Trigeminal+Neuralgia

According to Gronseth (2010), TN is caused by a blood vessel coming in to close contact with the trigeminal nerve. There are however, many reasons for this – neuropathic pain. The fifth cranial nerve is the trigeminal nerve (Gronseth, 2010). This disease is like a morphological nightmare (– in my opinion). There are many variations to this disease in regards to the type of pain and degree of its intensity.

Trigeminal Neuralgia was first named and formerly recognized in the early 1800’s by Heberden, and by John Fothergill in 1773, it was initially called Fothergill’s disease. It is also noted in even earlier times through similar but yet diverse symptoms, by some in the earliest centuries. For example, descriptions were documented by Artaeus of Cappadocia, who was born in 81 AD. There are also others that described the suffering from Bishop’s in 1274 and also a German physician named JL Bausch. He himself suffered from the disease and died from the residual effects. There are many others that have suffered from TN, including the wife of the Ambassador to France. Each seem to have similar and somewhat different descriptions of the pain. Some describe it as a tooth pain, others the lighting on a single side of the face. Then there are those that described it as a part of the tic douloureux. The reason it was called Fothergill’s disease initially, must be because John Fothergill presented his finding to the Medical Society in London in 1773. He was a respected man of his field and documented at least 14 cases. He noted it was more common with females than males. (Pearce, 2003).

The artery that compresses the nerve is related to the actual pain that is – shot like an injection of electrical or lightening shocks through the nerves into the facial area or a sever burning sensation (Tropy, Rogers, and Golub, 2013). This can occur through the single branch, two branches or all three. Three branched nerves in the face – either side are affected. In order to find some form of relief, medications are often prescribed. The common medications prescribed include; as carbazepine and oxycarbazepine. However, for many people these medicines do not work. Surgery is a possible option for those people.

Surgery such as the gamma-knife procedure uses radiation applied to the nerve and the nerve is compressed by a catheter inserted into the nerve with a balloon. The nerve is then chemically degenerated by glycerol to the point that the damaged nerve stops sending the pain responses. Another procedure is based on microvascular decompression. This process puts a barrier between the blood vessel and the nerve to inhibit their connection. This last surgical procedure is longer lasting. Neither are risk free, and the gamma –ray procedure does not always work (Gronseth, 2010).

There are many responses that occur from the distinct pattern of nerves that are misbehaving. There are recent hypotheses on the TN diagnosis patterns and TN’s actual neural- causes cause (Devor, Amir and Rappaport, 2002), but as far as root cause what triggers the disease to begin its painful attack is not clearly defined. For instance, some TN patients may have underlying conditions that instigated the TN disease. This could be due to trauma, tumors or multiple sclerosis.

Figure 1 shows the trigeminal nerve root gets pushed by the artery of that is pulsating past. The pulse should glide by without causing undue stress or pressure on the Trigeminal nerve. However with TN disease, the pulse will push on the nerve causes irregular activity (Kaufmann and Patel, 2001). The normal nerve and artery positions are shown in Figure 2.

Fig. 1 Depicts the abnormal compression that causes the patient severe pain.



Figure 2. The lack of compression allows the group of nerves to function normally.



The pain arise from the three nerves of the trigeminal nerve group:– V1, V2 and V3 that are racing down the side of the human face. These branches of nerves are ones that go across the lower face, the upper- mouth area and the eye (Gronseth, 2010). The most specific definitive way to describe TN is to state it as a distinct abnormalities of the trigeminal root or ganglion area – related to the afferent neurons of the Trigeminal. The injury causes hyper-excitability within the axons and axotomized somata. This brings on the pain paroxysms within the TN area (Devor, Amir and Rappaport, 2002). Figure 3 clearly identify the importance of the Trigeminal nerve system. It shows the main nerve branches and the secondary branches that are a subclass of smaller branches of nerves extending form the main system. (Anonymous 2004)



Current studies examine more ways to limit the pain but not find a cure. One of the latest studies involve using the gama-ray surgery. There are multiple studies for this relief surgery. However, there another surgery being used called transcranial MR-guided focus ultrasound surgery for TN. MRgFS is a form of neurosurgery that was not thought to be able to work on the TN pathway. So a cadaver model was used to simulate the surgery and is being considered for live patients or at least in vivo studies. 

 Literature Cited

Anonymous. 2004. Lecture #5 Nerves in dentistry and anesthetic. Dentin.Net. http://www.dentin.net/sguide5.htm Gronseth G. S. 2010. Ask the Experts: Trigeminal Neuralgia. Neurology Now, 6:2, 32. Kaufmann A. M. and M.Patel. 2001. Your Complete Guide to Trigeminal Neuralgia. University of Manitoba. Pearce J. M. S. 2003. Trigeminal neuralgia (Fothergill’s disease) in the 17th and 18th centuries. Journal of Neurology, Neurosurgery & Psychiatry 74: 12, 1688-1688. Rapoport, S. I. 1999. How did the human brain evolve? A proposal based on new evidence from in vivo brain imaging during attention and ideation. Brain research bulletin, 5:3, 149-165. Torpy J. M., J.L. Rogers and R. M. Golub. 2013. Trigeminal Neuralgia. JAMA, 309:10, 1058-1058. Figure 3 Image []