Epileptiform neuralgia

Description:

The disease is characterized by short paroxysms of the unilateral intensive painful shooting pains in a zone of an innervation of one or all branches of a trifacial which are often provoked by a touch to skin of a kurkovy zone. Kurkovy zones - sites of skin of lips, nasolabial folds, wings of a nose, eyebrows.

Frequency: 6-8 on 100 000 population, (women are ill more often, the disease develops aged 40 years are more senior.

Classification. Neuralgia is divided into two forms: primary (essential, idiopathic, typical) and secondary (symptomatic).

Symptoms of the Epileptiform neuralgia:

There are attacks of the painful pains which are localized in a zone of an innervation of one or several branches of a trifacial. Painful paroxysms proceed from several seconds to several minutes. They stop suddenly. In the mezhpristupny period of pains does not happen. The attack of pains usually is followed by vegetative manifestations (a hyperemia of the person, dacryagogue, the increased salivation), and also reflex reductions of mimic and chewing muscles. During an attack of the patient stiffens in a suffering pose, is afraid to move. Sometimes patients accept peculiar poses, hold the breath or, on the contrary, strenuously breathe, squeeze painful area or pound it fingers. On face skin, mucous membranes and even teeth, generally around a mouth and in gums, often there are small sites which mechanical or temperature irritation provokes emergence of a painful paroxysm (trigger, kurkovy or algogenny zones). More often pains at an epileptiform neuralgia arise in a branch zone II or III, or in the field of both branches. Neuralgia of the I branch meets seldom therefore at its diagnosis it is necessary to remember that usually it happens at defeat of an upper orbital crack (a frontal sinusitis, local inflammatory process, etc.).

At inspection during an attack or after it it is possible to define painful points at the place of an exit of branches of a trifacial, and also a hyperesthesia in the corresponding zones.

Pain at neuralgia has various character, it is more often burning, shooting, tearing, cutting, pricking, "beating with current". Sometimes painful attacks follow one after another at an interval of several minutes.

Remissions arise at treatment and, more rare, spontaneously. Their duration fluctuates from several months to several years. Quickly there occurs remission after alcoholization of peripheral branches of a trifacial, however with each subsequent alcoholization duration of remission is reduced, and the therapeutic effectiveness of a method decreases. As a result of alcoholization in a nerve destructive changes develop and the phenomena of iatrogenic neuritis (neuropathy) of a trifacial join neuralgia.

Except unilateral, there are also bilateral epileptiform neuralgias.

Dontogenous epileptiform neuralgias, dental pleksalgiya, post-herpetic neuralgia, neuralgia at defeat of a semi-lunar node belong to epileptiform neuralgias with dominance of a peripheral component of a pathogeny, neuralgia of separate nerves of the main branches of a trifacial, etc. Dontogenous neuralgia is more often shown by pains in innervation zones ІІ and ІІІ vervy a trifacial.

The course of dontogenous defeats of a trifacial differs in persistence and considerable expressiveness of both a painful, and vegetative component. Feature of dontogenous neuralgia is also the fact that they can is long to proceed, despite elimination of the main disease process which led to development of neuralgia. It is necessary to distinguish a dental pleksalgiya which is shown by upper and lower jaw pains from such neuralgia, and siagonagras meet twice more often than in lower as approximately at 50% of people the lower tooth texture is absent. Besides, the epileptiform neuralgia should be differentiated with arthrosis of a temporal and mandibular joint, a phantom dentagra, multiple sclerosis, glossofaringealny neuralgia.

Reasons of the Epileptiform neuralgia:

The most frequent reason - a trifacial prelum arteries or veins of a back cranial pole, a vascular loop with vascular anomaly. Trifacial branches can be also exposed to a compression in bone channels of a base of skull through which they pass. Narrowing of bone channels can be inborn and acquired at chronic inflammatory processes in adjacent zones (sinusitis, caries). The trifacial is less often compressed by a tumor of mostomozzhechkovy area. Process usually begins with a peripheral source of a painful impulsation. The irritation of various levels of system of a trifacial and peripheral vegetative educations of the person, reirritation of pontobulbospinalny conductors of pain and a reticular formation with formation of a multineyronalny reflex of neuralgia, and also involvement of nadsegmentarny formations of a brain with development of a dominant in a thalamus and bark of a great brain play a role.

Treatment of the Epileptiform neuralgia:

Appoint first of all anticonvulsant drug carbamazepine (Finlepsinum, Tegretolum) in individually picked up doses. Apply inside, starting with 1 tab. (0,2 g) 1-2 times a day daily, gradually increasing a dose by 1/2 tab. or by the whole tablet. Or apply Phenytoinum on 300-600 mg/days. For strengthening of action of an antikonvulsant use antihistaminic drugs - intramusculary 2 ml of 2,5% of solution of isopromethazine (Pipolphenum) or 1 ml of 1% of solution of Dimedrol for the night. Also vasodilators are shown spasmolytic. From physiotherapeutic methods apply an ionogalvanization with novocaine, pyramidon, diadynamic currents, ультрафонофорез with a hydrocortisone.

At inefficiency of medicamentous therapy resort to surgical intervention: a microsurgical decompression of branches of a trifacial at their exit from a brainstem or section of branches of a nerve proksimalny a gasserova of a node. At a dental pleksalgiya treatment should be begun with purpose of anesthetics of the systemic and mestnoanesteziruyushchy effect. First of all apply non-narcotic analgesics. Mestnoanesteziruyushchy means are shown to all patients: 5-10% anestezinovy or lidokainovy ointment which is slightly rubbed in previously dried mucous membrane of gums on site of a pain syndrome. The analgesic effect arises at once during embrocation and 15-30 min. proceed. Repeated rubbing in carry out according to indications till 3-10 times to days.