$Unique_ID{BRK00870}
$Pretitle{Ill Defined Symptoms and Rare Diseases}
$Title{What is "Tic Douloureux"?}
$Subject{tic douloureux pain}
$Volume{N-2}
$Log{}

Copyright (c) 1991   Tribune Media Services, Inc.


What is "Tic Douloureux"?


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QUESTION:  I have a condition called "tic douloureux" (painful tic).  It took
many years before a neurologist finally diagnosed it.  What can you tell me
about it and its treatment?

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ANSWER:  Most patients with this condition would agree that "painful tic" is
an appropriate name for what is known medically as trigeminal neuralgia, or
"tic douloureux".  Patients complain of sudden and excruciating pain on one
side of the face that feels sharp and stabbing, sometimes like an electric
shock.
     The pain occurs in spasms, subsides rapidly, and can be triggered by such
activities as talking, eating, feeling the wind blow against the side of the
face, seeing flashing lights, or even hearing sudden noises.
     Although sometimes difficult to identify because of the many conditions
which may provoke the symptoms, a careful diagnostic workup usually results in
establishing the precise diagnosis.  There are a number of treatments,
although some do pose certain risks.
     Trigeminal neuralgia is often caused by pressure from a blood vessel
pulsating against the trigeminal nerve.  Other causes are blamed on tumors,
multiple sclerosis, aneurysms, and angiomas.
     If diagnostic tests rule out causes like tumors that require specific
treatment, your doctor will probably try drug therapy first.  Phenytoin or
carbamazepine are two of the most popular choices, since both are generally
effective with long lasting results, although both can cause side effects.
     If your pain is especially severe, your doctor can also inject a local
anesthesia and/or prescribe a narcotic pain reliever.
     If drug therapy is unsuccessful in alleviating your pain, other
treatments can be used, but these can be risky:
     Injections of alcohol, glycerol, phenol, and hot water into part of the
trigeminal nerve can block the action of the nerve, thereby stopping pain, but
this procedure can also cause loss of feeling in the face.
     Surgically cutting or separating the trigeminal nerve branch relieves
pain longer than injections, but again, this is another treatment that can
cause numbness.
     The most common procedure performed today is posterior fossa
microvascular decompression.  This operation involves separating the blood
vessel that is pressing against the trigeminal nerve by placing a small
plastic implant, or similar device, between the vessel and the nerve to keep
them apart.
     About 80 percent of patients find pain relief with this operation for up
to five years.  Although this procedure does not cause a loss of sensation in
the trigeminal nerve, it can cause problems like hearing impairment and
hemorrhage.
     Another popular procedure is percutaneous trigeminal radiofrequency
coagulation.  A general anesthetic is injected through an insulated needle;
then a radio frequency current is used to coagulate the branches of the
trigeminal nerve.
     This procedure relieves pain in 80 to 98 percent of patients, but it too,
like many of the other treatments, may have complications.  The proper choice
of treatment depends upon your special case, and is one that will provide the
greatest chance of relief, with the least risks.
ÿ
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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
