Neuralgia

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• QHow is trigeminal neuralgia treated?

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  A Dr. Irene A. Semenov, DO , Neurology, answered on behalf of NorthShore University HealthSystem

  Treatment of trigeminal neuralgia consists of medical and surgical approaches. Initially, the patient is offered treatment with anticonvulsants, such as carbamazepine or oxcarbazepine, which may be quite effective in the early stages. However, the side effects such as sedation, dizziness and unsteadiness may limit the use of these medications.

  Approximately 50 percent of patients who get initial relief with medications eventually will need surgical therapy for their trigeminal neuralgia. The two most popular procedures are: gamma knife radiosurgery and micro vascular decompression. Gamma knife radiosurgery causes partial radiation injury to the trigeminal nerve and is entirely noninvasive, outpatient and painless. The main disadvantage is that the therapeutic effect is delayed by up to two months. The sensation to the face may be impaired in small percentage of patients. Micro vascular decompression is a major neurosurgical procedure, which is performed through a small opening in the back of the skull. The effect of the treatment is immediate and there is no risk of sensory loss the face.

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• QWhat is trigeminal neuralgia?

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  A Multiple Sclerosis Foundation answered

  Trigeminal neuralgia is pain caused by damage to the trigeminal nerve. It is characterized by a stabbing pain in the face that can result from almost any facial movement. It tends to be extremely painful and can interfere with activities of daily living. Trigeminal neuralgia is frequently an initial symptom of multiple sclerosis (MS), and it is commonly confused with dental pain. Between 1.9 to 4.9 percent of MS patients experience it.

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• QWhat are some complications of microvascular decompression?

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  A UCLA Health answered

  Microvascular decompression (MVD) is a major operation. There have been reports of major complications such as meningitis, stroke or even life-threatening complications and death. In our experience, we've never had anybody have a stroke or a fatal complication, but it's not out of the question, and so it is something that has to be carefully considered.
  
  In our experience, after the four-hour operation, many patients don't even have to go to the ICU. Now, almost half of them leave on the second day after surgery, so many people are having this operation with outstanding relief.
• QWhat are the symptoms of piriformis syndrome?

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  A Dr. Juan P. Villablanca, MD , Neuroradiology, answered on behalf of UCLA Health

  Symptoms of piriformis syndrome, a condition involving spasms of the piriformis muscle in the buttock, include leg pain and/or weakness, back pain and buttock pain. The buttock pain tends to radiate down the back of the leg, sometimes all the way down to the foot. Symptoms of piriformis syndrome are similar to those caused by sciatica. Sciatica is inflammation of the sciatic nerve, the large nerve in the lower back that runs down each leg. In some cases, spasms of the piriformis muscle can irritate the sciatic nerve, causing leg pain, numbness and tingling.

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• QWhat causes piriformis syndrome?

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  A Dr. Juan P. Villablanca, MD , Neuroradiology, answered on behalf of UCLA Health

  Piriformis syndrome can be caused by an injury to the pelvis or buttock after a fall or a slip. It can happen in people who are very active but who use their muscles asymmetrically. It also can happen in people with a condition affecting their spine, such as scoliosis, when the stress on the pelvis is asymmetric and causes unusual turns and twists that put the piriformis muscle into spasm. The piriformis muscle is a small muscle located deep within each buttock. In some cases, if the piriformis muscle is inflamed or in spasm, it becomes hard and tight like a ball. It presses on the sciatic nerve and eventually can irritate and damage the nerve. Sometimes in the body, a branch of a nerve or an entire nerve will pass through a muscle. It doesn’t take much muscle inflammation to really irritate a nerve that’s sitting right in the middle of a muscle.
• QCould dry eyes be related to trigeminal nerve pain?

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  A Dr. David R. Demartini, MD , Ophthalmology, answered

  Trigeminal neuralgia involves the trigeminal nerve which brings sensation from the face to the brain. This nerve acts abnormally when the slightest stimulation causes severe pain in this one nerve that can be very debilitating. Most patients try to avoid these slight sensations. Dryness is not a usual stimulating factor but it could be. Make-up or even a slight breeze have been known to cause this neuralgia.