Functional Neurology for Trigeminal Neuralgia

Functional neurology is a branch of neurology that focuses on the relationship between the brain and the body. It seeks to understand how the brain controls various functions in the body and how these functions can be improved or restored through multiple therapies and interventions.

Trigeminal neuralgia is a chronic pain disorder that affects the trigeminal nerve, which is responsible for transmitting sensation to the face, mouth, and jaw. It is characterized by severe facial pain triggered by even the slightest stimuli, such as speaking or eating.

Functional Neurology for trigeminal neuralgia is proven effective as it seeks to address the root cause of the pain rather than just masking the symptoms. One such approach is the use of neuroplasticity techniques, which involve rewiring the brain to help it better control and regulate pain.

Functional Neurology for trigeminal neuralgia may involve a combination of treatments such as physical therapy, chiropractic care, and cranial-sacral therapy in order to address the underlying dysfunction or irritation of the trigeminal nerve. These treatments may reduce the frequency and intensity of facial pain, as well as improve overall function and quality of life.

Overall, functional neurology offers a holistic and individualized approach to treating trigeminal neuralgia. By addressing the root cause of the pain and working to improve brain function, functional neurology can provide much-needed relief for individuals suffering from this chronic and debilitating condition.

Functional Neurology for Trigeminal Neuralgia

What is trigeminal neuralgia?

The trigeminal nerve, commonly known as the fifth cranial nerve and one of the most extensively dispersed nerves in the brain, is affected by the chronic pain syndrome trigeminal neuralgia (TN), also known as tic douloureux.

The “classic” or “typical” form of the disorder, known as “Type 1” or TN1, causes severe, sporadic, sudden burning or shock-like facial pain that can last anywhere from a few seconds to two minutes per episode. Neuropathic pain is defined as “pain associated with nerve injury or nerve lesion.” These assaults can come in fast succession and last up to two hours for every volley.

The “atypical” type of illness, often known as “Type 2” or TN2, is characterized by consistent, milder-intensity throbbing, burning, stabbing pain than Type 1.

The trigeminal nerve is one of the 12 pairs of nerves that connect to the brain. Three branches of the nerve carry sensations from the upper, middle, and lower faces, as well as the oral cavity, to the brain.

The ophthalmic, or upper, branch of the nerve provides sensation to the majority of the scalp, forehead, and front of the head. The maxillary, or middle, branch stimulates the face, upper jaw, top lip, teeth, and gums, as well as the side of the nose. The mandibular branch, also known as the lower branch, supplies nerves to the teeth, lower jaw, gums, and bottom lip. Multiple nerve branches may be affected by the condition. A facial injury may occasionally affect both sides of the face at different times.

Causes of trigeminal neuralgia

TN is linked to a number of medical conditions. A blood vessel pressing on the trigeminal nerve as it is exiting the brain stem can cause TN. This compression wears away or damages the protective coating that surrounds the nerve (the myelin sheath).

Multiple sclerosis, a disease that causes the deterioration of the myelin sheath of the trigeminal nerve, can also cause TN symptoms. Nerve compression from a tumor or an arteriovenous malformation, a tangle of arteries and veins, may cause TN symptoms in rare cases. Trigeminal nerve injury (possibly caused by sinus surgery, oral surgery, stroke, or facial trauma) can also cause neuropathic facial pain.

Symptoms of trigeminal neuralgia

The pain may be sudden, intense, and stabbing, or it may be more persistent, aching, and burning, depending on the type of TN. Sharp pain flashes can be caused by vibration and contact with the cheek, such as when shaving, putting on makeup, brushing one’s teeth, eating, drinking, chatting, or being in the wind. The discomfort may be limited to one area of the face or may spread. Episodes of discomfort are uncommon when the affected person is sleeping.

TN is characterized by attacks that stop for a short period of time and then resume, but the condition can also progress. As the number of pain-free intervals between attacks decreases, the assaults frequently worsen over time. The pain-free intervals eventually fade, and the painkillers no longer work. Although not fatal, the condition can be extremely debilitating. Because they are afraid of an impending attack, some people may avoid normal tasks or social interactions.

Functional Neurology for trigeminal neuralgia seeks to treat the underlying cause of TN instead of the symptoms.

Diagnosing Trigeminal Neuralgia

TN is characterized by attacks that stop for a short time and then resume, but the illness can progress. The attacks frequently worsen over time, with fewer and shorter pain-free intervals. Pain medication becomes less effective as the pain-free intervals fade. The disorder is not fatal, but it can be debilitating. Because of the agony, some people may forego regular activities or social connections in order to avoid an impending attack.

Most TN patients will eventually undergo an MRI scan to rule out tumors or multiple sclerosis as the source of their pain. This imaging may or may not show a blood artery squeezing the nerve. Special MRI imaging techniques can detect the presence and severity of nerve compression caused by a blood artery.

A positive response to a brief course of antiseizure medication may help to confirm a diagnosis of classic trigeminal neuralgia. As with other neuropathic pain diagnoses, TN2 is a more complex and difficult diagnosis, but it is supported by a positive response to low doses of tricyclic antidepressant drugs (such as amitriptyline and nortriptyline).

How is trigeminal neuralgia treated?

Anticonvulsant medications, which are used to stop nerve firing, are generally beneficial in the treatment of TN1 but are frequently ineffective in the treatment of TN2. These medications include gabapentin, carbamazepine, oxcarbazepine, topiramate, phenytoin, pregabalin, clonazepam, valproic acid, and lamotrigine.

Tricyclic antidepressants, such as nortriptyline or amitriptyline, can be used to treat pain. Common analgesics and opioids are rarely effective in treating the acute, persistent pain caused by TN1, but opioids can help some people with TN2. If medication fails to relieve pain or has severe side effects such as cognitive problems, memory loss, excessive fatigue, bone marrow suppression, or allergies, surgery may be recommended. Patients frequently seek surgical treatment for TN because it is a progressive illness that frequently becomes resistant to medication over time.

Several neurosurgical procedures are available to treat TN, depending on the individual’s preference, the nature of the pain, physical health, previous surgeries and blood pressure, the distribution of trigeminal nerve involvement, and presence of multiple sclerosis. Some procedures are performed as outpatients, while others may necessitate a more difficult procedure under general anesthesia. Many of these surgeries will result in some degree of facial numbness, and even if the procedure is initially successful, TN will frequently return. Hearing loss, balance issues, cerebrospinal fluid leakage (the fluid that bathes the spinal cord and brain), infection, and anesthesia Dolorosa are some of the other surgical concerns, depending on the technique (a combination of surface numbness and deep anesthetic).

A rhizotomy (rhizolysis) is a pain-blocking procedure that involves the destruction of nerve fibers. A TN rhizotomy always causes sensory loss and facial numbness. To treat trigeminal neuralgia, several types of rhizotomy are available:

Balloon compression works by damaging the insulation on nerves that control the sensation of light touch on the face.

Glycerol injection is also usually done as an outpatient procedure while the patient is sedated with intravenous medication. Pain is likely to return after a year to two years with this type of rhizotomy. The operation, on the other hand, can be repeated numerous times.

The most common procedure is outpatient radiofrequency thermal lesioning (also known as “RF Ablation” or “RF Lesion”). Three to four years after RF lesioning, approximately half of the participants experience recurrent symptoms. Additional numbness can extend pain relief even further, but it also increases the risks of anesthesia Dolorosa.

Using computer imagery, stereotactic radiosurgery (Gamma Knife, Cyber Knife) directs highly targeted beams of radiation at the location where the trigeminal nerve exits the brain stem. According to the International RadioSurgery Association, between 50 and 78 percent of people with TN who receive Gamma Knife radiosurgery experience “excellent” pain relief within a few weeks.

The most invasive of all TN operations, microvascular decompression (MVD), also has the lowest risk of pain recurrence. Approximately half of those who have MVD for TN will experience pain recurrence within 12 to 15 years. Individuals frequently spend several days in the hospital after surgery and will need to recover for several weeks afterwards.

Assume no vessels are detected pressing on the trigeminal nerve. In that case, a neurectomy (also known as partial nerve section) may be performed during an attempted microvascular decompression around the nerve’s entry point at the brain stem.

Surgical treatment for TN2 is typically more difficult than treatment for TN1, especially if vascular compression is not detected in brain imaging prior to surgery. Unless vascular compression is established, many neurosurgeons advise against using MVD or rhizotomy in patients with TN2 symptoms over TN1. Similarly, MVD for TN2 is less effective than MVD for TN1.

Functional Neurology for Trigeminal Neuralgia

Functional neurology can treat trigeminal neuralgia by identifying and addressing the underlying cause of the condition. This may involve identifying and correcting imbalances in the nervous system, such as abnormal firing patterns or nerve irritation.

Treatment may include techniques such as chiropractic adjustments, neurofeedback, and sensory-motor integration exercises to help improve nervous system function and reduce pain. Additionally, functional neurology practitioners may recommend dietary and lifestyle changes to support overall nervous system health and help manage trigeminal neuralgia symptoms.