Dr Jaydev Panchawagh, renowned Neurosurgeon in Pune writes…

Dr Jaydev is a specialist in brain and spine surgery. His passion is MVD surgery for the treatment of Trigeminal Neuralgia, Hemifacial spasm and Glossopharyngeal neuralgia.
In this article written by Dr Jaydev Panchwagh on the same subject, he has discussed various aspects of this deadly disease.
October 7th is known as World Trigeminal Neuralgia Day. In fact, the entire month of October is recognised as Trigeminal Neuralgia Awareness Month. On this occasion, Dr Jaydev Panchwagh has actively organised many seminars, public education lectures, interactions and also written a book that will be published shortly.
Medication is generally the mainstay in treatment of Trigeminal Neuralgia. But there are other options including a surgical one. A promising option that has the greatest potential to permanently cure it is MicroVascular Decompression Surgery (MVD Surgery).
This is what he has to say:
You can also listen to the experience of many patients in this talk as well.
Trigeminal Neuralgia is a neurological condition that causes severe facial pain. Unfortunately, it is often misdiagnosed due to its rarity and similarity to other conditions. This is why raising awareness about Trigeminal Neuralgia is so important. Here are some facts about this condition that you may find interesting:
If you or someone you know is experiencing facial pain that may be caused by Trigeminal Neuralgia, it is important to seek medical attention and receive a proper diagnosis. With proper treatment and support, it is possible to manage the symptoms of this condition and improve quality of life.
Dr Jaydev Panchawagh, renowned Neurosurgeon in Pune writes…
Dr Jaydev is a specialist in brain and spine surgery. His passion is MVD surgery for the treatment of Trigeminal Neuralgia, Hemifacial spasm and Glossopharyngeal neuralgia.
A rare and technically challenging Brain surgery performed by Dr Jaydev Panchawagh and his team gives a new lease of pain-free life to African woman at Pune.
Medicines for face pain treatment are generally those that are used to treat fits (convulsions, seizures). These come under the group called anti-convulsants (these numb the brain and prevent response to stimuli). Anti-convulsants are medicines used to control convulsions(or “fits”).
While there are many medicines that could be used, some are similar to the older versions, some are very different; and some medicines are not related at all. Acupressure, acupuncture, Ayurveda and Homeopathy have also been tried.
Basically, all act by numbing the brain (Central nervous system ). The intention is to reduce reactivity of the Trigeminal nerve, but no medicine can act on just one nerve. It therefore acts on the entire nervous system, numbing it. This is the primary reason for the major side-effects of medication.
So, for most people, medication is the first line of treatment. Most of them are off-label for the treatment of facial pain (Trigeminal Neuralgia). Most patients need to adjust the medication with varying combinations and dosages to get the best pain relief effect with minimal side-effects.
The following video describes the typical journey of a patient who has started having facial pain on one side of the face:
Among the medicines that are used for treatment of trigeminal neuralgia and face pain are
Carbamazepine/Oxcarbamazepine/Eslicarbamazepine,
Gabapentin/Pregabalin,
Phenytoin and other anti-convulsants,
Some anti-depressants,
Skeletal muscle relaxants,
Anaesthetics
Toxins.
These medicines have different formulations and trade names.
Initially only one drug is generally started, at a small dose, then the dose is increased as necessary. If the pain continues to increase in intensity and frequency, a second or third drug may be added. Please be sure to talk to your doctor about the effect and side-effects that you experience. Please look out for rashes or itching or some other sign that you maybe allergic to the drug.
There is a new drug that is being developed specifically for trigeminal neuralgia pain. Research is still on, and it is in the planning stage.
Please be sure to talk to your doctor about the effect and side-effects that you experience.
Common side effects of Medicines used for treatment of facial pain:
Memory loss
Reduced co-ordination
Confusion
Weight gain
Loss of balance
Drowsiness
Difficulty in finding the right words
Fatigue
Irritability
Dry Mouth
Nausea etc
No. Stopping the medicines used to treat your TN pain is as challenging as starting you on them.
Because of the need to titrate your dosages, or shift to a different medication you need to know this.
We need to change dosage or type of medicine if you are not responding, nature of pain has changed. a nerve block injection has failed or pain has recurred.
Typically, the medicines in high doses are tapered off over few weeks before stopping completely. This is especially true after you have undergone a successful MVD surgery. Dr Jaydev Panchwagh and his team have a specific protocol for tapering these drugs.
Typically, one notices dizziness, nausea, increased pain, agitation, confusion, disorientation, violent dreams, tremors, irritability etc
We have an entire website dedicated to treatment of Trigeminal neuralgia pain. You can find information here.
Is there any alternative to medicines?
Yes, people try naturopathy, Homeopathy, Ayurveda, or Acupuncture, Acupressure and others.
Some people believe exercises help them. Some make adjustments in food.
Do not worry! There are alternative treatments available. Nerve injections and Gamma knife procedures are nerve destructive procedures. Their effect is generally temporary. The success rate for pain relief is also less as compared to surgery.
Surgery for TN is called Microvascular Decompression (MVD surgery). It is generally a nerve preserving procedure, offers the potential of permanent pain relief. You can learn more about this here and here.
Dr Jaydev Panchwagh is the chief Neurosurgeon and Director of the Centre of excellence for MVD surgery in Pune, India. He has been keenly focused on MVD surgery for nearly twenty years and has operated on patients from more than 22 states in India, and about 13 countries around the world. He has performed more than 1900 MVD surgeries as of this date.
You can find more information on his work here.
कान और गले में दर्द होना, विशेष रूप से निगलने पर दर्द होना Trigeminal Neuralgia का संकेत (indicator) हो सकता है.
अधिक जानकारी के लिए, इन विडियो जरूर देखें. Glossopharyngeal Neuralgia.
गाल में दर्द, जबड़ों में दर्द, दांतों में दर्द, या निगलते समय दर्द ….ये सब Trigeminal Neuralgia के लक्षण हो सकते हैं.
चेहरे की नसो में दर्द को ट्राइजेमिनल न्यूराल्जिया कहते हैं।
चेहरे की नसो में दर्द का नाम ट्राइजेमिनल न्यूराल्जिया है. चेहरे के दर्द के कई कारण होते हैं. सबसे आम कारण ट्राइजेमिनल तंत्रिका को संकुचित करने वाली रक्त वाहिका है. (Nerve और blood vessel के बीच compression). Trigeminal neuralgia का दर्द कैसा रहता है? trigeminal neuralgia का दर्द बहुत ही भयानक और असहनीय होता है. कभी बिजली जैसा दर्द, तो कभी चुरी चुभो रहा हो ..इस जैसा…कई प्रकार है.
चेहरे का दर्द ट्राइजेमिनल तंत्रिका के संपीड़न के कारण होता है.
चेहरे की नसो में दर्द का इलाज, पहले दवाई से की जाति है. अगर दर्द कम नहीं हुआ तो एमवीडी सर्जरी (MVD surgery) कर सकते हैं.
कान और गले में दर्द अगर trigeminal neuralgia के वजह से है तो उसका इलाज हो सकता है. पहले दवाइयों से, फिर सर्जरी से. इस सर्जरी का नाम है मिक्रोवास्कुलर डीकम्प्रेशन सर्जरी. इसके बारे में और जानकारी के लिए हमारे Youtube चैनल देखें.
डॉ जयदेव पंचवाघ ब्रेन और स्पाइन सर्जन हैं जो इस MVD operation करने में काफी अनुभवी हैं.
Microvascular Decompression Surgery or MVD surgery is a brain operation, commonly done to relieve nerve compression of the fifth (Trigeminal nerve) and seventh (Facial Nerve) cranial nerves. Occasionally the ninth (Glossopharyngeal nerve nerve is also decompressed by itself or in conjunction with the Trigeminal nerve. Cranial Nerves are nerves that arise in the brain. They are twelve in number.
There are twelve nerves that arise from the brain, on each side. Of these, the fifth (Trigeminal nerve), seventh-eighth complex(Facial-Vestibulocochlear) and ninth(glossopharyngeal) nerves are prone to compression leading to hyperactivity disorders that need treatment.
The fifth cranial nerve is the Trigeminal Nerve. The Trigeminal nerve supplies the sensation to the face. It has three divisions : V1,V2 and V3. these supply specific areas of the face on each side.
The seventh-eighth cranial nerve complex is the Facial nerve-Vestibulocochlear nerve complex. The facial nerve supplies the facial muscles. The eighth nerve is the nerve of hearing and balance. This is the reason why in Hemifacial spasm, occasionally, either tinnitus or a clicking sound may be heard.
The ninth nerve is the Glossopharyngeal Nerve. It supplies sensation to base of tongue, tonsillar pillars and throat. There are other functions too, but this is the function most affected in glossopharyngeal neuralgia and causes pain while swallowing.
It is an operation done at the level of the brainstem, where the involved nerve exits/enters the brainstem. The blood vessel compressing the nerve is moved away from the nerve(decompressed) using a microscope/ endoscope or both. This is performed to treat Trigeminal neuralgia, Hemifacial spasm or glossopharyngeal neuralgia.
Certainly. Dr. Jaydev Panchwagh, chief Neurosurgeon and Director at the MVD Centre shows us how it is done. here:
If you are interested in knowing more about a video discussing diagnosis, symptoms, MRI and treatment, please click here.
Yes, you can read all about it on this page.
चेहरे की नसो में दर्द का नाम ट्राइजेमिनल न्यूराल्जिया है।
Trigeminal neuralgia का दर्द कैसा रहता है? trigeminal neuralgia का दर्द बहुत ही भयानक और असहनीय होता है. कभी बिजली जैसा दर्द, तो कभी चुरी चुभो रहा हो ..इस जैसा…कई प्रकार है.
इसके कई कारण होते हैं । सबसे आम कारण ट्राइजेमिनल तंत्रिका को संकुचित करने वाली रक्त वाहिका है ।
शुरू में इस बीमारी को ठीक करने के लिए दवाइयां दी जाती है..जैसे की Tegretol, Mazetol या Carbamazepine.
दर्द का वजह नस का कम्प्रेशन होता है. यह MVD surgery से ठीक हो सकता है.
चेहरे का दर्द ट्राइजेमिनल तंत्रिका के संपीड़न के कारण होता है । चेहरे की नस को Trigeminal Nerve नाम से जाना जाता है. इस तंत्रिका के तीन भाग होते हैं, जो चेहरे के ऊपरी, मध्य और निचले हिस्से को सप्लाई करते हैं.
चेहरे में दर्द , एक दुर्लभ nerve का विकार है। यह चेहरे के गंभीर दर्द का कारण बनता है.
गाल में दर्द या जबड़ा में दर्द ट्राइजेमिनल न्यूराल्जिया के कारण भी हो सकता है। Neuralgia याने नस में दर्द होना. इसी लिए इस नस के दर्द के बीमारी को {चेहरे की नसो में दर्द) trigeminal neuralgia बोलते हैं.
चेहरे की नसो में दर्द का इलाज, पहले दवाई से की जाति है। अगर दर्द कम नहीं हुआ तो एमवीडी (MVD) सर्जरी कर सकते हैं। यह ऑपरेशन न्यूरोसर्जन करते हैं.
रोगी को तेज बिजली की तरह का झटका लगता है जैसे आंख, गाल, मसूड़े या जबड़े में बिजली का दर्द ।
हां। TN भी कान में दर्द पैदा कर सकता है; लेकिन यह ग्लोसोफेरींजल न्यूराल्जिया से भी जुड़ा हो सकता है।
यदि आप ट्राइजेमिनल न्यूराल्जिया के बारे में अधिक जानना चाहते हैं, तो कृपया इस वीडियो पर क्लिक करें ।
Dr. जयदेव पंचवाघ न्यूरोसर्जन हैं । वह पुणे में एमवीडी सेंटर के निदेशक (डाइरेक्टर) हैं ।
उनका अनुभव बहुत विशाल है । उन्होंने अब तक 1850 से अधिक MVD सर्जरी की हैं.
अगर आप इसका इलाज के बारे जानना चाहते हैं, तो यह विडियो आपको उपयुक्त होगा…
This is a transcript of an interview with Dr Jaydev Panchwagh, neurosurgeon. This was aired on TV. He is the Director of the MVD Centre in Pune.
Interviewer: Doctor, I read up some articles on Trigeminal Neuralgia before this interview. It appears that the patients are affected by a very severe kind of pain in the face.
Dr Jaydev Panchawagh: Yes!! The pain is so severe and comes so suddenly that some patients even contemplate suicide!! The pain is variously described as sharp, stabbing, burning, shock-like etc.
Interviewer: I also read that there are many kinds of treatments available, but none really effective. Is that correct?
Dr Jaydev Panchawagh: Treatment of Trigeminal neuralgia is usually started with medicines (tegretol, Carbamazepine). Initially they are effective. But over a period of time, the pain takes over. We need to increase medicine doses. The pain gets controlled. Then over the next few months, medicines lose their effectiveness. The doses need to be further increased or medicines changed. This goes on till the pain becomes unbearable or the medicine’s side effects are not tolerated. The patient then has to consider other options. But in our MVD Centre, we often give the option of surgery before very high doses of medicines are reached. Because, the side effects are at this time unacceptable.
There are other treatment options like RFLG, nerve Blocks , balloon compression , or Gamma knife radiation but my particular preference has generally always been MVD surgery.
Interviewer: So, is MVD surgery a brain surgery?
Dr Jaydev Panchawagh: Yes, MVD or MicroVascular Decompression surgery is a brain surgery. The operation is performed where the Trigeminal nerve exits from the brainstem. It is in a very deep part of the brain.
Interviewer: Is MVD surgery risky?
Dr Jaydev Panchawagh: It is fairly safe in the hands of an experienced surgeon. The more MVD surgeries one performs, the more comfortable one becomes with the anatomy there. We become more aware of what to expect, what to do, what not to do. So the chances of success in the surgery also is much higher than in the hands of an inexperienced surgeon. This is one of the reasons why MVD surgery is best done at Centres which have a high volume of these surgeries.
The patient must therefore find out how many such surgeries the surgeon has performed. The potential risks could be infection, bleeding, hearing loss, facial numbness, and/or facial weakness (generally temporary), CSF leak, difficulty to talk/ swallow, stroke/ paralysis/risk to life (extremely rare).
Interviewer: Doctor, how many MVD surgeries have you performed so far?
Dr Jaydev Panchawagh: I have performed more than 1600 surgeries so far (from 2002 to 2022). You can access the testimonials of some of the patients here.
Interviewer: What is the aim of MVD surgery?
Dr Jaydev Panchawagh: The final goal is to prevent pain that arises because of compression of the Trigeminal Nerve either by a blood vessel or by brain tumors.
Interviewer: Is MVD performed for treatment of Trigeminal neuralgia alone?
Dr Jaydev Panchawagh: No, MVD can be performed for treatment of Hemifacial spasm ( affecting the Facial nerve) or Glossopharyngeal Neuralgia(affecting the glossopharyngeal nerve). You can know more about this in my video explaining Hemifacial spasm symptoms and causes.
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You may watch this video to know more about Glossopharyngeal neuralgia .
Trigeminal neuralgia is a chronic facial pain caused by a hyperactivity disorder of the Trigeminal nerve. In simple words, it is a symptom of Trigeminal nerve compression. This compression could be caused by a blood vessel or by a tumor, among many other causes. TN pain is severe and is generally treated with medicines, initially.
Trigeminal nerve is the fifth nerve which is given off from the brain. It is a cranial nerve. This is a sensory as well as motor nerve. It means that the nerve supplies sensation to the face and the motor component supplies muscles of chewing.
Commonly TN pain begins after some form of dental treatment, either an extraction or root canal work. However, the dental work actually is only a trigger, not the cause. Other triggers for the trigeminal neuralgia pain are brushing, eating, talking, shaving, touching etc.
Yes. TN itself can cause ear pain; but it may also be associated with Glossopharyngeal neuralgia which can also be the cause of ear pain.
The patient has severe electric shock like or lightning like pain in the eye, cheek, gums or jaws. Mostly, this disorder is diagnosed late. Thus the patient suffers for many years before they are told their diagnosis. It is frequently mistaken for migraine, dental pain or ear pain. MRI is performed to support the clinical diagnosis.
Yes, but a primary MVD always gives better success. Radio Frequency Lesioning or ablation of the trigeminal nerve is a destructive procedure. MVD surgery is a nerve-preserving procedure.
MicroVascular Decompression (MVD) surgery is a brain surgery and is performed by a neurosurgeon. An experienced neurosurgeon gives the best results, better success rates and lower chances of risks.
Sure. Please click here to read and watch videos of patient experiences. All these patients have been operated by our team, at the MVD Centre. You can click here to read more Frequently Asked Questions on Trigeminal neuralgia and MVD surgery. You can visit the home page of this website on trigeminal neuralgia treatment by clicking here.
The MVD centre is in Pune. The Director is Dr Jaydev Panchwagh, who has an experience of more than 30 years in the field of neurosurgery. His passion in the specialty is MVD surgery.
Symptoms of trigeminal Neuralgia are generally electric shock-like pain in the face. This could be in the forehead, eye, cheek, nose, upper or lower jaw areas.
Typically the triggers that set off an episode of Facial pain are touching, brushing, shaving, chewing and talking.
This pain is so severe and horrible that it is called the suicide disease! Watch this video to see how the TN attack looks.
The good news is, Yes!! Though medical treatment is the mainstay, especially in the initial phases of the disease, medicines soon become ineffective. Occasionally, the patient has a pain holiday and comes to believe that his/her pain has been cured. But it comes back with a vengeance, and this is the time that most patients usually seek permanent treatment.
Initially, after the diagnosis of Trigeminal neuralgia is made, the patient is referred to a neurologist, to start medical therapy. The neurologist adjusts the doses as necessary, and helps the patient understand how to time the doses to get best pain relief. The neurosurgeon is involved when the patient no longer finds medication useful, or when the side-effects of medicines are unbearable. The neurosurgeon then offers Microvascular Decompression surgery as a possible permanent treatment.
Yes. Dr Jaydev Panchwagh is a neurosurgeon practising in Pune, Maharashtra. He is passionate about treating Trigeminal neuralgia and Glossopharyngeal Neuralgia. With the aim of focusing on the treatment of this deadly pain, he has been instrumental in putting together a dedicated team. He is the Founder-Director of the Centre Of Excellence for MVD surgery. It is perhaps the only one of its kind in India.