Atypical trigeminal neuralgia ( ATN ), or type 2 trigeminal neuralgia , is a form of trigeminal neuralgia, a fifth cranial nerve disorder. This form of nerve pain is difficult to diagnose, because it is rare and the symptoms overlap with some other disorders. Symptoms can occur other than having migraine headaches, or can be wrong for migraines alone, or dental problems such as temporomandibular joint disorders or musculoskeletal problems. ATN can have a variety of symptoms and the pain can fluctuate in intensity ranging from mild pain to burning or burning sensation, as well as the extreme pain experienced with the more common trigeminal neuralgia.
Video Atypical trigeminal neuralgia
Signs and symptoms
ATN pain can be described as severe, painful, piercing, and burning. Some patients have persistent migraine headaches. Others may experience severe pain in one or the three branches of the trigeminal nerve, affecting the teeth, ears, sinuses, cheeks, forehead, upper and lower jaw, behind the eyes, and scalp. In addition, those with ATN may also experience shock or stabbing found in TN type 1.
Many TN and ATN patients experience pain that is "triggered" by a light touch on the shifting trigger zone. ATN pain tends to worsen by talking, smiling, chewing, or in response to sensations like cold winds. The pain of ATN often continues, and periods of remission are rare. TN and ATN can be bilateral, although the character of the pain is usually different on both sides at a time.
Maps Atypical trigeminal neuralgia
Cause
ATN is usually associated with inflammation or demyelination, with increased trigeminal nerve sensitivity. This effect is believed to be caused by an infection, a demyelinating disease, or a trigeminal nerve compression (by a vein or arterial infiltration, tumor, or arteriovenous malformation) and is often confused with dental problems. An interesting aspect is that this form affects both men and women alike and can occur at any age, unlike typical trigeminal neuralgia, most commonly seen in women. Although TN and ATN most often present in the fifth decade, cases have been documented as early as infancy.
Risk
Both forms of facial neuralgia are relatively rare, with recent events estimated between 12 and 24 new cases per hundred thousand inhabitants per year.
ATN is often undiagnosed or misdiagnosed for a long time, which causes a lot of unexplained pain and anxiety. A National Patient Survey conducted by the US Trigeminal Neuralgia Association in the late 1990s showed that average facial neuralgia patients could see six different doctors before receiving the first definitive diagnosis. The first practitioner to see facial neuralgia patients is often a dentist who may not have had in-depth training in facial neurology. Thus ATN can be misdiagnosed as a Common Tempormandibular Disorder.
This disorder is considered by many medical professionals to form the most severe form of chronic pain known in medical practice. In some patients, the pain may be unresponsive to even opioid drugs at any dose level that makes the patient awake. Therefore, this disorder gets a nickname that is unfortunate and possibly inflammatory, "suicidal disease".
ATN symptoms may overlap with pain disorders that occur in teeth called atypical odontalgia (literal meaning "unusual toothache"), with pain, burning, or stabbing localized pain in one or more adjacent teeth and jaws. The pain may appear to shift from one tooth to the next, after the root canal or extraction. In a desperate attempt to reduce the pain, some patients undergo multiple root canal or extraction ducts, but in the absence of evidence suggestive X-rays from tooth abscesses.
The symptoms of ATN may also be similar to postpetic herpetic neuralgia, which causes nerve inflammation when latent herpes zoster virus from chickenpox cases reappears in a nasty rash. Fortunately, post herpes neuralgia is generally treated with drugs that are also the first drug tried for ATN, which reduces the negative impact of misdiagnosis.
The subject of atypical trigeminal neuralgia is considered problematic even among experts. The term atypical TN is broad and due to the complexity of the condition, there is a big problem with defining further conditions. Some medical practitioners no longer make a distinction between facial neuralgia (a nominal inflammatory condition) than facial neuropathy (direct physical damage to the nerves).
Because of the variability and inappropriateness of their pain symptoms, ATN or atypical odontalgia patients may be misdiagnosed with atypical facial pain (AFP) or "hypochondriasis", both of which are considered problematic by many practitioners. The term "atypical facial pain" is sometimes given for pain that crosses the midline of the face or does not match the expected limits of the neural distribution or characteristics of a validated medical entity. Thus, AFP appears to consist of diagnosis by reduction.
As noted in the material published by the National Pain Foundation [USA]: "Atypical facial pain is a confusing term and should not be used to describe patients with trigeminal neurgia or trigeminal neuropathic pain." Actually, AFP is classified as "somatiform pain disorder. "This is a psychological diagnosis that must be confirmed by a psychologist of pain Patients with AFP diagnosis have no identifiable physical cause for pain Pain is usually constant, described as ill or burning, and often affects both sides of the face (this is almost unheard of in patients with trigeminal neuralgia.) Pain often involves the areas of the head, face, and neck that are outside the sensory area supplied by the trigeminal nerve.It is important to correctly identify patients with AFP from treatment to this highly medical Surgical procedures are not indicated for atypical facial pain. "
The term "hypochondriasis" is closely related to "somatoform pain disorders" and "conversion disorders" in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV). In July 2011, the DSM-IV axis is undergoing major revisions to DSM-V, with the introduction of the new designation "Complex Somatic Symptom Disorder". However, it remains to be pointed out that one of these "distractions" can reliably be diagnosed as a medical entity with discrete and reliable therapy.
It is possible that there are trigger factors or triggers that need to be recognized by patients to help manage their health. Bright light, sound, stress, and poor diet are examples of additional stimuli that can contribute to the condition. Pain can cause nausea, so beyond the obvious need to treat pain, it is important to make sure to try to get enough rest and nutrition.
Depression often coincides with neuralgia and neuropathic pain of all kinds, as a result of the negative effects caused by pain on a person's life. Depression and chronic pain may interact, with chronic pain often affecting the patient for depression, and depression that operate for gum energy, disrupting sleep and increasing sensitivity and sense of suffering. Dealing with depression should be considered as important as finding immediate relief from pain.
Diagnosis
Treatment
Drugs
Treatment of people who are believed to have ATN or TN usually starts with drugs. The first-choice drug for facial neuralgia is carbamazepine, an anti-seizure agent. Due to the significant side effects and hazards of these drugs, others have recently come into common use as an alternative. These include oxcarbazepine, lamotrigine, and gabapentin. A patient's positive response to one of these drugs can be considered as supporting evidence for the diagnosis, which is made from a medical history and pain presentation. There is no current medical test to confirm TN or ATN for sure.
If anti-seizure drugs are found to be ineffective, one of the tricyclic antidepressant drugs such as amitriptyline or nortriptyline, may be used. Tricyclic antidepressants are known to have double action against depression and neuropathic pain. Other drugs may also be tried, either individually or in combination with an anti-seizure agent, including baclofen, pregabalin, anti-seizure medications (for calming nerve endings), muscle relaxants, and opioid drugs such as oxycodone or combination oxycodone/paracetamol.
For some people with ATN opioids may be the only viable medical option that maintains a quality of life and personal function. Despite considerable controversy in public policy and practice in this branch of medicine, practice guidelines have long been available and published.
Surgery
If drug therapy is found to be ineffective or cause crippling side effects, one of several neurosurgical procedures may be considered. The available procedures are believed to be less effective with type II (atypical) trigeminal neuralgia than type I (typical or "classic") TN. Among these procedures, the most effective and long-lasting has been found as microvascular decompression (MVD), which seeks to relieve direct compression of the trigeminal nerve by separating and coating the blood vessels around the appearance of these nerves from the brain stem. , under the cranium.
The choice of surgical procedures is made by the physician and patient in consultation, based on the patient's pain presentation and the health and medical experience of the physician. Some neurosurgeons resist the application of MVD or other surgery for atypical trigeminal neuralgia, given the widespread perception that ATN pain is less responsive to this procedure. However, recent papers show that in cases where pain initially presents as TN type I, surgery may be effective even after the pain has evolved into type II.
References
External links
- Trigeminal Neuralgia Fact Sheet National Institute of Neurological Disorders and Stroke
Source of the article : Wikipedia
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