QUESTION: I have a condition called "tic douloureux" (painful tic).
It took many years before a neurologist finally diagnosed it.
What can you tell me about it and its treatment?
ANSWER: Most patients with this condition would agree that "painful tic" is an appropriate name for what is known medically as trigeminal neuralgia, or "tic douloureux".
Patients complain of sudden and excruciating pain on one side of the face that feels sharp and stabbing, sometimes like an electric shock. The pain occurs in spasms, subsides rapidly, and can be triggered by such activities as talking, eating, feeling the wind blow against the side of the face, seeing flashing lights, or even hearing sudden noises. Although sometimes difficult to identify because of the many conditions which may provoke the symptoms, a careful diagnostic workup usually results in establishing the precise diagnosis.
There are a number of treatments, although some do pose certain risks. Trigeminal neuralgia is often caused by pressure from a blood vessel pulsating against the trigeminal nerve.
Other causes are blamed on tumors, multiple sclerosis, aneurysms, and angiomas. If diagnostic tests rule out causes like tumors that require specific treatment, your doctor will probably try drug therapy first.
Phenytoin or carbamazepine are two of the most popular choices, since both are generally effective with long lasting results, although both can cause side effects. If your pain is especially severe, your doctor can also inject a local anesthesia and/or prescribe a narcotic pain reliever. If drug therapy is unsuccessful in alleviating your pain, other treatments can be used, but these can be risky: Injections of alcohol, glycerol, phenol, and hot water into part of the trigeminal nerve can block the action of the nerve, thereby stopping pain, but this procedure can also cause loss of feeling in the face. Surgically cutting or separating the trigeminal nerve branch relieves pain longer than injections, but again, this is another treatment that can cause numbness. The most common procedure performed today is posterior fossa microvascular decompression.
This operation involves separating the blood vessel that is pressing against the trigeminal nerve by placing a small plastic implant, or similar device, between the vessel and the nerve to keep them apart. About 80 percent of patients find pain relief with this operation for up to five years.
Although this procedure does not cause a loss of sensation in the trigeminal nerve, it can cause problems like hearing impairment and hemorrhage. Another popular procedure is percutaneous trigeminal radiofrequency coagulation.
A general anesthetic is injected through an insulated needle; then a radio frequency current is used to coagulate the branches of the trigeminal nerve. This procedure relieves pain in 80 to 98 percent of patients, but it too, like many of the other treatments, may have complications.
The proper choice of treatment depends upon your special case, and is one that will provide the greatest chance of relief with the least risks.
The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.
