55 Questions answered
Why is raising awareness for Trigeminal Neuralgia important?
As a functional neurosurgeon, I know that there are effective treatments for Trigeminal Neuralgia that can help patients. What I find is that in Singapore, and many of the other parts of the world as well, there are not enough support groups. The awareness of this disease is probably not as good as it should be. So, I think one of the aims is to raise awareness on uncommon diseases and also, because it is less known as a disorder, patients find that they are bouncing from doctor to doctor, until they find the right doctor to treat them.
Is numbness a symptom of trigeminal neuralgia?
Numbness is not frequent in trigeminal neuralgia. In classic trigeminal neuralgia, patients have no neurological findings and no numbness or weakness on their face. If they do have numbness, we may need to investigate it more.
How does trigeminal neuralgia feel like?
It is an acute severe pain and the most classic way it feels is a severe stabbing electric-like pain. Not everyone has the classic form though.
How does one get diagnosed for trigeminal neuralgia?
It is a clinical diagnosis. MRI is not necessary for the diagnosis but to confirm the compression. If there are no symptoms from trigeminal neuralgia, it may not be important to diagnose it. There are patients occasionally who have an MRI scan where it looks like their nerves are compressed by blood vessels, but show no symptoms. So they might have trigeminal nerve compression but without the neuralgia.
What is Trigeminal Neuralgia?
Trigeminal Neuralgia is not a common disorder, but is also not as uncommon as you think. Trigeminal Neuralgia is a type of facial pain that affects half the face and has a very characteristic feature, like sharp and shooting pain. We’re not really sure what the incidence is in Singapore. There is no exact data, but around 0. 03% of the population has it. So, maybe several thousand patients have it per year.
Does trigeminal neuralgia affect one’s lifestyle and diet?
The triggers for many patients become clear over time. For many of them, it is about avoiding those triggers, so for many of them, they will not brush one side of their teeth or brush less and be gentle about it. When they are washing their face, they have to wash it carefully and, sometimes, they forget and they have a sudden attack or pain that sets as a trigger.
Are there any contraindications for Rhizotomy?
Rhizotomy is where we use a needle to go through the cheek to reach the nerve near the base of the brain. It's quite a long needle. There is no specific contraindication per se, things like patients being on anticoagulant medication being the key one. I think the main thing in terms of choosing rhizotomy versus something else is the symptom duration and how long the patient expects to be controlled like I said rhizotomy does not last so long and there is a higher failure rate.
Are MRI scans necessary before proceeding with surgical procedures for trigeminal neuralgia?
Usually yes. We can discuss surgical treatment, but we would not want to proceed before having an MRI scan.
Is Trigeminal Neuralgia a new disorder?
It is not a new disorder. It has been known since the early 1800s, described and written in the medical literature. In the 1970s, people developed a surgical technique that helped to cure this problem, after which there has been more emphasis and awareness placed on disease as well.
Is trigeminal neuralgia similar to fibrous dysplasia?
No. It is different. Pain on the face may be from various reasons and in this case, it’s a specific cause for this that we can treat. The underlying cause is different, thus treatment is different as well.
What is the maximum duration of carbamazepine for trigeminal neuralgia?
There have been patients who have been on this drug for 30 years. Because their symptoms are not so severe, it can be used for a very long time. There are some side effects like a drop in sodium level for example, but it can be used for quite a while. If it's not successful, there are other medications that can be tried like Phenytoin or other drugs in terms of treatment. But we generally find that patients have to add more and more medications to it and it becomes less and less effective. If one medicine fails, the chances of the second one failing increases.
What are the possible reasons that microvascular decompression procedure (MVS) fails?
There may be many causes of failure. It could be surgical factors, the nerve and blood vessels compressed, and occasionally people may miss the compression. So these are the technical factors in any kind of procedure. Occasionally the pain reoccurs even though it has been decompressed correctly. Not everything is known about trigeminal neuralgia, and there are other factors that may cause the pain to recur as well, despite adequate decompression.
Is there any new research or technology for trigeminal neuralgia that we should be aware of?
There are more types of medication that are always promoted for Neuralgia. Eventually, most of the patients become numb to them and they have to take increasing doses with side effects. So, there are some limits medication can offer. As it worsens, patients find themselves on 2-3 medications, which I personally feel is very unsatisfactory because we just keep adding medication. In terms of surgical treatment, it has become safer and safer.
Are there disorders commonly mistaken for Trigeminal Neuralgia?
There is quite a variety of facial pain that affects people. Trigeminal Neuralgia itself is classic in the sense that there are certain types of symptoms you get which makes it a clear clinical diagnosis of Trigeminal Neuralgia. Some patients find the symptoms may evolve, change, and develop atypical features, meaning features that are not so commonly seen in the classic form. These may have a cause similar to Trigeminal Neuralgia, but just a bit different. Dental problems or headache may also affect the face.
Can trigeminal neuralgia symptoms present on both sides of the face?
Very rarely, yes. Most of the time trigeminal neuralgia is on one side of the face. On the MRIs, we may find compression on both sides, but they may not have symptoms on both sides. If someone has symptoms on both sides, we have to look at a different diagnosis.