Peripheral Nerve Stimulation for Treatment of Trigeminal Neuralgia
AlexanderYakovlev, MD, Comprehensive Pain Management of the Fox Valley, Appleton,Wis.
Sergey A. Karasev, MD, Comprehensive Pain Management of the Fox Valley, Appleton,Wis.
Victoria E.Yakovleva, Comprehensive Pain Management of the Fox Valley, Appleton,Wis.
INTRODUCTION
Trigeminal Neuralgia (Tic Douloureux) is the most common of all neuralgias, rarely occurs before the age 35 with incidence slightly greater in women than men. Traditional treatment options for trigeminal neuralgia include anticonvulsants, antidepressants, non-steroidal anti-inflammatory medications, and opioids.Treatment with these medications is often ineffective and wrought with intolerable side effects. Peripheral nerve stimulation(PNS) has been used to treat a variety of neuropathies, including supraorbital, ileoinguinal, occipital, post-herpetic, and trigeminal with excellent relief of pain.Treatment of trigeminal neuralgia using PNS can lead to decreased reports of pain as well as a reduced need for oral pain medications. Three patients suffering from intractable trigeminal neuralgia underwent PNS placement. One of them was male and three were females aged from 24 to 73.
METHODS
The patients failed conservative therapy and received no pain relief from stereotactic radiofrequency ablation of the trigeminal ganglion.The patients underwent successful 2 day trial of percutaneous placement of two 8-electrode leads.Two weeks later the patients underwent implantation with permanent leads placed subdermally and RstoreULTRA (Medtronic Inc., Minneapolis, MN) rechargeable generators.
FIGURES
RESULTS
At 12 months post-implant, the patients continued to report good pain control and improved functional status. All patients were able to decrease or discontinue use of pain medications.
CONCLUSION
PNS may be a safe and effective technique for control of refractory-to-conventional-treatment trigeminal neuralgia. PNS is also an excellent option for patients with co-morbidities which make them less ideal candidates for more invasive interventions.
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