Treatment. Facial neuropathy

Facial neuropathy, or trigeminal neuralgia, is a condition that affects the trigeminal nerve and results in painful sensations. The last may range from light to severe and usually appears in a pattern of attacks. Nowadays, there are various treatments available. Therefore, accurate diagnosis and treatment of trigeminal neuralgia are imperative.

Trigeminal neuralgia diagnosis

Generally, a doctor diagnoses trigeminal neuralgia based upon the patient’s description of the pain. It includes telling the healthcare provider about the type, location, and triggers of painful sensations. 

• Type. Pain resulting from facial neuropathy has a characteristic appearance: it is abrupt, shock-like, and brief.
• Location. Trigeminal neuralgia causes pain that locates in specific parts of the face.
• Triggers. Pain related to this condition usually appears after light stimulation of cheeks, such as eating, smiling, or being exposed to a cool breeze.

Additionally, the doctor may recommend some tests to diagnose trigeminal neuralgia and determine what causes this condition. They may involve:

• A neurological examination. It is the procedure during which the specialist determines the exact location of the pain by touching and examining parts of the patient’s face. Additionally, this method helps the doctor identify which branch of the nerve is affected. The doctor can also use reflex tests to determine whether compressed nerve causes the symptoms.
• Magnetic resonance imaging (MRI). The doctor orders an MRI scan of the head to determine if a tumor or multiple sclerosis is causing trigeminal neuralgia. Occasionally, the healthcare provider may inject a dye into an artery or vein to visualize the blood vessels and highlight blood flow. This procedure is called a magnetic resonance angiogram.

It is worth mentioning that accurate diagnostics is essential because there are a lot of facial pain sources aside from trigeminal neuralgia. Therefore, to ensure the proper diagnosis and assigned treatment, the doctor may recommend additional tests to rule out other possible conditions.

Trigeminal neuralgia treatment

Since facial neuropathy affects the nerves, traditional pain pills like generic anti-inflammatory drugs and opioids are not typically effective in controlling the pain that occurs with the disorder. Trigeminal neuralgia treatment options include medications, surgery, and rhizotomy.

Medications are usually the first, and sometimes the only, step in the treatment of trigeminal neuralgia. However, some people develop resistance to the drugs over time and stop responding to them. In addition, this treatment option might cause adverse side effects. If it is the case, surgery and injections can help to manage this condition.

Trigeminal neuralgia medications

Medications for trigeminal neuralgia aim to reduce or block pain signals sent to the brain. Available options may include:

• Anticonvulsants. This group of drugs is effective in managing facial neuropathy. However, some side effects can develop as a result of taking these medications. They may include drowsiness, nausea, dizziness, or confusion. Moreover, carbamazepine, one of the types of anticonvulsants, can induce a severe reaction in some patients. Therefore, it is recommended to perform genetic testing before taking this medication. It is worth mentioning that sometimes the patient’s response to the drug becomes reduced over time. In this case, the doctor would increase the dose. 
• Antispasmodic agents. The doctor can prescribe muscle-relaxing agents either alone or in combination with carbamazepine. However, side effects such as confusion, nausea, and drowsiness may develop.
• Botox injections. Some studies revealed that botox injections could reduce the pain resulting from trigeminal neuralgia. This treatment method can help patients who no longer respond to medications. However, more researches are needed. 

Trigeminal neuralgia surgery

Another trigeminal neuralgia treatment method is surgery. The options may include:

• Microvascular decompression. It is the relocation or removal of blood vessels in contact with the trigeminal root to restore normal nerve function. Generally, the surgeon only relocates arteries but can remove the vein if needed. Moreover, if arteries don’t press on the nerve, the doctor may partially cut the trigeminal nerve during the surgery. For most patients, this procedure eliminates or reduces the pain. However, painful sensations can recur in some people. Notably, such a surgery poses some risks, including facial weakness or numbness, decreased hearing, stroke, or other complications. Still, most patients don’t experience facial numbness after undergoing the procedure.
• Brain stereotactic radiosurgery (Gamma knife). It involves the direction of a focused dose of radiation to the root of the trigeminal nerve. As a result, radiation damages the nerve and lessens or eliminates pain. Notably, relief typically comes gradually and may take up to a month. However, sometimes pain can recur. In this case, the surgeon can repeat the procedure. Facial numbness can develop as a side effect.

Other trigeminal neuralgia treatments

Another possible treatment option is rhizotomy. It is the destruction of the nerve fibers to reduce the pain. However, this method results in some facial numbness. There are several types of rhizotomy that include:

• Glycerol injection. The doctor injects a small amount of sterile glycerol into the trigeminal cistern. It causes damage to the trigeminal nerve and blocks pain signals relieving the pain. However, some patients experience recurrence of pain, and many encounter facial numbness or tingling.
• Radiofrequency thermal lesioning. It involves selective destruction of nerve fibers associated with pain. This effect is accomplished by heating an electrode connected to the trigeminal nerve until it damages the nerve fibers and creates a lesion (injury). Doctors may create additional lesions if the pain doesn’t go away. Temporary numbness in the face is often a result of radiofrequency thermal lesioning. It is worth mentioning that the pain may recur after three to four years.
• Balloon compression. The doctor damages the nerve and blocks pain signals by inflating the balloon located in the part of the nerve that goes through the base of the skull with enough pressure. This procedure is effective in controlling pain for most people, at least temporarily. Most patients experience some temporary facial numbness after undergoing balloon compression.

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