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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Outcome after radiofrequency thermocoagulation in patients with trigeminal neuralgia was assessed in a prospective, longitudinal study. Forty-eight consecutive patients with chronic facial pain presenting for surgery to a neurosurgeon were studied. Patients were assessed preoperatively by an independent clinician both clinically, and with the use of two questionnaires: the McGill Pain Questionnaire (MPQ) and the Hospital Anxiety and Depression (HAD) scale. From these assessments, two groups of patients were identified: 31 with pure trigeminal neuralgia (TN group) and 17 with trigeminal neuralgia together with atypical facial pain and mixed trigeminal neuralgia (MTN group). All underwent radiofrequency thermocoagulation at the level of the Gasserian ganglion. Patients were reviewed by the same clinician 3 months later and then followed up by a self-administered questionnaire at 6 months, 1 year, 2 years and 3 years. The mean follow-up time was 30+/-12 months. The mean time to recurrence of pain was 40 months for the TN group and 36 months for the MTN group. Depression and anxiety dropped more significantly post-operatively in the TN group than the MTN group. TN group were more satisfied with their outcome, complained of fewer complications and were more willing to have repeat surgery if necessary than patients in MTN group. The number and severity of complications varied at different time points. Careful selection of patients for surgery using objective assessments will decrease morbidity and improve satisfaction. Physical morbidity and recurrence rates are insufficient to gauge outcomes. Psychological, sociological and patients' views must be included in evaluations.
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PMID:A prospective, longitudinal study on patients with trigeminal neuralgia who underwent radiofrequency thermocoagulation of the Gasserian ganglion. 992 76

The binding of [11C]diprenorphine to mu, kappa, and delta subsites in cortical and subcortical structures was measured by positron emission tomography in vivo in six patients before and after surgical relief of trigeminal neuralgia pain. The volume of distribution of [11C]diprenorphine binding was significantly increased after thermocoagulation of the relevant trigeminal division in the following areas: prefrontal, insular, perigenual, mid-cingulate and inferior parietal cortices, basal ganglia, and thalamus bilaterally. In addition to the pain relief associated with the surgical procedure, there also was an improvement in anxiety and depression scores. In the context of other studies, these changes in binding most likely resulted from the change in the pain state. The results suggest an increased occupancy by endogenous opioid peptides during trigeminal pain but cannot exclude coexistent down-regulation of binding sites.
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PMID:Measurement of changes in opioid receptor binding in vivo during trigeminal neuralgic pain using [11C] diprenorphine and positron emission tomography. 1041 36

Trigeminal neuralgia is a recurrent severe shooting neuropathic pain which can be managed both pharmacologically and surgically. However, there are no prospective data that compare these two therapeutic strategies. This study therefore aimed to assess long-term outcome in patients with intractable trigeminal neuralgia treated with oxcarbazepine and later with surgery. Fifteen patients (11 females) with trigeminal neuralgia intractable to available drugs (carbamazepine, phenytoin and baclofen), were prospectively followed for 13 years (1986-1999) with a total follow up time from onset of disease of 16 +/- 6 years (mean +/- SD), range 8-30 years. All patients were contacted in 1999 and 12 replied, two had died and one had last replied in 1996. Patients were first treated with oxcarbazepine 1200 +/- 600 mg daily dosage (mean +/- SD) and subsequently with surgery of their choice. The outcome measures used were: McGill Pain Questionnaire, Hospital Anxiety and Depression Scale, patient satisfaction questionnaire and clinicians' global evaluation. Pain control was initially achieved in all patients and oxcarbazepine was used continuously or intermittently for 4.0 +/- 3 years (mean +/- SD). Thirteen patients experienced some mild side effects and a dose-dependent hyponatraemia was noted. Subsequently, 12 patients required surgery (five microvascular decompressions and seven surgery at the level of the Gasserian ganglion) to control their pain and were followed up for 4.3 +/- 1.7 years post surgery (mean +/- SD). Three patients required repeat surgery to control their pain, which was successful in two. A further two patients continued with low dose medication post initially successful surgery. Three patients reported numbness and one hearing loss after surgery. Kaplan Meier analysis 3 years after oxcarbazepine use and then 3 years after surgery showed that the mean time for recurrence of pain after oxcarbazepine treatment was 10 months whilst for surgery it was 28 months (P<0.0001). Pain free periods and types of complications post surgery varied and depended on the type of surgery performed. Due to the small numbers, it was not possible to analyse the different types of surgical procedures individually. Outcomes after any type of surgery were better on all evaluations and eight patients felt that they should have had surgery earlier. Oxcarbazepine is a potent antineuralgic drug with very good acceptability and tolerability. However, its effectiveness was rather short term necessitating surgical intervention. As surgery was associated with better outcome, patients may therefore benefit from having surgery earlier rather than later in the disease process in order to improve quality of life, freedom from medication and the need for regular follow up. Surgery does not provide pain relief for all patients. This is the first study that has compared outcome in a group of patients who have had both pharmacological and surgical treatments. As these data cannot be extrapolated to other antineuralgic drugs, similar comparative studies would be appropriate.
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PMID:Long-term cohort study comparing medical (oxcarbazepine) and surgical management of intractable trigeminal neuralgia. 1183 25

Multiple sclerosis is a complex neurological condition affecting sensory and motor nerve transmission. Its progression and symptoms are unpredictable and vary from person to person as well as over time. Common early symptoms include visual disturbances, facial pain or trigeminal neuralgia and paraesthesia or numbness of feet, legs, hands and arms. These, plus symptoms of spasticity, spasms, tremor, fatigue, depression and progressive disability, impact on the individual's ability to maintain oral health, cope with dental treatment and access dental services. Also, many of the medications used in the symptomatic management of the condition have the potential to cause dry mouth and associated oral disease. There is no cure for multiple sclerosis, and treatment focuses on prevention of disability and maintenance of quality of life. Increasingly a multi-disciplinary team approach is used where the individual, if appropriate his/her carer, and the specialist nurse are key figures. The dental team plays an essential role in ensuring that oral health impacts positively on general health.
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PMID:Multiple sclerosis and oral care. 1222 18

The etiology of trigeminal neuralgia is unknown, but both peripheral and central causes have been suggested. To investigate the role of central neurochemical mechanisms we measured epinephrine, norepinephrine and their breakdown product, vanilly mandelic acid (VMA), in the cerebrospinal fluid (CSF) of 16 patients (53.3 +/- 8.3 years) suffering from trigeminal neuralgia. As markers for the dopaminergic system, we determined CSF levels of dopamine and its metabolite homovanillic acid (HVA). As a marker for the serotonergic system, we measured CSF levels of serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA). In addition, levels of the neuropeptides substance P and somatostatin were determined. The concentration of norepinephrine (P < 0.01), VMA (P < 0.05) and HVA (P < 0.05) were significantly decreased in patients with trigeminal neuralgia and correlated with the duration of the disease and depression scores. 5-HIAA was also significantly decreased (P < 0.05) compared to control patients. Whereas substance P was significantly elevated (P < 0.05), somatostatin was significantly decreased (P < 0.05). Various correlations between the classical neurotransmitters and the neuropeptides could be established. We hypothesize than the sum of complex neurochemical changes plays a role in the etiology of trigeminal neuralgia, which can be separated in local and more central proceedings. The increase in substance P, a major nociceptive neuromodulator, supports the concept of a local neurogenic inflammation, possibly located in the trigeminovascular system. Depending on the duration of the disease and depression, the loss of serotonergic, dopaminergic and noradrenergic innervation seems to reflect more central changes, possibly due to alterations in their antinociceptive descending pathways.
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PMID:[Substance P, somatostatin and monoaminergic transmitters in the cerebrospinal fluid of patients with chronic idiopathic trigeminal neuralgia]. 1279 48

A 77-year-old woman with hypertension and senile depression had suffered from medically unresponsive trigeminal (left ophthalmic) neuralgia despite microvascular decompression surgery for twice. The patient underwent stereotactic gamma knife radiosurgery (77 Gy) for the neuralgia, resulting in pain relief. However, approximately 20 months after the radiosurgery, she developed left facial palsy with hydrodipsia, left xerophthalmia, and left facial hypesthesia. Oral prednisolone was administered, and these symptoms disappeared in several months. This is the first report of facial palsy following gamma knife radiosurgery for trigeminal neuralgia.
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PMID:[A case of delayed facial palsy following gamma knife radiosurgery for intractable trigeminal neuralgia]. 1616 95

This study presents the result of the studies explaining the effects of acupuncture on various systems and symptoms. It has been determined that endomorphin-1, beta endorphin, encephalin, and serotonin levels increase in plasma and brain tissue through acupuncture application. It has been observed that the increases of endomorphin-1, beta endorphin, encephalin, serotonin, and dopamine cause analgesia, sedation, and recovery in motor functions. They also have immunomodulator effects on the immune system and lipolithic effects on metabolism. Because of these effects, acupuncture is used in the treatment of pain syndrome illnesses such as migraine, fibromyalgia, osteoarthritis, and trigeminal neuralgia; of gastrointestinal disorders such as disturbance at gastrointestinal motility and gastritis; of psychological illnesses such as depression, anxiety, and panic attack; and in rehabilitation from hemiplegia and obesity.
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PMID:The mechanism of acupuncture and clinical applications. 1639 78

Trigeminal neuralgia (TN) is an uncommon neuropathic condition associated with excruciating facial pain. It is important to determine the effect of TN pain on patient functioning and to characterize relevant pharmacologic treatment patterns and health resource utilization in general practice. Eighty-two patients with TN were identified in a general practice setting during an observational survey of broad neuropathic pain syndromes in six European countries. Patients answered a questionnaire that included pain severity and interference items from the modified Short Form Brief Pain Inventory (mBPI-SF), the EuroQol Survey of functioning and well-being (EQ-5D), and questions related to current treatment, health status, and resource utilization. Physicians provided information on medications prescribed for TN pain and pain-related comorbidities (anxiety, depression, and sleep disturbance). The mean patient age was 62.7 +/- 15.8 years, 46% were > or =65 years, and 66% of patients had TN >1 year of duration. The mean Pain Severity Index was 4.2 (range 0-10), reflecting moderate pain despite 94% of patients taking prescription medications for their TN pain. Prescription medications included carbamazepine (mean daily dose 534.1 +/- 269.8 mg), the recommended first-line pharmacologic therapy for TN. Pain severity was significantly associated with reduced EQ-5D health state valuation (P < 0.001) and greater pain interference (mBPI-SF) (P < 0.001). These findings demonstrate that TN pain presents a substantial patient burden expressed as interference with daily functioning and reduced health status associated with pain severity. This burden may result from both suboptimal management strategies and the frequent resistance of this neuropathic condition to treatment, and suggests a need for more effective pain management strategies.
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PMID:Patient burden of trigeminal neuralgia: results from a cross-sectional survey of health state impairment and treatment patterns in six European countries. 1714 91

Paroxysmal pain in a 64-year-old woman diagnosed with trigeminal neuralgia disappeared with the administration of carbamazepine, but carbamazepine had to be discontinued because of intolerable lassitude and liver dysfunction. Afterward, the paroxysmal pain reoccurred, and depressive symptoms appeared. Milnacipran was then administered at a dosage of 50 mg/d for 2 months, and the paroxysmal pain and depression disappeared completely. Carbamazepine is the drug of first choice for trigeminal neuralgia, but the present results suggest that milnacipran is worth investigating for patients who do not respond to carbamazepine, who cannot stay on carbamazepine because of side effects, and who exhibit depressive symptoms.
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PMID:Successful treatment of trigeminal neuralgia with milnacipran. 1754 52

Deep brain stimulation is a minimally invasive targeted neurosurgical intervention that enables structures deep in the brain to be stimulated electrically by an implanted pacemaker. It has become the treatment of choice for Parkinson's disease, refractory to, or complicated by, drug therapy. Its efficacy has been demonstrated robustly by randomized, controlled clinical trials, with multiple novel brain targets having been discovered in the last 20 years. Multifarious clinical indications for deep brain stimulation now exist, including dystonia and tremor in movement disorders; depression, obsessive-compulsive disorder and Tourette's syndrome in psychiatry; epilepsy, cluster headache and chronic pain, including pain from stroke, amputation, trigeminal neuralgia and multiple sclerosis. Current research argues for novel indications, including hypertension and orthostatic hypotension. The development, principles, indications and effectiveness of the technique are reviewed here. While deep brain stimulation is a standard and widely accepted treatment for Parkinson's disease after 20 years of experience, in chronic pain it remains restricted to a handful of experienced, specialist centers willing to publish outcomes despite its use for over 50 years. Reasons are reviewed and novel approaches to appraising clinical evidence in functional neurosurgery are suggested.
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PMID:Deep brain stimulation: indications and evidence. 1785 Jan 94


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