarbazepine, phenytoin and gabapentin. In my experience carbamazepine and oxcarbazepine are the most effective drugs. Unfortunately they both come with side effects, in particular sedation and cognitive slowing. In most MSers the trigeminal neuralgia usually responds to these medications and resolves over 6-12 weeks. I also treat sudden-onset trigeminal neuralgia as a relapse and offer a course of high-dose steroids that in some cases helps with the pain. It is reassuring therefore that in MSers with refractory TN there is a non-invasive treatment that may help them. Gamma knife radiosurgery uses a technique of delivering high-dose radiation to small area within the brain. In the case of TN is is delivered into the root entry zone and targets the nerve fibres as they enter the brain stem. This treatment seems to help and reduces the severity of the pain and renders over half of subjects pain-free. One of the side-effects is persistent numbness in the face that is due to permanent damage to those nerve fibers from the radiation therapy."

Epub: Weller et al. Single-Institution Retrospective Series of Gamma Knife Radiosurgery in the Treatment of Multiple Sclerosis-Related Trigeminal Neuralgia: Factors that Predict Efficacy. Stereotact Funct Neurosurg. 2013 Nov 8;92(1):53-58.
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