Trigeminal Neuralgia Trigeminal neuralgia is inflammation of the

  • Slides: 23
Download presentation
Trigeminal Neuralgia

Trigeminal Neuralgia

 • Trigeminal neuralgia is inflammation of the trigeminal nerve, causing intense facial pain,

• Trigeminal neuralgia is inflammation of the trigeminal nerve, causing intense facial pain, paroxysmal, sharp pain and follow by lacrimation, facial spasm. • It is also known as tic douloureax because the intense pain cause patients to control their face into a grimace and cause the head to move away from the pain

Causes trigeminal neuralgia • Most often, the cause of trigeminal neuralgia is idiopathic, •

Causes trigeminal neuralgia • Most often, the cause of trigeminal neuralgia is idiopathic, • There are some instances when the nerve can be compressed by nearby blood vessels, aneurysms, or tumors.

Causes trigeminal neuralgia • There are inflammatory causes of trigeminal neuralgia because of systemic

Causes trigeminal neuralgia • There are inflammatory causes of trigeminal neuralgia because of systemic diseases including multiple sclerosis, sarcoidosis, and Lyme disease. • There also is an association with collagen vascular diseases including scleroderma and systemic lupus erythematosus.

Symptoms of trigeminal neuralgia • Acute onset of sharp, • Stabbing pain to one

Symptoms of trigeminal neuralgia • Acute onset of sharp, • Stabbing pain to one side of the face. • It tends to begin at the angle of the jaw and radiate along the junction lines; • Between the ophthalmic branch. V 1 and maxillary branch V 2, or the maxillary branch V 2 and the mandibular branch V 3.

Symptoms of trigeminal neuralgia • The pain is severe and described as an electric

Symptoms of trigeminal neuralgia • The pain is severe and described as an electric shock. • It may be made worse by light touch, chewing, or cold exposure in the mouth. • In the midst of an attack, affected individuals shield their face trying to protect it from being touched. • This is an important diagnostic sign because with many other pain syndromes like a toothache, the person will rub or hold the face to ease the pain

Symptoms of trigeminal neuralgia • While there may be only one attack of pain,

Symptoms of trigeminal neuralgia • While there may be only one attack of pain, the person may experience recurrent sharp pain every few hours or every few seconds. • Between the attacks, the pain resolves completely and the person has no symptoms. • However, because of fear that the intense pain might return, people can be quite distraught. • .

Symptoms of trigeminal neuralgia • Trigeminal neuralgia tends not to occur when the person

Symptoms of trigeminal neuralgia • Trigeminal neuralgia tends not to occur when the person is asleep, and this differentiates it from migraines, which often waken the person • After the first episode of attacks, the pain may subside for months or years but there is always the risk that trigeminal neuralgia will recur without warning.

The International Headache Society has established criteria for making the diagnosis and includes the

The International Headache Society has established criteria for making the diagnosis and includes the following 1. Paroxysmal attacks of pain lasting from a fraction of a second to 2 minutes, affecting 1 or more divisions of the trigeminal nerve 2. Pain has at least one of the following characteristics: (1) intense, sharp, superficial or stabbing; or (2) precipitated from trigger areas or by trigger factors 3. Attacks stereotyped in the individual patient 4. No clinically evident neurologic deficit 5. Not attributed to another disorder

Triggers • • • Shaving Stroking your face Eating Drinking Brushing your teeth Talking

Triggers • • • Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Washing your face

Gbr Klinik: • Insidens 4, 3 per 100. 000 populasi /tahun • Perempuan >

Gbr Klinik: • Insidens 4, 3 per 100. 000 populasi /tahun • Perempuan > laki: 1, 17 : 1 • Sering pada usia dewasa setelah 40 thn, ditemukan juga pada anak usia 12 thn. • Nyeri tajam menusuk seperti kesetrum listrik -> 20 -30 detik secara paroksismal. • Unilateral (97%) dapat bilateral • Paling sering pada cabang ke 2 & 3, • Presipitasi mengunyah, menggigit, kontak pada daerah trigger zone.

Anatomi Transmisi Impuls Rasa Nyeri Reseptor nosiseptif miofasial Serabut aferent urutan pertama (first order)

Anatomi Transmisi Impuls Rasa Nyeri Reseptor nosiseptif miofasial Serabut aferent urutan pertama (first order) Nervus Trigeminus Gangglion Trigeminus Brainstem setinggi Pons Cab. Segmen Spinalis Cervical atas C 1 – C 2 Berakhir TNC Medulary dorsal horn (MDH) = Spinal Dorsal Horn (SDH) Neuron Aferent urutan kedua (second order) Neuron Aferent urutan ketiga (third order) Korteks somatosensoris sekunder

 • Pada saat ini belum ada tes yang reliabel dalam mendiagnosa trigeminal neuralgia.

• Pada saat ini belum ada tes yang reliabel dalam mendiagnosa trigeminal neuralgia. • Jadi diagnosa trigeminal neuralgia dibuat berdasarkan anamnesa pasien secara teliti dan cermat. {Zakrzewska, 1995}

Treatments and drugs • Medications – Anticonvulsants • • • Karbamasepin Phenytoin Klonazepam As.

Treatments and drugs • Medications – Anticonvulsants • • • Karbamasepin Phenytoin Klonazepam As. Valproat Baclofen – Antispasmodic agents

treatment for trigeminal neuralgia • Idiopathic trigeminal neuralgia most often is treated with good

treatment for trigeminal neuralgia • Idiopathic trigeminal neuralgia most often is treated with good success using a single anticonvulsant medication such as carbamazepine (Tegretol). • Gabapentin (Neurontin, Gabarone), baclofen and phenytoin (Dilantin, Dilantin-125) may be used as second line drugs, often in addition to carbamazepine. In many patients, as time progresses, carbamazepine becomes less effective and these drugs can be used in combination to control the pain. • Should pain persist and medication fail to be effective, surgery or radiation therapy may be other treatment options. • Lamotrigine (Lamictal) may be prescribed for multiple sclerosis patients who develop trigeminal neuralgia.

Non medikamentosa • Surgery – Microvascular decompression – Gamma Knife radiosurgery • Types of

Non medikamentosa • Surgery – Microvascular decompression – Gamma Knife radiosurgery • Types of rhizotomy include: – Glycerol injection. – Balloon compression. – Radiofrequency thermal lesioning

Complementary and alternative treatments for trigeminal neuralgia include • • • Acupuncture Biofeedback Vitamin

Complementary and alternative treatments for trigeminal neuralgia include • • • Acupuncture Biofeedback Vitamin therapy Nutritional therapy Electrical stimulation of nerves

New Patient Carbamazepine (CBZ) Relief Continue CBZ Reduce Slowly Alergic response or Other severe

New Patient Carbamazepine (CBZ) Relief Continue CBZ Reduce Slowly Alergic response or Other severe side effects Partial Relief CBZ plus Phenytoin or oxcarbaazepine Relief Continue CBZ plus Phenytoin No Relief CBZ plus Baclofen Relief No Relief Continue Phenytoin Baclofen Reduce Slowly Relief No Relief Algoritma terapi medikamentosa trigeminal neuralgia 1

Relief No Relief Continue CBZ plus Baclofen Lamotrigine or Relief Continue Baclofen Valproic acid

Relief No Relief Continue CBZ plus Baclofen Lamotrigine or Relief Continue Baclofen Valproic acid or Reduce Slowly Clonazepam Surgery Tricyclic Antidepresant No Relief Continue Algoritma terapi medikamentosa trigeminal neuralgia

Selamat Belajar

Selamat Belajar