What is Refractory Trigeminal Neuralgia? Part 3 Dr.Roopesh Kumar

Описание: What is #Refractory #Trigeminal #Neuralgia? Part 1 Dr.Roopesh Kumar

#toothache #NeuroDoctor #DrRoopeshKumar
Hello. In the last episode, “What is trigeminal neuralgia, How is it diagnosed, and how is it treated” is what we discussed. Towards the end I had mentioned, refractory trigeminal neuralgia.

That is, out of a hundred people, for 20% to 30% of the people even medications don't help. Certain medicines have side effects, therefore we would not be able to prescribe that either.
This category of patients are separately assessed, and to help them recover from a disease like this, is very important.

Reason being, people with such pain cannot be social. They will be in fear. When would the pain come? When would I be able to eat? They would not eat, drink water or even brush,
as they would be in constant fear. For such people, there is surely a solution. There are good solutions.

For refractory neuralgia, we treat it in three ways.

First is an injection, a little away from the mouth, like an injection, a little inside, in the operation theatre, with an x-ray guidance, such an injection is given. It is called radio frequency ablation. Through the injection at the area through which the nerve passes, we burn a little bit around the nerve. Once we burn it, for them the pain reduces. This is one type of treatment.

Sometimes, a chemical, that is, a chemical called glycerol, using the same type of needle, if injected around the nerve, that too can help reduce the pain.

These are all called percutaneous techniques. Percutaneous techniques are not permanent solutions. They are temporary solutions. Up to 3 - 6 months they will not get the pain. If the pain returns, the procedure might have to be repeated.

The small issue in percutaneous procedures is that, the side on which the procedure is done, there is a chance for the face becoming numb on that side. That is the sensitivity could be diminished. Only if the sensitivity diminishes, the pain will reduce. Therefore, that is a mild side effect. But we cannot call it a side effect, it is a treatment effect. It is communicated to the patients before the procedure. It would feel a bit numb, not to worry. But it is not a permanent cure. For a transient relief from the pain, there is a solution like this.

Sometimes, the patients say, “tell me a permanent option, I cannot get this injection repeatedly, which is temporary.” The permanent solution Is a procedure called 'micro vascular decompression'. If we consider the nature of this procedure, it is a surgical procedure. Behind the ear, a small hole is made, and through a microscope, we find the blood vessel and the nerve and in a way that the both don't rub, a Teflon patch, a medical sponge, in between the blood vessel and the nerve, if the sponge is placed, it is a permanent cure for this problem.

Immediately after this procedure is completed, patients are relieved of the pain. Patients tell initially, "doctor, when you mentioned the operation, we were in fear and did not come. Had we known that the pain would reduce so much, we would have undergone the procedure long back. we would not have suffered in pain for so long."

Invariably, this is a response we get from all patients. Therefore, instead of being in the fear of undergoing the procedure because it is a surgery, undergoing this procedure willingly, will bring about a good solution for the people, especially in such a painful condition.

Thank you.


Chapters

00:29 Side effect of medications
00:48 Situation of the patients in pain
01:13 First type of treatment - An injection
01:38 Second type of treatment - Glycerol injection
01:49 percutaneous techniques
02:06 Numbness
02:47 Surgical procedure - micro vascular decompression


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