Khatuaeva A. A¹., Karpov S.M².

Graduate student¹, professor, doctor of medical sciences²

Department of Neurology, Stavropol State Medical University

Trigeminal neuralgia diagnostic criteria

Trigeminal neuralgia (TN) is a most widespread and severe form of facial pain. The disease is known from ancient times, but for the first time it was described by M. Andre only in 1756 and he called it “a pain tic” [6]. The detailed description of TN was represented by J. Forthergil in monograph “Facial pain lesion” [7], deservedly considered to be a fundamental manual.

It is known that trigeminal neuralgia is characterized by hard paroxysmal painful sensations more frequently in the zones of second and third branches, usually unilaterally. Pain occurs spontaneously or in consequence to a trigger area irritation. The attack can last from some seconds to several minutes. TN progression is remittent, and with age remissions decrease. This aspect of disease is described as a classic idiopathic true typical neuralgia of a trifacial nerve.

The main reason for trigeminal neuralgia is a nerve compression in the area of its exit from a braincase through a narrow bone canal by an abnormally situated vessel (more frequently of the superior cerebellar artery), aneurysm, chronic facial infections (dental caries, highmoritis), overcooling of face. Quite often first signs of trifacial neuralgia occur after extraction of a painful tooth, cerebral tumor, cerebrovascular disturbances such as atherosclerosis; multiocular sclerosis.

Trigeminal neuralgia diagnostic as of one of the variants of neuropathic pain is made after a clinical examination, and methods of instrumental examination such as computer tomography, magnetic resonance tomography, evoked potentials of cerebrum and spinal marrow are supplementary methods of examination (Ustiuzhantsev N.E., Balandina I.A.).

Nowadays in conditions of explosive progress of science the trigeminal neuralgia studies implicate the multidiscipline approach with the application of clinic, epidemiological, pathomorphological, neurovizualizational, ultrasound, electrophysiological, biochemical, pharmacological and other contemporary methods of investigation; elaboration and implementation in practical health protection of new methods of conservative and surgical treatment.

Trigeminal neuralgia diagnostic criteria:

1. Paroxysms of facial or cerebral (frontal) attacks of the average duration of 5-20 sec but not more than 2 min. Pain has a darting character and can be compared to electric shock.

2. Pain has not less than 4 typical characteristics:

- Sharpness, severity

- Occurrence evoked by trigger points irritation or accomplishment of day to day activities: eating, talking, washing face, shaving, teeth brushing;

- “pain behavior” (patients try not to move, freeze, stop talking);

- In the attack-free interval neurological symptoms are absent [4,8].

3. Attacks are stereotypic but specific for every affected person.

4. Localization is strictly limited by a trigeminal nerve zone, 2 or 3 branches more often (in 5% of cases – 1 branch).

Conclusion: Diagnosis is established when other reasons of facial pain are excluded after determination of anamnestic data, thorough neurological examination and application of supplementary special methods of examination if necessary, including computer and magneto-resonance tomography, electrophysiological, ultrasound, biochemical and other examination methods. MRI in vascular regime with stem and vessels identification, as well as special technique of 3D magneto-resonance tomography (MRI) with contrast are used to reveal a blood vessel compressing the nerve in the trunk entrance to exclude or detect a neurovascular conflict.

References:

1. Балязина Е. В. Терапия классической невралгии тройничного нерва // Медицинский вестник Северного Кавказа. — 2011. — № 2. — С. 39-41.

2. Карпов С.М., Хатуаева А.А., Христофорандо Д.Ю. / Вопросы лечения тригеминальной невралгии // Современные проблемы науки и образования. – 2014. – № 1;

3. Карпов С.М. Христофорандо Д.Ю., Батурин В.А., Карпов А.С. /
Новый взгляд на патогенез и лечение невралгии тройничного нерва // Фундаментальные исследования. - 2012. № 8-2. С. 326-329.

4. Ревегук Е.А., Карпов С.М. Актуальность проблемы невралгии тройничного нерва в Неврологии // Успехи современного естествознания. — 2013. — №9. — С. 127-128.

5. Хатуаева А.А. Современные представления об этиологии и патогенезе невралгии тройничного нерва // Международный научно-исследовательский журнал.- 2013. - №10 (17) часть 5. С 31-33.

6. Andre M. Remarques sur certains mouvements convulsifs. Delaguette. - Paris, 1756.

7. Fotergill J. On a painfull affection of the face // Medical observations and inquires by society of physicians. J. 1773. P. 129-142.

8. Ogleznev KY, Grigoryan YA, Shesterikov SA The pathophysiological mechanisms of and treatments for facial pain // "Science". Siberian Branch. 1990. 192 pp.

9. Shmyrev VI Rybakov AS The modern concept of the pathogenesis of trigeminal neuralgia // Journal. nevrol. and psychiatrist. them. SS Korsakov. 2006. V. 106. 3. T. S. 64-74.

10. Khatuaeva A.A. Contemporary approaches to the trigeminal neuralgia therapeutic management / Khatuaeva A.A., Karpov. S.M., Frantseva A.P. European Sciences review Scientific journal //2014. № 11–12. Р 33-36.