In 1962, Blom introduced the antiepileptic drug tegretol ( carbamazepine , finlepsin , stazepine ) into the practice of treating trigeminal neuralgia , which opened up real prospects for the successful treatment of this severe suffering. In the Soviet Union, other antiepileptic drugs were successfully used for the treatment of trigeminal neuralgia : trimethine, ethosuximide ( suksilep ), morpholep , clonazepam, sodium valproate .
The use of antiepileptic drugs should be combined with the appointment of vitamins B] and B12, and in patients with common vascular diseases – compliment , trental , no-shpa, nicotinic acid. Physiotherapeutic procedures are also known, such as diadynamic or sinusoidal modulated currents, UHF therapy, hydrocortisone phonophoresis , ultrasound, electrophoresis of novocaine, salicylic sodium, etc. If local inflammatory processes (sinusitis, dental diseases) are detected, treatment should be aimed at eliminating them.
The low effectiveness of conservative treatment of trigeminal neuralgia before the use of antiepileptic drugs has led to the development of various methods of surgical treatment, many of which are currently of only historical interest. Operations are applied both on the peripheral branches of the trigeminal nerve, and on intracranial structures. “Chemical transection” of a nerve by introducing 80% alcohol with novocaine into the exit site on the face is almost not currently used, since it gives only a temporary effect. With the regeneration of the nerve, the pain resumes, a productive process occurs in the nerve, which leads to a decrease in the effectiveness of repeated blockades and antiepileptic drugs. They successfully cut the nerve with a lyophilized dura mater wrapping its central end , removing the walls of the infraorbital canal, closing the mandibular canal with a pin , introducing hot water into the trigeminal node and the root of the trigeminal nerve, as well as stereotactic destruction of the node.
Glossopharyngeal Neuralgia
It is much less common trigeminal neuralgia. The etiology of the disease is poorly understood. Among the established causes, tumors and osteophytes of the jugular opening, cicatricial changes in the nerve root, and aneurysms are described.
The disease is characterized by attacks of acute (tugging, boring) pain lasting several tens of seconds, localized in the root of the tongue, tonsil, palatine arch. Often pain radiates into the ear, into the throat, around the corner of the lower jaw. Paroxysms of pain can be accompanied by fainting conditions with bradycardia , a drop in blood pressure. This, obviously, is due to the fact that the depressor passes through the glossopharyngeal nerve , which carries impulses from the carotid sinus to the vasomotor center. Trigger zones are found at the root of the tongue, on the tonsil, palatine arch. Pain is provoked by swallowing, especially hot or cold food, coughing, laughing, etc. Patients avoid communication, try to swallow “on one side”, eat only warm, liquid food.
The treatment is the same as for trigeminal neuralgia. In cases of detection of processes that compress the nerve, surgery is indicated.
Neuralgia of the superior laryngeal nerve
An extremely rare disease, the cause of which is unknown. It is manifested by bouts of excruciating pain lasting from several seconds to a minute, localized in the larynx. Along with pain, bouts of severe coughing can be observed. On palpation on the lateral surface of the larynx above the thyroid cartilage (the site of perforation of the upper laryngeal nerve membrana thyreoidea ), a pain point is noted, pressure on which can cause an attack. Conservative treatment is the same as with trigeminal neuralgia.