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What about Treatment?

Controlling the symptoms of TN

Even before diagnosis, it is possible that you will have been placed on medication due to the excruciating nature of the pain. The usual range of painkilling medications, even morphine, have no effect so it is necessary for you to be prescribed anticonvulsant drugs(used to treat epilepsy) - the first-line one being carbamazepine  - and sometimes antidepressants.  These drugs were never specifically designed for TN but they “dull down” the nervous system dramatically.  It is important to start on a low dose of medication and very gradually, over a number of days or weeks, increase the dose until hopefully the pain is under control or relieved altogether.

Dosages should be monitored by your medical practitioner and certain medications require regular blood tests.  Sometimes, a mixture of medication may be prescribed, depending on your type of pain.  You may have to try a few medications before finding the one best suited to you.  Anticonvulsants do have side effects and it is common for TN patients to experience drowsiness, dizziness, unsteadiness, confusion, blurred vision, memory problems, difficulty in concentrating and nausea.

It is also possible to have an extreme allergic reaction to some anticonvulsants.  In this case, which can involve a serious rash, you should seek urgent medical attention.  However, it can sometimes be dangerous to cease medication suddenly, so always visit your medical practitioner if you have any concerns, especially if you are feeling very depressed. 

Double Choice

© M. Willett

Surgical treatment

If your pain persists after a few months on the medication, or if the side effects are so serious that your quality of life has become significantly impaired, a surgical procedure may be an option for you.  TN may have a significant and adverse effect on the quality of your life.  You may be living in fear of another attack and you may feel isolated and alone.

You may also begin to feel very despondent through your inability to function as an individual.  If so, it will be necessary for you to make an informed decision about your future treatment and this may include surgery.  However, please bear in mind that certain surgical procedures are not suitable for anything other than classic trigeminal neuralgia and if you do not have the correct diagnosis, surgery may make your situation far worse.

Surgery can broadly be split into two categories:  non-invasive and invasive.  Non-invasive surgeries include injections through the cheek (commonly known as percutaneous procedures) and Sterotactic Radiosurgery (eg, Gamma Knife, LINAC and Cyberknife) which does not involve an incision but is a dose of radiation.  Invasive surgery is Microvascular Decompression (MVD) which involves opening the skull and lifting the offending blood vessel(s) away from the nerve, or Internal Neurolysis (IN) which involves "combing" the nerve.

Whichever option you decide upon, it is important to recognise that all procedures have risks.  Before making any decision, it will be necessary to research your options thoroughly and in conjunction with your medical practitioner.  If you wish to explore the surgery options, it is advisable to see a neurosurgeon.  This can be arranged through your GP.












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Page last updated on 11 Aug 2015