Trigeminal neuralgia - diagnosis and therapy

How is the diagnosis made?

Although the symptoms are so typical, there are always patients who are treated for tooth or sinus problems. If trigeminal neuralgia is suspected, especially in younger people (who are more likely to have a secondary form), a brain sphincter is made to exclude underlying diseases and treat them if necessary.

What is the therapy for trigeminal neuralgia?

Even if the diagnosis of a classic trigeminal neuralgia is made, that does not mean that complete and long-term healing is always possible. Subsequent forms of treatment are available.

Tablets in trigeminal neuralgia

Since the acute pain lasts so short, it can hardly be tackled with an acute treatment; instead, regular medication is used. Normal painkillers do not help. Instead, anticonvulsants or antiepileptics (for example carbamazepine, oxcarbazepine, lamotrigine) are available, ie medicines that are otherwise used to treat convulsions.

In trigeminal neuralgia, however, the required dose is usually lower, sometimes - by an experienced specialist - several remedies must be combined. Unfortunately, although the strength and frequency of pain attacks can usually be reduced, they can not completely disappear. If the pain stops under the therapy, after two months it can be tried to "sneak out" the remedies again slowly.

Spraying as a new form of treatment

Recently, the successful use of local injections of botulinum toxin has also been reported - a neurotoxin that is also used in other pain syndromes. However, larger studies are still pending.

Sclerotherapy of nerve conduction

Sclerotherapy is also called percutaneous thermocoagulation in the jargon. During a short anesthetic, a small cut in the skin with a probe heat is brought to the nerve nodes and thus prevented the nerve conduction. However, the effect diminishes over time.

Operation for trigeminal neuralgia

Modern methods include Janetta's microvascular decompression, which does not damage the nerve. Under general anesthesia, a Teflon sponge is inserted between the nerve and the vessels touching it, in order to prevent a pressure effect on the nerve. The relapse rate is low, side effects may be on the affected side hearing loss or numbness in the face.

Irradiation: high recidivism rate

With the so-called gamma knife ("ray knife") is a newer radiosurgical method available in which the affected nerve node is extremely precisely switched off by gamma rays. The good results so far are unfortunately affected by a relatively high recidivism rate.

Alternative medicine

The effectiveness of alternative methods is controversial; Acupuncture is well established. In homeopathy, especially for the acute treatment Verbascum and Aconitum are used; however, a constitutional therapy is recommended rather with an experienced therapist. For the Schüßler salts, a test with No. 7 Magnesium Phosphoricum (applied as an ointment) is recommended.

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