Idiopathic epileptiform neuralgia

Description:

Is primary (essensealny) epileptiform neuralgia.

Symptoms of the Ideopatichesky epileptiform neuralgia:

Pain arises on one of trifacial branches on the one hand. In 35% neuralgia covers maksillyarny (II) and mandibular (III) branches of a trifacial. The isolated defeat of an ophthalmic branch (I) meets in 2,8%.
The idiopathic epileptiform neuralgia is a painful pain syndrome, it can lead to a suicide side. The name "painful tic" (tic douloureux), applied for the first time to the description of idiopathic trigeminal neuralgia, characterizes short duration and the paroxysmal nature of this pain at classical neuralgia, the lasting second.
The epileptiform neuralgia is, as a rule, shown 40 years (90%) are aged more senior, and is slightly more often at women. On 100 000 population the disease is shown on average at 4-5. In some populations trigeminal neuralgia is shown more often – with multiple sclerosis trigeminal neuralgia occurs at patients in 4%, among them often there is bilateral trigeminal neuralgia. 2% of patients with multiple sclerosis have trigeminal neuralgia.

Reasons of the Ideopatichesky epileptiform neuralgia:

Etiology and pathogeny of idiopathic neuralgia it is not clear. The arterial compression occurred at patients to whom the microvascular decompression was carried out to 85% cases, it was combined with a venoznay compression in 68%. Separately the venous compression met in 13%.
According to one theory ectopic impulses with the subsequent pain are formed in a trifacial and a node for the second time from a vascular compression. It is promoted by demyelination on the party of a compression.

Some researchers of one of the reasons of trigeminal neuralgia consider the virus agent. Reactivation of a virus of herpes is revealed in 27 – 94% at the patients  who underwent different types of neurosurgical procedures for an occasion of trigeminal neuralgia. It is meant that the virus leads to dysfunction of a trigeminal node. It is supposed also  that the latent virus of herpes can also be the cause of a trigeminal nervalgiya.

Treatment of the Ideopatichesky epileptiform neuralgia:

Medicinal treatment – the most effective medicine in treatment of trigeminal neuralgia is carbamazepine (Tegretolum, Finlepsinum). He acts by an inactivation of neyronalny natrium channels and thus reduces excitability of neurons. The effective dose fluctuates within 600 – 1200 mg / д (concentration in plasma within 40 – 100 mkg/ml). Some side effects (as dizziness, drowsiness, an ataxy, a diplopia) which are associated with carbamazepine complicate use for elderly people. From the moment of remission emergence the dose can be lowered to controlled pain. Taking into account possibility of an agranulocytosis or aplastic anemia (as rare side effect) it is necessary to carry out often within the first year a blood analysis, further the research needs to be conducted once a year.

By efficiency takes the second place фенитион. The mechanism of effect of drug it is similar to carbamazepine. From the side effects arising at reception of a fenition are known – a hirsutism, a posterization of features,  a gingivalny hypertrophy, a cerebellar ataxy. At a heavy attack the patient it is appointed фосфентоин in a dose of 250 mg.
Surgical treatment – the most effective and physiological intervention at trigeminal neuralgia is a microvascular decompression.

Cherezkozhny interventions: - the radio-frequency rhizotomy – at the same time to the area of a root of a tronichny nerve is established an electrode and by creation of high temperature on a tip of a needle destruction of the corresponding portions of a root responsible for a pain syndrome is made. At a radio-frequency rhizotomy of destruction thin painful fibers are exposed first of all. The probability of a recurrence of a pain syndrome at this procedure within the first 6 years makes 5%,  within the next 11 years the probability of a recurrence reaches 74%.  Painful sensitivity arises in 5 - 25%,  decrease in a corneal reflex meets in 15%, weakness of a masseter in 4%. For avoiding of complications from an eye some researchers recommend to avoid this procedure at defeat of the first branch.
The Glitserolovy rhizotomy – probability of numbness of the person (5%) is less, than at other percutaneous methods.
Cherezkozhny balloon microcompression – at 62,5% of patients are observed fine and satisfactory result after this procedure. At this procedure in 11% acoustical disturbances meet. However probability of a recurrence

Radio surgery with the help scale – a knife – the most minimum invasive procedure. At the same time to the area of a root of a trifacial the dose 70 – 90 is given in one step heat.  At 77% of patients the good result (regress or reduction of intensity of a pain syndrome makes 50 – 92%) within 18 months is observed.  In 10% the recurrence of a pain syndrome was observed, at 10% were observed front paresthesias. Good results were observed at patients who were not exposed to neurosurgical interventions earlier.

Complications at surgical intervention are connected with an infection,  possible damage of a brainstem to a decompression zone.

In clinics where the decompression is carried out often the following complications – a front dysesthesia – 0,3%, numbness of the person – 0,15%,  injury of a cerebellum or a hearing disorder meet - <1%, ликворея - < 2%.

At thermocoagulation the dysesthesia arises at 5 – 25% of patients, numbness in the field of a cornea – 15%, weakness of masseters – 4%.

The balloon microcompression is connected with the big frequency of a hearing disorder – 11% and connected with frequent motor disturbances.

According to some information in the absence of treatment eventually typical trigeminal  neuralgia is transformed to atipichesky. Therefore some specialists recommend early intervention.