Trigeminal Neuralgia

Trigeminal Neuralgia is a painful condition wherein a patient suffers attacks of facial pain. The pain associated with trigeminal neuralgia is shooting and jabbing, much like sudden burst of live wires on the face. While these episodes of pain may be few and far between in the initial stages, the attacks are more frequent and painful as the disease progresses. It can be felt on a small portion of the face or the larger area. In most cases, it affects just one side of the face. The trigeminal nerve, originating from deep in the brain serves the facial area. Any disturbance in its function leads to trigeminal neuralgia or tic douloureux. The possible causes for the pain are stroke, tumor or multiple sclerosis. Usually this disorder is noticed in persons over 50 years and women seem to be more affected by it than men.

The pain associated with trigeminal neuralgia is so intense that it affects the day-to-day life of the patient. Activities like eating, drinking, shaving, brushing the teeth and talking can become agonizing. Consequently, it leads to anxiety and irritability and nutritional deficiencies since the patient is likely to avoid eating. A patient may need to be hospitalized if the pain is acute. An MRI of the head may be suggested to aid diagnosis.

Trigeminal Neuralgia is treated with carbamazepine - a drug used to treat seizures and convulsions. Other drugs include baclofen, gabapentin, clonazepam, lamotrigine, topiramate and sodium valporate. But these drugs are not without unpleasant side effects. Percutaneous stereotactic radio frequency thermal rhizotomy (PSRTR) is a procedure whereby a doctor passes electric current to damage the nerve fibers that cause pain. Alternatively MVD (Microvascular decompression) can also ease pain without damaging any part of the trigeminal nerve. But there are inherent risks such as facial weakness or reduced hearing. High dose radiation is used to damage the root of the trigeminal nerve. This can be successful in reducing pain. Percutaneous glycerol rhizotomy (PGR) is a surgical procedure involving injection of small amounts of sterile glycerol into the skin to block pain signals.

Botox

Botox is the brand name for Botulinum Toxin Type A. It is a protein complex produced by the bacterium 'Clostridium botulinum' - the same bacterium that causes the form of food poisoning known as botulism. Botox, however, is a purified form of this bacterium. Dermatologists used it to treat muscle disorders such as uncontrolled blinking. Botox was approved by the FDA in 1989 to treat eye muscle disorders such as blepharospasm, uncontrollable blinking, and strabismus, - crossed eyes. In 2000, it was approved to treat cervical dystonia (a disorder that causes severe neck and shoulder contractions). As an unusual side effect of the eye disorder treatment, doctors observed that Botox softened the frown lines between the eyebrows.

When Botox is injected through the skin into the muscle with a needle, it keeps the muscle from contracting. Because of this temporary paralysis, wrinkles become less obvious. A trained doctor will inject small amounts of Botox into a small part of the muscle to render it immobile. The horizontal wrinkles of the forehead, the vertical 'frown' wrinkles of the brow (between the two eyebrows) and crow's feet beside the eyes are the areas best suited to Botox cosmetic.

Small doses of botox are injected directly into the muscles of the face. Prior to injecting botox, the doctor will first determine the area of injection based on the person's ability to move certain muscles in the brow area. An improvement in frown lines will be noticed within 3- 7 days and could last up to 4 months. However results may vary. Although there is no chance of contracting botulism from Botox injections, there are some risks associated with the procedure. If too much toxin is injected or if it is injected into the wrong facial area, a person can end up with droopy eyelid muscles that could last for weeks. This particular complication was observed in clinical trials. Other botox side effects are:

• Headache
  
• Flu like symptoms
  
• Temporary eyelid drop
  
• Nausea
  
• Squint/Double vision
  
• Twitching of eye
  
• Facial pain
  
• Redness at injection site
  
• Muscle weakness
  

Botox procedures are not recommended for pregnant women or those suffering from neurological disorders. Possible allergies must also be looked into. A qualified dermatologist is the best person to administer botox treatments. This minimizes the potential for misuse. Botox treatment is resorted to by those who do not wish to face the risk of surgery and prefer being treated for a few minutes every three to four months.