Trigeminal Neuralgia


Pathology: 

Trigeminal Neuralgia is a debilitating pain affecting the distribution of one or more of the branches of the Trigeminal nerve. This nerve is a sensory nerve (also called the Vth cranial nerve) and has both motor and sensory components. It is the sensory component where this pain is localised. The V1 or ophthalmic branch is sensory to the temple and forehead, the V2 is sensory to the cheek and upper jaw while the V3 is sensory to the chin and lower jaw. The V2 and V3 nerve branches also supply adjacent gum and soft tissue in the mouth including the teeth.

The pain is described as extremely severe, lasting a few minutes and with a well described trigger zone that sets the pain off. The patient can find minimal therapy to relieve the pain in the acute phase. Eventually the patient finds their way to their dentist or medical practitioner for diagnosis and treatment. Since the pain is localised to the face the first exclusion criteria is to ascertain whether there are dental causes for the pain. This may include dental caries, cracked teeth, jaw joint osteoarthritis or a developing dental abscess caused by apical periodontitis. Generally the dentist will exclude dental causes. The next investigative step is to order an CT and MRI/MRA. In some cases Trigeminal Neuralgia is caused by compression of the Trigeminal nerve root with an aberrant artery (arteriole) in the middle cranial fossa (Meckel’s cave). Sometimes there may be a tumour (schwannoma) on the nerve itself. In these cases of Trigeminal Neuralgia we have evidence of direct pathology. In the majority of cases Trigeminal Neuralgia develops with no evidence of a lesion.

The treatment of Trigeminal Neuralgia depends upon the aetiology. If there is clear evidence of a neurovascular intracranial cause then surgery should be considered to alleviate the symptoms. From a neurosurgical perspective this is called Janetta’s procedure where a small silicone sheet is placed between the arteriole and the nerve. It can be very effective and lead to cure.

In many cases of Trigeminal Neuralgia the aetiology is much more obscure. Indeed one may have the pain without any obvious reason and only a trial of Tegretol (carbamazepine) will confirm the diagnosis. If the patient is receptive to the Tegretol then they may have to be on this medication for life. If they require increasing higher dosage of Tegretol then the side effects are significant with drowsiness and stupor the main sequelae. Trigeminal Neuralgia itself may become so debilitating that suicide may be contemplated. Psychological and medical support are important.

Stem Cells for Trigeminal Neuralgia:

It has been described by Professor Russell Vickers that stem cells are neurotrophic and will repair damaged nerve cells. For patients that present with idiopathic trigeminal neuralgia there is no rationale explanation as to the cause of why the nerve cells are pathlogical save for the assumption they require repair or replacement. This is the methodology of utilising stem cells since these cells will differentiate into neurones and assist with re-establishing the correct transmission of the nerve impulse. The underlying damage to the neurone and the pain it produces is broadly called neuropathic pain. Professor Vickers has undertaken studies and published data on the treatment of neuropathic pain with stem cells showing efficacy.

From a surgical perspective the collection and harvesting of stem cells has already been covered. For treatment of the affected branch Professor Vickers and his team will deposit the stem cells and stromal vascular fraction to the foramina where the Trigeminal nerve branches enter and exit. This includes foramen rotundum, foramen oval, pterygopalatine ganglion, mandibular foramen and mental foramen. It is without mention that Professor Vickers and his team are all cranio-maxillofacial surgeons and have undertaken theses injections on thousands of patients with no deaths nor complications. It is considered doubtful that any other stem cell clinic would have such in-house medical expertise.

Summary

Trigeminal Neuralgia is a relatively uncommon facial pain of both known and unknown origins. After surgery or treatment with medications the use of stem cells with targeted therapy is possible as a salvage treatment. The concept of repairing damaged nerves with cells that differentiate to healthy neurones is theoretical. Merely cutting the nerve could exacerbate the pain. Professor Vickers and his team are ready to assist.

At Eurostemcell.life we pride ourselves on ensuring patients know the team diagnosing and conducting their stem cell therapy. Professor Russell Vickers is the lead specialist, working within a team of specialist surgeons and doctors.

Important questions that patients should ask of any treating clinicians and facility:

  • Are my treating doctors specialist surgeons/doctors and stem cell experts?
  • How many publications and research based studies have they published in peer reviewed journals?
  • Can they augment stem cell therapy with the known benefits of adjunctive therapy?

Eurostemcell.life is Europes premier stem cell organisation guided by evidence based medicine and clinical research.

Our founding director, Professor Russell Vickers PhD, MDsc, M Med, MA, FFPM (ANZCA) is an Australian and New Zealand board registered surgeon with over 100 publications, books and thousands of invited lectures and presentations on stem cells, pain, peptide synthesis and biochemistry. Professor Vickers is the leader of a family team of surgeons assisting him including Dr Peter Vickers, MD, FRCS (Edinburgh), FRACDS, Dr Richard Vickers, MD, FRCS (England, Glasgow, Ireland), FRACDS (OMS) and Dr Jessica Vickers, MD, MCOM, BA/BN as co-ordinator.

This medical summary has been written by Professor Vickers and his family team of specialist consultants.

It has been written by medically qualified writers.

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