Trigeminal Neuralgia and Multiple Sclerosis
Trigeminal neuralgia, also known as tic douloureux, is an extremely painful nerve disorder that occurs in about 3 to 4 percent of individuals who have multiple sclerosis. About 2 to 4 percent of patients with trigeminal neuralgia have MS.
Approximately 4 million people around the world and 45,000 in the United States have been diagnosed with trigeminal neuralgia, which has the unfortunate distinction of being called the suicide disease. That’s because the intense pain associated with this nerve, which is one of the largest that carries messages from the brain to the face, drives about 50 people per year to commit suicide.
The electric shock-like pain usually affects the jaw and lower face, although it can attack around the nose and above the eye. Most people experience the pain on one side of the face only.
Causes of trigeminal neuralgia
This condition is caused by irritation of the trigeminal nerve, which travels up both sides of the head. Each nerve has three branches, each of which is responsible for either (1) sensation in the eye, upper eyelid, and forehead; (2) sensation in the lower eyelid, cheek, nostril, upper lip, and upper gum; and (3) sensation in the jaw, lower lip, lower gum, and muscles used for chewing.
Typically, the pain occurs when there is contact between the trigeminal nerve at the base of the brain and a healthy vein or artery. The pressure on the nerve causes the nerve to misfire.
Trigeminal neuralgia also can occur when the myelin sheaths are damaged, as in multiple sclerosis. When the condition develops in young adults, multiple sclerosis may be the cause. In fact, trigeminal neuralgia can be an initial symptom of MS.
Women are twice as likely as men to develop trigeminal neuralgia, and the condition usually affects people older than 50. When the pain occurs, it can last for as long as 2 minutes at a time, and multiple events can occur throughout the day. Triggering events can be as simple as a gentle breeze, talking, smiling, chewing, swallowing, or a light touch.
Diagnosis and treatment of trigeminal neuralgia
Use of magnetic resonance imaging (MRI) can let you know if multiple sclerosis or a tumor is irritating the trigeminal nerve. If neither of these factors are involved, then the cause of trigeminal neuralgia may not be found.
Trigeminal neuralgia is usually treated with an anticonvulsant drug called carbamazepine. One significant problem with this drug is that it becomes less effective over time. Side effects can include dizziness, double vision, drowsiness, and nausea.
Two other anticonvulsant drugs are also prescribed: oxcarbazepine, which is similar to carbamazepine but has fewer side effects; and phenytoin, which was the first drug ever used to treat this condition and can cause balance problems, drowsiness, and gum overgrowth.
A muscle relaxant called baclofen is sometimes used to treat trigeminal neuralgia. Its side effects include confusion, depression, and drowsiness. Other drugs may be prescribed, but they often require high doses to be effective. They include clonazepam, gabapentin, lamotrigine, sodium valproate, and topiramate.
Surgical procedures may help individuals who have not responded to medications. Two general types of surgical treatments are available: through the skin or open.
Through the skin approaches are recommended for individuals who have multiple sclerosis, who are elderly or medically frail, or anyone who has not gotten relief from the open method. The latter approach is usually reserved for younger, healthier individuals.
Some of the available surgical techniques to treat trigeminal neuralgia are listed below. You should discuss all options with your healthcare provider.
- Microvascular decompression is an invasive procedure that involves moving a blood vessel away from the trigeminal nerve. The procedure is done through an opening in the skull. There is a small risk of double vision, stroke, facial numbness, facial weakness, decreased hearing, or death associated with this approach.
- Percutaneous stereotactic rhizotomy destroys the part of the nerve that causes the pain. A needle is administered through the cheek into the trigeminal nerve. Heat is passed through the needle to destroy some of the nerve fibers.
- Stereotactic radiosurgery is a noninvasive approach that involves administering a single, highly concentrated dose of ionizing radiation to a site at the trigeminal nerve root. This causes the slow formation of a lesion that eventually interrupts transmission of pain signals to the brain. This method avoids many of the risks and complications of other treatments.
Trigeminal neuralgia is not common among people who have multiple sclerosis. However, for those who suffer with it, understanding the condition and how to treat it are critical and should be discussed with a neurologist.
Also read about alternative treatments for MS