Treatment
What Medical Treatment is Available?
There are various medical and surgical treatments for TN. The usual process is to start with medications, most commonly anticonvulsants originally developed to treat epilepsy. Patients need to understand that these medications do not work like painkillers; you need to maintain a therapeutic level of medication in your blood for effective relief of the pain. Regular blood tests are needed in order to check the medication level in your blood. Taking the medication irregularly is not effective. To avoid severe side-effects, the medication is increased or decreased slowly, according to your doctor's advice. After the patient is pain-free for about 3 to 6 weeks, the medication is then slowly tapered. Abrupt withdrawal can lead to serious side-effects. Always maintain good communication with your doctor when you are under medical treatment: it will allow him to find the right treatment and the right dose you need to stop the severe attacks of pain. Most commonly used anticonvulsants are: carbamazepine (Tegretol); oxcarbazepine (Trileptal); baclofen (Lioresal); gabapentin (Neurontin); phenytoin (Dilantin, Epanutin). Treatment can also include antidepressants such as amitriptyline.
What Surgical Options Are There?
When medications are not working, or when severe side-effects are unacceptable, surgery is considered. You will need to be referred to a neurosurgeon with experience in TN.
Surgical procedures vary from nerve blocks through the cheek to open skull surgery or radiation. It is a difficult decision to make, and it is your referring doctor's and neurosurgeon's duty to inform you about all the procedures available.
Simple surgical procedures are used to damage the TN nerve in order to block the electrical activity transmitting the pain. They involve passing a needle through the cheek under local anaesthetic. Then the nerve can be: bathed in glycerol (glycerol injection), frozen (cryotherapy), heated (thermocoagulation or radiofrequency rhizotomy), or compressed with a small balloon (balloon compression). These procedures leave a feeling of numbness in the face. The average period of relief varies from a few months to a few years. They can be repeated easily.
The other option is Microvascular Decompression (MVD). An opening is made behind the ear, and the surgeon moves away all blood vessels or arteries compressing the nerve. It requires a general anaesthetic and a minimum stay of approximately one week in hospital. Numbness in the face is extremely rare. 95% of patients have immediate relief after an MVD; about 75% are still pain-free 5 years later.
Gamma Knife is a fairly new procedure involving radiation beams targeted with high precision to the base of the nerve. Although the first results are promising, there is no long-term study on the success rate, and there are only three hospitals in the UK which carry out this procedure . But it has many advantages for the patient, as it is mostly pain-free and non-invasive.
The usual process when you have TN is to try medications first. Then, if pain persists or returns, you can consider having surgery. MVD is generally recommended for younger healthy patients, because this is their best chance for long-term relief. Peripheral procedures are recommended for elderly or frail patients, or for those who do not want to take the risks associated with major surgery but would accept a feeling of numbness in the face.
Having surgery is an important decision to make, and it should be discussed with an experienced neurosurgeon who can explain all possible side-effects and consequences of the operation. There is no procedure that is 100% sure to be effective. It is therefore important to receive clear and complete information before making a decision.
This page was updated on 25 July 2011
