TRIGEMINAL NEURALGIA- THE CURSE THAT CAN BE CURED IF OPERATED IN TIME.

Trigeminal Neuralgia is also called as the ‘suicide disease’ due to extreme torment that this pain causes.

It is also described as one of the worst pains experienced by human beings.

Synapse Foundation has focused specifically on this disorder because it is curable with a specific type of neurosurgery called as MVD surgery.
This surgery needs advanced neurosurgical instrumentation and highly skilled surgical team over the period of the last 15 years over 1300 MVD surgeries have been carried out with the help of the top neurosurgical instruments acquired through the foundation’s efforts.

Synapse Brain and Spine foundation plans to expand this work with the aim of alleviating the human misery and pain of this disorder in even more patients.

Advanced Neuro Microscope is needed to carry out the surgeries with more precision and better results.

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‘Trigeminal Neuralgia is one of the cruellest disease that can happen to a human being. It reduces one to such an inhuman condition that only the sufferer can tell you about it. It surpasses all the severe punishments even the Satan can imagine & execute in hell’.

Shocking though these words may sound, they are very much the descriptions given by the patients themselves. These words are in fact less dramatic than listening to them describe their pain and how pathetic their lives have become. These very sentences have been vocalized in the foundation's OPD by sufferers of Trigeminal Neuralgia.

Various adjectives and descriptive phrases used by these sufferers can give us some idea about this malady: ‘Sudden’, ‘lancinating’, ‘burning’, ‘electric shock’, ‘current-like’, ‘pricking of a thousand needle’, ‘akin to red chilly powder being thrown on the face and eye’, ‘lightening hitting one side of the face’ are a few of them.

Trigger Factors and Points:

Typically, there is a trigger point on one side of the face which, when touched, starts this attack. A breeze touching the face, washing the face, gums getting touched by a toothbrush or food or water, facial movements while speaking, shaving, applying makeup etc. are few of the triggers which start the attack.

The pain in confined to one side of the face in upper, mid or lower portion or in combination of all three areas.

An attack typically lasts for a few minutes, but it is so severe that the patient wishes that she/he were better unconscious than suffer. These pain episodes occur unpredictably and are fairly frequently; the patient lives in constant dread of an impending attack.

History

There are documented cases of suicides in the past few centuries committed by the sufferers and some even had such behavioural changes due to the severe pain that they were thought to be mentally ill and were kept in mental asylums.

A description by one Dr John Locke written in 1677 December is available and one can clearly see that he was referring to Trigeminal Neuralgia.
He was called in one night to examine the countess of Northumberland, wife of the British ambassador to France. He writes,
“On Thursday night last, I was called to see her and I found her in a fit of such violent and exquisite torment, that it forced her to such shrieks and cries as you would expect from one upon the rack. When the fit came, there was, to use my lady’s own expression, pain like a flash of fire all of a sudden. It shot into the right half of her face.

…….these violent fits of pain terminated on their own and then my lady was perfectly well, excepting only a dull pain which ordinarily remained in her teeth……….speaking was apt to put her into this painful torment ; sometimes opening her mouth to take anything or touching her gums……”

Diagnosis and Treatment

Initially, the cause of the pain is not easily apparent to the patient. It could be mistaken for pain coming from the gums and teeth and some of them get their teeth removed. However to no avail.

Month or years of agony reduce such a patient to one who is afraid to eat, speak, go out in wind, and brush his or her teeth and carrying pain relieving medications with them.

Some medicines like carbamazepine (Tegretol, mazetol), clonazepam, gabapentin, pregabalin, amitriptiline etc. are initially useful to some extent in some people. But their effect is temporary. They need to be taken continuously to prevent an attack and, being medicines acting on the nervous system, can have severe side effects. In spite of this, it is true that drugs are the first line of treatment for a few months.

But as the days and months pass, this ‘drug numbed’ patient carries on with progressively increasing doses of medicines and altered personality due to this chronic pain syndrome. The close relatives are initially worried & later irritated. Sometimes the spouses of the patient are depressed because of this disease.

Is there no alternative for these unfortunate patients........ ?

There certainly is!

Do they know about it?............. Very few do.

Radiofrequency lesioning, glycerol rhizotomy, radiofrequency ablation etc. are a few alternatives which are known to some people. But all of them are destructive procedures.

So, what is a non-destructive and most physiological alternative? It is called MVD, or Microvascular Decompression.

Towards the end of the last century, it was suspected and then confirmed that the commonest cause of this disease is a blood vessel (Commonly an artery but veins, arterioles also) pressing on this nerve in the region where the trigeminal nerve enters into the brain. This is called the Root Entry Zone (REZ).

These blood vessels indent into this zone and this is the reason behind attacks of the neuralgia. The answer is, like all profound truths, simple. We separate this vessel from the nerve and keep it separated by a small Teflon sponge. This procedure is performed under the neurosurgical microscope and it is effective in 98% of the patients according to our experience of more than 1300 such surgeries and which corresponds to the international experience.

We have been involved in these surgeries for the past 15 years and can say with confidence that this surgery should be offered to these unfortunate patients early in the course of the disease. This will certainly prevent the inevitable cascade of suffering and more suffering, which has been described above.

According to Dr. Peter Jannetta, who did a great work in MVD surgery field in the last century, the efficacy of surgery is higher when done early in the course of the disease and before any of the destructive procedure like radiofrequency lesioning is attempted. The success rate also is better in experienced hands.

Another misconception in some doctor’s minds is that this surgery is not for the elderly. On the contrary, to quote Jannetta, “this surgery is eminently suitable for the elderly sufferers, as the cerebellum is atrophic and the corridor to the nerve wide open for the surgeon.” Dr Jaydev Panchawagh’s series also confirms this.

Dr Jaydev Panchawagh Says:

For the last few years, it has been my endeavor to inform, educate & relieve these patients of pain to the best of my ability.

At the foundation, we think that there is no better joy for us than to see a cured Trigeminal Neuralgia patient smiling after MVD surgery. The commonest reaction coming from a cured patient is “Doctor, why were we not informed about this MVD procedure before? We would not have lost these last few years of our life due this horrible pain, had we come to you earlier”.

We wish that the option of this surgery reaches as many patients as possible and that their life becomes really comfortable.

The acquisition of a state of the art Neuro Microscope will boost these efforts many folds.