Trigeminal Neuralgia (Tic Doloureux)

Has an incidence of 12–27:100,000/y.

More common in women and pts >50 y.

1–5% of pts with MS have TN, and 2–4% of pts with TN have tumors or vascular malformations in the posterior fossa. There is an association with Charcot-Marie-Tooth disease.

Evaluate comorbidities with pts with MS, tumors.

Liver enzyme induction with use of antiepileptic drugs.

Difficulties with mastication might lead to nutritional deficits.

Bradyarrhythmias with percutaneous balloon compression.

Severe bradycardia/asystole with manipulation of the fifth nerve in the posterior fossa or with balloon compression

Oversedation and management of the airway in RFA procedures

Postop exacerbation of MS

TN is a facial pain syndrome characterized by recurrent episodes of intense pain over the distribution of the fifth cranial nerve, more commonly the V2 and V3 divisions. Diagnosis is made by pain distribution and quality. Characteristic pain is severe in intensity, shooting or stabbing, lasts seconds to minutes, and is often precipitated by light touch or cold air. Pt may have bouts over weeks or months, with some spontaneous remissions up to 6 mo. Usually the bouts become more frequent and the pain more sustained. Pts with MS rarely have remissions.

Imaging techniques such as MRI and MRA are used to evaluate nerve decompression, and to rule out MS and tumors.

Neurologic exam is normal in most pts, with the exception of a minimal amount of sensory loss over the affected area.