DEAR DR. GOTT: My mother-in-law has been diagnosed with trigeminal neuralgia. There are many treatment options, but she would have to travel to another state for some of them. She is in her 90s, so travel is difficult for her. The headaches are severe and have landed her in the hospital in the past. There is a procedure using a gamma ray that we are considering but are unable to find statistics on a cure rate. What can you tell us about this and other treatment options that might be available for this condition?
DEAR READER: This condition, also referred to as tic douloureux, is a nerve disorder that originates from the trigeminal nerve at the base of the brain. The condition typically presents in older adults and may be part of the aging process, but it can affect people of any age. Women over the age of 50 are more prone than are men.
Trigeminal neuralgia may result from a swollen blood vessel, multiple sclerosis or a similar disorder that compresses the nerve or harms the myelin sheath that protects specific nerves, or less likely, from the presence of a tumor compressing the nerve. If it presents in a person under the age of 40, a cause is more likely to be found than if it appears later in life. Testing to determine a cause might include laboratory work, MRI or neurological testing.
Symptoms include painful spasms resembling electric shocks (generally on one side of the face only), around the eye, cheek or jaw. It can be triggered by chewing, eating, drinking, brushing the teeth, shaving or by simply touching the face lightly. Initial attacks might be brief; however, they can progress to occur more frequently and last longer.
Relief or a reduced level of pain from symptoms might be accomplished with the use of muscle relaxants, some anti-seizure medications or tricyclic antidepressants. It is not uncommon for any medication to become less effective over time. When that occurs, alcohol injections that numb the face or surgery may be appropriate. Several possible forms of surgery such as gamma-knife radiosurgery, balloon compression, glycerol injections, microvascular decompression, the use of electric current to destroy nerve fibers associated with pain or rhizotomy (cutting a portion of the trigeminal nerve) may be recommended. Alternative treatment includes acupuncture, biofeedback or vitamin and nutritional therapy.
The gamma-ray procedure to which you refer may offer a noninvasive option for patients that cannot consider traditional surgery for a variety of reasons, such as advanced age. It may require a single night’s hospitalization, is generally covered by insurance, and represents a major advance. The cost of the procedure is up to one-third less than with invasive surgery. Because no surgical incision is made, the side effects are fewer and recuperation is substantially faster. In one single treatment session, more than 190 beams of gamma radiation are directed toward the nerve at the point where it branches out. Only the area being treated receives the significant dose of radiation, leaving the surrounding tissue unharmed. Current statistics show a cure rate of 70 percent to 75 percent for the first year. This rate drops to around 50 percent at three years.
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