Trigeminal neuralgia

William Calvin wcalvin at stein1.u.washington.edu
Sun Dec 26 14:11:47 EST 1993


>I have been taking Tegretol for several months now. At first the effect 
>was disorientation and drowsiness. But over time that effect wore off. 
>I'm taking it for Trigeminal Neuralgia. They eliminated the attacks, 
>although the dull sharp pain would still be there at times---but no 1 
>minute attacks, NO tic.

You are, I trust, pain-free most of the time, i.e., no lingering pain 
between attacks (If not, ignore all that follows).  Re meds, you ought to be 
able to get phone advice on adjusting dose, so long as you can handle the 
blood tests closer to home.

There are two classes of surgical intervention for trigeminal neuralgia, 
if the meds don't work.  Might check your library for Mark Shelton's
WORKING IN A VERY SMALL PLACE (1987).  The puzzle of understanding 
trigeminal neuralgia is discussed in an essay "What to do about tic 
douloureux" in my book THE THROWING MADONNA (1983,1991).

The mostly widely available surgical procedure is a percutaneous 
procedure where one sticks a needle into the trigeminal nerve, just 
inside the skull where the ganglion is, and cooks a little bit of it with 
radio-freqneucy heating.

The more elegant treatment appears to get at the cause, which is an 
elongated artery that is traumatizing, with every heartbeat, the 
trigeminal nerve, right where it enters the brainstem.  The surgery 
merely moves the artery away.  This is major 
surgery, but it is getting less so; a friend of mine is now making holes 
about the size of a quarter.  It's a little riskier, just because of the 
general anesthetic risk, but it has an excellent cure rate.  Peter 
Jannetta at U of Pittsburgh is the pioneer, but there are now dozens of 
major neurosurgical centers that can probably do the operation.

Good luck,
    William H. Calvin   WCalvin at U.Washington.edu
    University of Washington  NJ-15
    Psychiatry & Behavioral Sciences
    Seattle, Washington 98195 
FAX:1-206-720-1989






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