Trigeminal neuralgia articles Archives | Trigeminal Neuralgia Treatment

Trigeminal Neuralgia Awareness Day

Posted on October 10, 2023 | by Dr. Jaydev Panchwagh | Leave a Comment

On the occasion of Trigeminal Neuralgia Awareness Day, Dr Jaydev Panchwagh says: “Trigeminal Neuralgia is an often misunderstood disease, especially in the early phase, when a diagnosis is not established. It is characterised by severe facial pain that is agonising enough to warrant thoughts of self-harm. It is therefore known as ‘ Suicide Disease'”. He an eminent Neurosurgeon in the city of Pune and an internationally acclaimed specialist in MVD surgery, for Trigeminal Neuralgia and Hemifacial Spasms.

In this article written by Dr Jaydev Panchwagh on the same subject, he has discussed various aspects of this deadly disease.

Trigeminal Neuralgia Awareness Day

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-some facts

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:

Trigeminal Neuralgia affects the trigeminal nerve, which is responsible for transmitting sensations from the face to the brain.
The pain caused by Trigeminal Neuralgia is often described as a sharp, stabbing sensation that can last for several seconds or minutes.
The pain can be triggered by simple activities such as chewing, talking, or even brushing your teeth.
Trigeminal Neuralgia is more common in women than men and typically affects people over the age of 50.
There are several treatment options available for Trigeminal Neuralgia, including medication, surgery, and alternative therapies such as acupuncture and chiropractic care.
Despite these treatments, many people with Trigeminal Neuralgia continue to experience chronic pain and may require ongoing management of their symptoms.
Trigeminal Neuralgia Awareness Day on October 7th is an opportunity to educate the public about this condition and advocate for improved access to care and support for those affected by it.

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.

Surgical Treatment for Trigeminal Neuralgia ..a complex situation!

Posted on June 28, 2023 | by Dr. Jaydev Panchwagh | Leave a Comment

Surgical treatment of Trigeminal Neuralgia by MVD surgery is a fairly straightforward one; but if it is complicated by a cerebellar AVM, there are many twists and turns that could potentially be serious.

https://timesofindia.indiatimes.com/city/pune/complex-neurosurgery-at-city-hospital-rids-malawi-woman-of-excruciating-pain/articleshow/101324489.cms

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.

Arterio-Venous-Malformations (AVM)

AVMs occurring inside the brain are formidable Neurosurgical challenges.

What is an AVM?

An AVM is an area of a densely packed conglomerate of malformed blood vessels. Normally an artery supplying a particular part of brain divides into smaller ‘arterioles’ and then even smaller ‘capillaries’. These smaller vessels have a strong muscular coat in their walls so that they can shrink in diameter to allow the blood flow in brain tissue to be slow and steady for the oxygen delivery to happen effectively.

The used blood is then collected by draining veins which open into bigger venous channels to take it to lungs eventually.

Why is an AVM dangerous?

In an AVM, not only are the vessels malformed, but the muscular layer in the smaller capillaries is absent, making them unable to contract. Also the smaller capillary layer is often absent. This causes direct shunting of arterial blood to the veins at very high speeds and flow rates.

AVMs in the brain are even more formidable as they occur in very important areas and their removal is considered one of the most difficult of brain surgeries…..which are , as a group challenging in the first place.

Secondly, brain being the most prized organ for the body, it’s blood flow follows slightly different rules than the remainder of the body. “Blood brain barrier” and “Cerebral blood flow Autoregulation” are only two examples of its (brain’s) unique nature.

Some of these unique characteristics could also be absent in AVMs, making them difficult to be tamed by surgery.

Another problem with the AVM is a “steal” phenomenon. As the name suggests, due to a very high flow across the AVM and reduced resistance for the flow in this area, some of the blood supply of the surrounding brain is “stolen” by the AVM.

The blood vessels which lead to the AVM, though not directly taking a part in formation of the AVM, increase in diameter, become tortuous and thicken due to continuous higher blood stream flowing through them.

Is AVM dangerous?

Brain AVMs can present with sudden bleeding or fits.

AVMs presenting with compression of the nerves causing neuralgia though known is extremely rare.

Details of this rare case….intolerable Face pain

In the rarest of rare, and surgically challenging case, a 54 year old eastern African patient was treated by combination therapy of Angiography led Embolization followed by Brain surgery to remove the malformation completely.

She was suffering from severe pain in the distribution of Trigeminal nerve and Glossopharyngeal Nerve for last many years.

The pain became intolerable even on very high doses of medicines.

Trigeminal Neuralgia and Glossopharyngeal Neuralgia in same patient

For her double Neuralgia, (Trigeminal Neuralgia and Glossopharyngeal Neuralgia) she came to the MVD surgery Centre at Pune.

But in her case, a simple MVD surgery would not have been sufficient as a more formidable problem in the form of Cerebellar AVM was present in the same area as the nerves.

In fact, the nerves were getting compressed due to high engorged blood vessels supplying the AVM.

Thus it was a much complex problem.

The treatment was planned with a detailed planning sessions with Neurosurgeon Dr Jaydev Panchwagh and interventional vascular specialist Dr Alurkar.

“This was rarest of the rare case, as we had to not only relieve her of extreme pain but while doing it, needed to eliminate the AVM completely.”

Staged operation

In the first stage, AVM was partly occluded by Angiography guided intervention technique.

In this a very thin catheter is inserted in the blood vessels supplying the AVM and medical glue is injected into the vessels.

This glue flows forward a bit and immediately becomes hard, this occluding the AVM blood vessels.

“However, we have to be careful as, if even a small excess amount is injected, it could occlude normal blood vessels or it can flow in normal circulation causing obstruction at undesired sites”

“Also due to tortuosity and curvaceous nature of AVM vessels, some of the vessels may not be approachable for threading the catheter.”

Therefore, after safe embolization, the AVM needs to be removed to ensure instant cessation of bleeding risk.”

“AVM surgery needs skilled operator and has to be done with meticulous planning and with the most modern Neurosurgical equipment.

After embolization, this AVM was still getting blood supply from multiple arteries and was in the cerebellum.

During the surgery, we have to be very careful to separate very important blood vessels which are “passing'” next to the AVM but not supplying it. They are the “transiting vessels” they need to be preserved.

Also, the actual feeding vessels are high flow vessels and need secure clipping before cutting them.

After 8 hour long meticulous surgery, we had to do the most important part.

That was to separate the blood vessels compressing the trigeminal and Glossopharyngeal nerves to treat her pain of Trigeminal and Glossopharyngeal double neuralgia.”

What is MVD surgery?

MVD surgery is a brain surgery during which the affected nerve..in this case the Trigeminal nerve and glossopharyngeal nerve is made free of compression from the offending blood vessel by using a piece of teflon pad. In experienced hands it has low risk.

Dr Jaydev Panchwagh

Dr Jaydev Panchwagh is an eminent neurosurgeon in India. He is based out of Pune. He is the Director of Centre of excellence for MVD surgery, at Pune. He has performed more than 2000 MVD surgeries for Trigeminal neuralgia and glossopharyngeal neuralgia.

Doctor heals Mauritian of chronic facial pain (Trigeminal Neuralgia)

Posted on July 6, 2020 | by Dr. Jaydev Panchwagh | 23 Comments

pune doctor sets mauritian free from chronic pain — Trigeminal neuralgia coverage

This is an article on Chronic facial pain (Trigeminal Neuralgia) from Times of India, Pune, published on May 7 2018.

For five years, 60-year-old Sawmy, a Mauritius national, suffered from severe pain in his face. Sawmy is an agriculturist by profession. He is married and has triplets.

The condition, Trigeminal neuralgia (TN) was such that he would go without eating for days together. Medicines would prove useful only for short periods of time. As is common in cases of TN, he was caught between the side effects of the high-dosage medicines and attacks of severe pain.

Any severe pain that remains untreated or partially treated for a prolonged period of time gets complicated, and its intensity worsens. This is termed chronic pain syndrome. In Sawmy’s case, the syndrome had turned his life upside down.

“In his desperate search to find a cure, Sawmy had gone to France — his sister lives there — where he consulted a number of doctors, to no avail. “I was on high doses of medicines. They were mainly three types of pain modulators. I developed drowsiness, forgetfulness and loss of balance due to the prolonged use of the drugs,” he said. All the doctors in France did was prescribe more medicines, which only worsened the side effects for Sawmy. “The repeated attacks of pain caused personality changes — they made me more irritable,” he said.

He eventually found relief in Pune, while browsing on Youtube and the internet. Though he didn’t have any acquaintances in India, Sawmy visited Pune after contacting Dr Jaydev Panchwagh over Whatsapp. “I contacted him for trigeminal neuralgia surgery. This alone speaks about the severity of pain I had, and how desperate I was to get rid of it,” he recalled. He now says that Dr Jaydev Panchwagh is one of the best neurosurgeons for trigeminal neuralgia surgery.

Explaining this unusual case, Dr. Jaydev Panchawagh said, “The drugs prescribed to patients suffering from Trigeminal neuralgia are mainly pain modulators. They are of different varieties or groups. The problem with the drugs is that they don’t target the Trigeminal nerve where the pain originates. So they (the drugs) act on the entire nervous system and cause neurological side effects.”

He added: “In simple words, these medicines numb the nerves. The drugs do not target the basic cause of neuralgia, which is vascular compression on the nerve as seen in majority of the cases, Dr. Panchawagh said.

“A very important aspect is the fact that chronic pain (if persistent for a year or more) can lead to permanent changes in the brain, including shrinkage, especially in the setting of neuropathy. Widespread impact on memory and cognition, sleep, sexual function, and development of hypertension are other important consequences. The psychology of chronic pain can best be understood as ‘learnt helplessness’, that is, the psychology of a person who is trapped in a situation from which there is no escape.”

Microvascular decompression surgery, or MVD surgery, is the most beneficial surgical treatment for permanently treating trigeminal neuralgia, claim doctors. “It is the only procedure which treats the basic cause of the trigeminal neuralgia,” said Dr Jayadev Panchawagh, who carried out the surgery on Sawmy. He has operated on more than 950 other patients since 2005.

Sawmy underwent the surgery under care of Dr Jaydev Panchwagh in Pune. “It has been 22 days now with no attacks of pain. I don’t have to take any medicines post-surgery. It is a huge relief. Surgery has proved to be a boon. I wish I knew about it earlier,” he said, when interviewed after his MVD operation for Trigeminal Neuralgia.

ABOUT THE CONDITION

There are two nerves-one on each side of the face-that carry the sensation from the face and gums to the brain. They are called trigeminal nerves. Sensations from the right side of the face are carried by the right trigeminal nerve. Neuralgia means nerve pain. Compression by a pulsatile blood vessel causes trigeminal neuralgia in a majority of the cases.

How patients describe the pain due to TN

* The worst pain experienced by mankind

* The pain you would not wish even on your enemies

* Death is better than this suffering

* Pain of 1,000 knives piercing the face

* A hot ‘chilli bomb’ exploding on one side of your face

This is a potentially misunderstood medical condition. The behavioural and emotional changes in the patient is difficult to understand for others. It is also a condition that can be diagnosed if one is aware of its existence.

* Trigeminal neuralgia is also known as the ‘suicide disease’ because of the intense pain triggered by talking, eating or even a breeze.

* A study has revealed the 92% of patients were unaware of the diagnosis prior to their doctor telling them..

* Most of them were treated for dental or jaw pain, migraine or even psychiatric illness

* The reason for misdiagnosis is low awareness of the condition.

http://https://timesofindia.indiatimes.com/city/pune/city-doc-sets-mauritian-free-from-chronic-pain/articleshow/64056058.cms