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- $Unique_ID{BRK00870}
- $Pretitle{}
- $Title{What is "Tic Douloureux"?}
- $Subject{tic douloureux pain Ill Defined Symptoms symptom nerves trigeminal
- neuralgia tics sharp stabbing spasms blood vessel pressure trigeminal nerve
- tumors multiple sclerosis aneurysms angiomas posterior fossa microvascular
- decompression operation percutaneous radiofrequency coagulation}
- $Volume{N-2}
- $Log{}
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- Copyright (c) 1991-92,1993 Tribune Media Services, Inc.
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- What is "Tic Douloureux"?
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- QUESTION: I have a condition called "tic douloureux" (painful tic). It took
- many years before a neurologist finally diagnosed it. What can you tell me
- about it and its treatment?
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-
- ANSWER: Most patients with this condition would agree that "painful tic" is
- an appropriate name for what is known medically as trigeminal neuralgia, or
- "tic douloureux". Patients complain of sudden and excruciating pain on one
- side of the face that feels sharp and stabbing, sometimes like an electric
- shock.
- The pain occurs in spasms, subsides rapidly, and can be triggered by such
- activities as talking, eating, feeling the wind blow against the side of the
- face, seeing flashing lights, or even hearing sudden noises.
- Although sometimes difficult to identify because of the many conditions
- which may provoke the symptoms, a careful diagnostic workup usually results in
- establishing the precise diagnosis. There are a number of treatments,
- although some do pose certain risks.
- Trigeminal neuralgia is often caused by pressure from a blood vessel
- pulsating against the trigeminal nerve. Other causes are blamed on tumors,
- multiple sclerosis, aneurysms, and angiomas.
- If diagnostic tests rule out causes like tumors that require specific
- treatment, your doctor will probably try drug therapy first. Phenytoin or
- carbamazepine are two of the most popular choices, since both are generally
- effective with long lasting results, although both can cause side effects.
- If your pain is especially severe, your doctor can also inject a local
- anesthesia and/or prescribe a narcotic pain reliever.
- If drug therapy is unsuccessful in alleviating your pain, other
- treatments can be used, but these can be risky:
- Injections of alcohol, glycerol, phenol, and hot water into part of the
- trigeminal nerve can block the action of the nerve, thereby stopping pain, but
- this procedure can also cause loss of feeling in the face.
- Surgically cutting or separating the trigeminal nerve branch relieves
- pain longer than injections, but again, this is another treatment that can
- cause numbness.
- The most common procedure performed today is posterior fossa
- microvascular decompression. This operation involves separating the blood
- vessel that is pressing against the trigeminal nerve by placing a small
- plastic implant, or similar device, between the vessel and the nerve to keep
- them apart.
- About 80 percent of patients find pain relief with this operation for up
- to five years. Although this procedure does not cause a loss of sensation in
- the trigeminal nerve, it can cause problems like hearing impairment and
- hemorrhage.
- Another popular procedure is percutaneous trigeminal radiofrequency
- coagulation. A general anesthetic is injected through an insulated needle;
- then a radio frequency current is used to coagulate the branches of the
- trigeminal nerve.
- This procedure relieves pain in 80 to 98 percent of patients, but it too,
- like many of the other treatments, may have complications. The proper choice
- of treatment depends upon your special case, and is one that will provide the
- greatest chance of relief with the least risks.
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- The material contained here is "FOR INFORMATION ONLY" and should not replace
- the counsel and advice of your personal physician. Promptly consulting your
- doctor is the best path to a quick and successful resolution of any medical
- problem.
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