Webinar
Chronic Pain Management (Part 1): Dealing with Excruciating Pain- Trigeminal Neuralgia
Saturday, July 18th, 2020, 10:30:00 AM
Ask Dr Nicolas Kon about:
Some questions you can ask are:
- Am I at risk for Trigeminal Neuralgia?
- What are the symptoms for Trigeminal Neuralgia?
- Is it treatable or curable?
After completing medical school, Dr Nicolas Kon continued his medical training in neurosurgery and neurocritical care at various institutes in the UK which include the National Hospital for Neurology and Neurosurgery (London), Charing Cross Hospital (London), Addenbrooke’s Hospital (Cambridge) as well as the National Neuroscience Institute (NNI) in Singapore. He obtained his PhD at Imperial College London and subsequently completed his fellowship at Toronto Western Hospital, University of Toronto in Canada. Before practising at Mount Elizabeth Hospital. Currently, he is an Adj Associate Professor at the Yong Loo Lin School of Medicine, NUS. He is actively involved in several clinical and translational research and multi-centre international trials. In addition, he holds several patents for his discoveries. He has authored more than 80 peer-reviewed publications and serves on the Centralised Institutional Review Board. Dr Kon is the first neurosurgeon to use the Brainpath minimally invasive neurosurgical technique in Asia. He has a longstanding commitment to neurosurgery and has received a long service award from the National Neuroscience Institute, Singapore for his contribution. In addition, Dr Kon also has a strong passion towards patient care and has been awarded several Service with A Heart awards by the SGH.
Questions 10
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.
Is trigeminal neuralgia caused by an inflammation of the blood vessel?
Trigeminal neuralgia itself is caused by compression, as the vessel rubs against the nerve and that damages the nerve as it rubs more and more. It is not a blood vessel problem but rather the compression and rubbing on the nerve that causes the damage.
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.
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.
What is the prognosis and recurrence rate post surgery of trigeminal neuralgia surgery?
Essentially immediately after surgery, up to 90% patients feel that their pain is better and then we stop them on whatever drugs they are on for the next few weeks. There is a chance of recurrence with time the symptoms may come back and about 20% of patients do find that there is a recurrence in the next 5 years.
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.
Can gabapentin be an alternative drug for trigeminal neuralgia?
Gabapentin is another medication commonly used for pain of nerve origin, so a neuropathic pain. It can be tried as an alternative; some patients may need a combination of both carbamazepine plus Gabapentin for it to work. Especially if patients have a lot of side effects from carbamazepine where they may need to deal with dizziness or sleepiness.
Which nerves and blood vessels are compressed in trigeminal neuralgia?
The nerve most commonly affected is the fifth cranial nerve, aka the trigeminal nerve, while the vessel itself is the superior cerebellar artery.
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.
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.