During an appearance on The Great Indian Kapil Show, Salman Khan opened up about his health struggles and how despite dealing with 3 neurological conditions, he is still going to work everyday. The 59-year-old actor shared that he has Trigeminal Neuralgia, a rare neurological disorder that causes chronic, debilitating pain in the trigeminal nerve in the face. Keep reading as we explain all aspects of Trigeminal Neuralgia from causes, diagnosis and management.
What is Trigeminal Neuralgia?
Trigeminal Neuralgia (TN), colloquially known as "tic douloureux" or the "Suicide Disease," is a debilitating chronic pain condition that afflicts the trigeminal nerve, causing recurrent, intense electric shock-like pains in the facial regions it supplies.
We spoke to our expert Dr (Col) Joy Dev Mukherji, Vice Chairman & Head- Neurology, Neurosciences, Max Super Speciality Hospital, Saket, as he sheds light on the causes, risk factors, diagnosis, and various management options for individuals grappling with this challenging condition.
Causes of Trigeminal Neuralgia
The primary cause of TN is often the compression of the trigeminal nerve root near its entry into the pons. This compression, typically by an adjacent artery or vein, accounts for 80-90% of TN cases. Additionally, other factors contributing to nerve compression include:
- meningioma
- acoustic neuroma
- epidermoid cyst
- arteriovenous malformation
- saccular aneurysm
Multiple sclerosis, leading to demyelination of the trigeminal nerve nucleus, is a recognised risk factor, reported in 2-4% of TN patients.
Diagnosis of Trigeminal Neuralgia
While Trigeminal Neuralgia is primarily a clinical diagnosis, it is crucial to conduct an MRI of the brain with and without contrast to rule out structural brain lesions in all suspected cases. Patients under 40 years of age, those with bilateral symptoms, and those exhibiting sensory loss on examination are at higher risk of secondary trigeminal neuralgia.
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Treatment/ Management Options for the Suicide Disease
The management of TN varies based on factors such as age, general health, disease severity, and the underlying cause. Here are some key approaches:
1. Pharmacologic Therapy
- First-line treatment involves anticonvulsant drugs, with carbamazepine being the most commonly used.
- Oxcarbazepine is an emerging alternative for those who cannot tolerate or do not respond to carbamazepine.
- Muscle relaxants like Baclofen can be beneficial.
- Other medications include lamotrigine, phenytoin, gabapentin, clonazepam, and valproic acid.
2. Botulinum Toxin Injections
- Botulinum toxin injections are being explored as a treatment option, providing relief for some individuals.
3. Surgical Therapy
- For patients resistant to medical therapy, surgical options may be considered.
- Microvascular decompression addresses nerve compression by repositioning or removing offending vessels.
- Ablative procedures, such as rhizotomy, chemical injection, or mechanical balloon compression, aim to disrupt the pain signals.
- Peripheral neurectomy and nerve blocks target specific branches of the trigeminal nerve.
- Radiosurgery involves precise delivery of radiation to the affected nerve.
Bottomline
"Trigeminal Neuralgia presents significant challenges for those affected, impacting their quality of life. While the condition's aetiology is complex, a combination of clinical evaluation, imaging, and an array of treatment options provides hope for managing and alleviating symptoms. A collaborative approach involving healthcare professionals and patients can contribute to a better understanding and more effective management of this intricate pain syndrome," concluded Dr Mukherji.