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1.
Neuroradiology ; 66(2): 161-178, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38159141

RESUMO

Craniofacial pain syndromes exhibit a high prevalence in the general population, with a subset of patients developing chronic pain that significantly impacts their quality of life and results in substantial disabilities. Anatomical and functional assessments of the greater occipital nerve (GON) have unveiled its implication in numerous craniofacial pain syndromes, notably through the trigeminal-cervical convergence complex. The pathophysiological involvement of the greater occipital nerve in craniofacial pain syndromes, coupled with its accessibility, designates it as the primary target for various interventional procedures in managing craniofacial pain syndromes. This educational review aims to describe multiple craniofacial pain syndromes, elucidate the role of GON in their pathophysiology, detail the relevant anatomy of the greater occipital nerve (including specific intervention sites), highlight the role of imaging in diagnosing craniofacial pain syndromes, and discuss various interventional procedures such as nerve infiltration, ablation, neuromodulation techniques, and surgeries. Imaging is essential in managing these patients, whether for diagnostic or therapeutic purposes. The utilization of image guidance has demonstrated an enhancement in reproducibility, as well as technical and clinical outcomes of interventional procedures. Studies have shown that interventional management of craniofacial pain is effective in treating occipital neuralgia, cervicogenic headaches, cluster headaches, trigeminal neuralgia, and chronic migraines, with a reported efficacy of 60-90% over a duration of 1-9 months. Repeated infiltrations, neuromodulation, or ablation may prove effective in selected cases. Therefore, reassessment of treatment response and efficacy during follow-up is imperative to guide further management and explore alternative treatment options. Optimal utilization of imaging, interventional techniques, and a multidisciplinary team, including radiologists, will ensure maximum benefit for these patients.


Assuntos
Neuralgia Facial , Qualidade de Vida , Humanos , Reprodutibilidade dos Testes , Cefaleia , Cabeça , Nervos Espinhais/cirurgia , Resultado do Tratamento
2.
Artigo em Inglês | MEDLINE | ID: mdl-37887684

RESUMO

Background: Orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes mainly characterized by painful attacks localized in facial and oral structures. According to the International Classification of Orofacial Pain (ICOP), the last three groups (non-dental facial pain, NDFP) are cranial neuralgias, facial pain syndromes resembling primary headache syndromes, and idiopathic orofacial pain. These are often clinical challenges because the symptoms may be similar or common among different disorders. The diagnostic efforts often induce a complex diagnostic algorithm and lead to several imaging studies or specialized tests, which are not always necessary. The aim of this study was to describe the encountered difficulties by these patients during the diagnostic-therapeutic course. Methods: This study was based on the responses to a survey questionnaire, administered to an Italian Facebook Orofacial Patient Group, searching for pain characteristics and diagnostic-therapeutic care courses. The questionnaire was filled out by patients affected by orofacial pain, who were 18 years and older, using a free online tool available on tablets, smartphones, and computers. Results: The sample was composed of 320 subjects (244F/76M), subdivided by age range (18-35 ys: 17.2%; 36-55 ys: 55.0%; >55 ys 27.8%). Most of the patients were affected by OFP for more than 3 years The sample presented one OFP diagnosis in 60% of cases, more than one in 36.2% of cases, and 3.8% not classified. Trigeminal neuralgia is more represented, followed by cluster headaches and migraines. About 70% had no pain remission, showing persisting background pain (VAS median = 7); autonomic cranial signs during a pain attack ranged between 45 and 65%. About 70% of the subjects consulted at least two different specialists. Almost all received drug treatment, about 25% received four to nine drug treatments, 40% remained unsatisfied, and almost 50% received no pharmacological treatment, together with drug therapy. Conclusion: To the authors' knowledge, this is the first study on an OFP population not selected by a third-level specialized center. The authors believe this represents a realistic perspective of what orofacial pain subjects suffer during their diagnostic-therapeutic course and the medical approach often results in unsatisfactory outcomes.


Assuntos
Neuralgia Facial , Transtornos de Enxaqueca , Neuralgia do Trigêmeo , Humanos , Dor Facial/diagnóstico , Dor Facial/terapia , Dor Facial/etiologia , Neuralgia Facial/diagnóstico , Neuralgia Facial/terapia , Neuralgia Facial/complicações , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/terapia , Inquéritos e Questionários
3.
Cephalalgia ; 43(8): 3331024231187160, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37548299

RESUMO

BACKGROUND: Primary headache syndromes such as migraine are among the most common neurological syndromes. Chronic facial pain syndromes of non-odontogenic cause are less well known to neurologists despite being highly disabling. Given the pain localization, these patients often consult dentists first who may conduct unnecessary dental interventions even if a dental cause is not identified. Once it becomes clear that dental modalities have no effect on the pain, patients may be referred to another dentist or orofacial pain specialist, and later to a neurologist. Unfortunately, neurologists are also often not familiar with chronic orofacial pain syndromes although they share the neural system, i.e., trigeminal nerve and central processing areas for headache disorders. CONCLUSION: In essence, three broad groups of orofacial pain patients are important for clinicians: (i) Attack-like orofacial pain conditions, which encompass neuralgias of the cranial nerves and less well-known facial variants of primary headache syndromes; (ii) persistent orofacial pain disorders, including neuropathic pain and persistent idiopathic facial/dentoalveolar pain; and (iii) other differential diagnostically relevant orofacial pain conditions encountered by clinicians such as painful temporomandibular disorders, bruxism, sinus pain, dental pain, and others which may interfere (trigger) and overlap with headache. It is rewarding to know and recognize the clinical picture of these facial pain syndromes, given that, just like for headache, an internationally accepted classification system has been published and many of these syndromes can be treated with medications generally used by neurologists for other pain syndromes.


Assuntos
Dor Crônica , Neuralgia Facial , Transtornos da Cefaleia , Neuralgia , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/etiologia , Síndrome , Dor Facial/etiologia , Neuralgia/diagnóstico , Neuralgia Facial/diagnóstico , Cefaleia/diagnóstico , Cefaleia/complicações , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/complicações , Dor Crônica/diagnóstico
4.
World Neurosurg ; 170: e57-e69, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36273728

RESUMO

BACKGROUND: Trigeminal neuropathy represents a subset of several facial pain syndromes that are difficult to diagnose and treat. Although many surgical modalities are available, outcomes remain suboptimal. The aim of this study is to present our experience in management of trigeminal neuropathy with a focus on the effectiveness and long-term efficacy of the different surgical procedures. METHODS: A single-center retrospective cohort study was conducted from December 2012 until February 2020. RESULTS: Twenty-eight patients (19 females, 9 males) were included in this study. They had 40 surgical interventions. At last follow-up, 1 patient (33.3%) treated by spinal cord stimulation (SCS) had no pain recurrence and 2 patients (66.6%) had their devices removed because of therapeutic failure. Median time to pain recurrence after SCS was 19.5 months (interquartile range [IQR], 29.79 months). Six patients were treated with peripheral nerve stimulation (PNS). At last follow-up, 2 patients had satisfactory pain relief, whereas half of the patients had no improvement. For the 17 patients treated with computed tomography-guided trigeminal tractotomy/nucleotomy, true failure occurred 7 times in 6 patients. Median time to pain recurrence was 5.6 months (IQR, 6.2). Of the 6 patients treated with caudalis DREZ, 3 (50%) had satisfactory pain relief for >1 year and the median time to pain recurrence was 3.9 months (IQR, 29.53). CONCLUSIONS: Trigeminal neuropathy is a difficult to treat entity of facial pain syndromes. The long-term efficacy of available interventions does not meet patients' satisfaction. More organized prospective studies with longer follow-up are needed to define the patient population best served by each surgical modality.


Assuntos
Dor Crônica , Neuralgia Facial , Doenças do Nervo Trigêmeo , Neuralgia do Trigêmeo , Masculino , Feminino , Humanos , Resultado do Tratamento , Seguimentos , Estudos Retrospectivos , Estudos Prospectivos , Dor Crônica/etiologia , Dor Crônica/cirurgia , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/cirurgia
5.
Otolaryngol Clin North Am ; 55(3): 595-606, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35680205

RESUMO

Though there have been considerable strides in the diagnosis and care of orofacial pain disorders, facial neuralgias, and myofascial pain dysfunction syndrome remain incredibly cumbersome for patients and difficult to manage for providers. Cranial neuralgias, myofascial pain syndromes, temporomandibular dysfunction (TMD), dental pain, tumors, neurovascular pain, and psychiatric diseases can all present with similar symptoms. As a result, a patient's quest for the treatment of their orofacial pain often begins on the wrong foot, with a misdiagnosis or unnecessary procedure, which makes it all the more frustrating for them. Understanding the natural history, clinical presentation, and management of facial neuralgias and myofascial pain dysfunction syndrome can help clinicians better recognize and treat these conditions. In this article, we review updated knowledge on the pathophysiology, incidence, clinical features, diagnostic criteria, and medical management of TN, GPN, GN, and MPDS.


Assuntos
Doenças dos Nervos Cranianos , Neuralgia Facial , Neuralgia , Neuralgia do Trigêmeo , Doenças dos Nervos Cranianos/diagnóstico , Dor Facial/diagnóstico , Dor Facial/etiologia , Dor Facial/terapia , Cefaleia , Humanos , Neuralgia/diagnóstico , Neuralgia do Trigêmeo/diagnóstico
7.
Headache ; 61(9): 1441-1451, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34618363

RESUMO

OBJECTIVE: This study aimed to characterize key features, and to assess the clinical development of common nondental facial pain syndromes such as persistent idiopathic facial pain (PIFP), trigeminal neuralgia (TN), and neuropathic facial pain (NEUROP). METHODS: This is a longitudinal study in which prospective questionnaire data of patients presenting to a specialized outpatient clinic were collected from 2009 to 2019. A telephone interview was conducted with the same patients in 2020 to assess the natural disease history. RESULTS: n = 411 data sets of patients with chronic facial pain were compiled. Among these were n = 150 patients with PIFP, n = 111 patients with TN, and n = 86 patients with NEUROP. Guideline therapy had not been initiated in 38.7% (58/150; PIFP), 19.8% (22/111; TN), and 33.7% (29/86; NEUROP) patients. Of the patients with PIFP, 99.3% (149/150) had primarily consulted a dentist due to their pain syndrome. The additional telephone interview was completed by 236 out of the 411 patients (57.4%). Dental interventions in healthy teeth had been performed with the intention to treat the pain in many patients (78/94 [83.0%] PIFP; 34/62 [54.8%] TN; 19/43 [44.2%] NEUROP), including dental extractions. 11.3% (7/43) of the patients with TN had never profited from any therapy. In contrast, 29.8% (28/94) of the patients with PIFP had never profited from any therapy. Furthermore, the primary pharmaceutical therapy options suggested by national guidelines were, depending on the substance class, only considered to be effective by 13.8% (13/94; antidepressants) and 14.9% (14/94; anticonvulsants) of the patients with PIFP. CONCLUSIONS: Facial pain syndromes pose a considerable disease burden. Although treatment of TN seems to be effective in most patients, patients with PIFP and NEUROP report poor effectiveness even when following guideline therapy suggestions. In addition, unwarranted dental interventions are common in facial pain syndromes.


Assuntos
Neuralgia Facial , Dor Facial , Neuralgia do Trigêmeo , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Neuralgia Facial/diagnóstico , Neuralgia Facial/tratamento farmacológico , Neuralgia Facial/epidemiologia , Neuralgia Facial/fisiopatologia , Dor Facial/diagnóstico , Dor Facial/tratamento farmacológico , Dor Facial/epidemiologia , Dor Facial/fisiopatologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Remissão Espontânea , Fatores Sexuais , Neuralgia do Trigêmeo/diagnóstico , Neuralgia do Trigêmeo/tratamento farmacológico , Neuralgia do Trigêmeo/epidemiologia , Neuralgia do Trigêmeo/fisiopatologia , Adulto Jovem
8.
Phys Med Rehabil Clin N Am ; 32(4): 601-645, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34593133

RESUMO

Headache disorders and trigeminal neuralgia are common conditions representing the types of craniofacial pain syndrome that can significantly impact quality of life. Many cases are refractory to traditional pharmacologic treatments, whether oral or intravenous. Radiofrequency ablation has been increasingly used as a tool to treat resistant, chronic pain of both of these disorders. Multiple studies have been reported that illustrate the efficacy of radiofrequency ablation in the treatment of the numerous headache subtypes and trigeminal neuralgia.


Assuntos
Ablação por Cateter , Neuralgia Facial , Ablação por Radiofrequência , Neuralgia do Trigêmeo , Neuralgia Facial/terapia , Humanos , Qualidade de Vida , Resultado do Tratamento , Neuralgia do Trigêmeo/cirurgia
9.
Dtsch Arztebl Int ; 118(6): 81-87, 2021 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-33827748

RESUMO

BACKGROUND: Idiopathic facial pain syndromes are relatively rare. A uniform classification system for facial pain became available only recently, and many physicians and dentists are still unfamiliar with these conditions. As a result, patients frequently do not receive appropriate treatment. METHODS: This article is based on pertinent publications retrieved by a selective search in PubMed, focusing on current international guidelines and the International Classification of Orofacial Pain (ICOP). RESULTS: The ICOP subdivides orofacial pain syndromes into six major groups, the first three of which consist of diseases of the teeth, the periodontium, and the temporomandibular joint. The remaining three groups (non-dental facial pain) are discussed in the present review. Attack-like facial pain syndromes most closely resemble the well-known primary headache syndromes, such as migraine, but with pain located below the orbitomeatal line. These syndromes are treated in accordance with the guidelines for the corresponding types of headache. Persistent idiopathic facial pain (PIFP) is a chronic pain disorder with persistent, undulating pain in the face and/or teeth, without any structural correlate. Since this type of pain tends to become chronified after invasive procedures, no dental procedures should be performed to treat it if the teeth are healthy; rather, the treatmentis similar to that of neuropathic pain, e.g., with antidepressant and anticonvulsive drugs. Neuropathic facial pain is also undulating and persistent. It is often described as a burning sensation, and neuralgiform attacks may additionally be present. Trigeminal neuralgia is a distinct condition involving short-lasting, lancinating pain of high intensity with a maximum duration of two minutes. The first line of treatment is with medications; invasive treatment options should be considered only if pharmacotherapy is ineffective or poorly tolerated. CONCLUSION: With the aid of this pragmatic classification system, the clinician can distinguish persistent and attack-like primary facial pain syndromes rather easily and treat each syndrome appropriately.


Assuntos
Neuralgia Facial , Neuralgia , Neuralgia do Trigêmeo , Neuralgia Facial/diagnóstico , Neuralgia Facial/terapia , Dor Facial/diagnóstico , Dor Facial/terapia , Cefaleia , Humanos
10.
Curr Opin Neurol ; 34(3): 373-377, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33661160

RESUMO

PURPOSE OF REVIEW: Trigeminal neuralgia is a well-known facial pain syndrome with several treatment options. In contrast, non-neuralgiform idiopathic facial pain syndromes are relatively rare, reflected by the fact that, until 2020, no internationally accepted diagnostic classification existed. Like trigeminal neuralgia, these non-dental facial pain syndromes need to be managed by neurologists and pain specialists, but the lack of pathophysiological understanding has resulted in an underrepresented and undertreated patient group. RECENT FINDINGS: This work provides a brief overview of the most common primary facial pain syndromes, namely, the facial attack-like facial pain, which corresponds to attack-like headache, the persistent idiopathic facial pain (formerly 'atypical facial pain'), and trigeminal neuropathy. What these disorders have in common is that they should all be treated conservatively. SUMMARY: On the basis of pragmatic classifications, permanent and attack-like primary facial pain can be relatively easily differentiated from one another. The introduction of the new International Classification of Orofacial Pain offers the opportunity to better coordinate and concentrate scientific efforts, so that in the future the therapy strategies that are still inadequate, can be optimized.


Assuntos
Dor Facial , Neuralgia do Trigêmeo , Neuralgia Facial , Dor Facial/diagnóstico , Dor Facial/terapia , Cefaleia , Humanos , Neuralgia do Trigêmeo/diagnóstico , Neuralgia do Trigêmeo/terapia
11.
Headache ; 61(3): 414-421, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33586784

RESUMO

OBJECTIVE: Present two cases of nervus intermedius neuralgia (NIN) in which patients described unilateral deep ear pain as their primary complaint and present a summary of NIN cases reported in the literature. BACKGROUND: The nervus intermedius is a tiny branch of the facial nerve that, with neuralgia, can present as a deep ear pain (NIN). The International Classification of Headache Disorders, 3rd edition, (ICHD-3) criteria for an NIN diagnosis include a unilateral deep ear pain with possible radiation that occurs in paroxysms with sharp pain and a tactile trigger. METHODS: A PubMed search was conducted for NIN and geniculate neuralgia. Two patients recently diagnosed with NIN at a single clinic were selected for case reports to highlight the variability of symptom presentation. RESULTS: The two cases reported here and the 127 cases reported in the literature show a wider range of presentations than included in the ICHD-3 criteria, including variable pain radiation sometimes diagnosed as concurrent trigeminal, glossopharyngeal, or occipital neuralgia. Pain was reported as constant or paroxysmal, as well as dull, sharp, or neuralgiform with inconsistent presence of triggers. While ICHD-3 does mention reported taste change, lacrimation, and salivation, the literature reports a much wider range of potential features associated with NIN. Optimal medical treatment is unclear given the predominance of surgical reporting of positive response to microvascular decompression, nerve sectioning, or other procedures. The two cases described here were successfully managed medically. CONCLUSION: NIN can present as described in the ICHD-3, but a more variable presentation may be possible. More studies are needed to clarify presentation, optimal medical treatment, and surgical indications for patients with NIN, especially when patients have no clear neurovascular conflict on neuroimaging.


Assuntos
Dor de Orelha/fisiopatologia , Neuralgia Facial/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Can J Neurol Sci ; 48(5): 690-697, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33234176

RESUMO

OBJECTIVES: Occipital nerve regional stimulation (ONS) is reported to improve pain in several studies. We examined long-term pain and functional outcomes of ONS in an open-label prospective study. METHODS: Patients with medically refractory and disabling craniofacial pain were prospectively selected for ONS. Primary outcome was a change in mean daily pain intensity on the numeric pain rating scale (NPRS) at 6 months. Secondary outcomes included changes in NPRS, Headache Impact Test-6 (HIT-6), Migraine Disability Assessment (MIDAS), Pain Disability Index (PDI), Center for Epidemiologic Studies Depression Scale - Revised (CESD-R), and Short Form-36 version 2 (SF36) at last follow-up. RESULTS: Thirteen patients (mean age 49.7 ± 8.4) diagnosed with occipital neuralgia (6), hemicrania continua (2), persistent idiopathic facial pain (2), post-traumatic facial pain (1), cluster headache (1), and chronic migraine (1) were enrolled. Mean NPRS improved by 2.1 ± 2.1 at 6 months and 2.1 ± 1.9 at last follow-up (23.5 ± 18.1 months). HIT-6 decreased by 8.7 ± 8.8, MIDAS decreased by 61.3 ± 71.6, and PDI decreased by 17.9 ± 18. SF36 physical functioning, bodily pain, and social functioning improved by 16.4 ± 19.6, 18.0 ± 31.6, and 26.1 ± 37.3, respectively. Moderate to severe headache days (defined as ≥50% of baseline mean NPRS) were reduced by 8.9 ± 10.2 days per month with ONS. CONCLUSION: ONS reduced the long-term NPRS and moderate-severe monthly headache days by 30% and improved functional outcomes and quality of life. A prospective registry for ONS would be helpful in accumulating a larger cohort with longer follow-up in order to improve the use of ONS.


Assuntos
Terapia por Estimulação Elétrica , Neuralgia Facial , Adulto , Dor Facial/terapia , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
13.
Int J Mol Sci ; 21(23)2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33271955

RESUMO

We evaluated the mechanisms underlying the oxytocin (OXT)-induced analgesic effect on orofacial neuropathic pain following infraorbital nerve injury (IONI). IONI was established through tight ligation of one-third of the infraorbital nerve thickness. Subsequently, the head withdrawal threshold for mechanical stimulation (MHWT) of the whisker pad skin was measured using a von Frey filament. Trigeminal ganglion (TG) neurons innervating the whisker pad skin were identified using a retrograde labeling technique. OXT receptor-immunoreactive (IR), transient receptor potential vanilloid 1 (TRPV1)-IR, and TRPV4-IR TG neurons innervating the whisker pad skin were examined on post-IONI day 5. The MHWT remarkably decreased from post-IONI day 1 onward. OXT application to the nerve-injured site attenuated the decrease in MHWT from day 5 onward. TRPV1 or TRPV4 antagonism significantly suppressed the decrement of MHWT following IONI. OXT receptors were expressed in the uninjured and Fluoro-Gold (FG)-labeled TG neurons. Furthermore, there was an increase in the number of FG-labeled TRPV1-IR and TRPV4-IR TG neurons, which was inhibited by administering OXT. This inhibition was suppressed by co-administration with an OXT receptor antagonist. These findings suggest that OXT application inhibits the increase in TRPV1-IR and TRPV4-IR TG neurons innervating the whisker pad skin, which attenuates post-IONI orofacial mechanical allodynia.


Assuntos
Traumatismos dos Nervos Cranianos/complicações , Neuralgia Facial/etiologia , Neuralgia Facial/metabolismo , Neurônios/metabolismo , Ocitocina/administração & dosagem , Canais de Potencial de Receptor Transitório/genética , Gânglio Trigeminal/metabolismo , Animais , Modelos Animais de Doenças , Neuralgia Facial/diagnóstico , Imunofluorescência , Regulação da Expressão Gênica/efeitos dos fármacos , Limiar da Dor/efeitos dos fármacos , Ratos , Receptores de Ocitocina/genética , Receptores de Ocitocina/metabolismo , Canais de Potencial de Receptor Transitório/metabolismo
14.
Prog Neurol Surg ; 35: 125-132, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33045706

RESUMO

Although commonly seen in the clinical practice, chronic orofacial pain quite often does not have a clear unambiguous organic origin. It may be difficult to find optimal pharmacotherapy, and in many cases, this pain may become pharmacotherapy resistant. Neuromodulation, particularly with electromagnetic neurostimulation techniques, has been widely used for the treatment of different types of pharmacoresistant pain, and repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) exemplify readily available noninvasive neuromodulation methods. We have used rTMS and tDCS to treat pharmacoresistant chronic orofacial pain. rTMS uses an electromagnetic coil placed over the patient's head to induce electrical current impulses within the brain tissue, thereby modulating brain activity. In tDCS, an electrode placement location(s) must be chosen in accordance with the density and the time course of the current, mainly to prevent undesired pathological changes in the underlying tissue. Transcranial neuromodulation methods provide a nondestructive and reversible approach to treatment of severe and otherwise uncontrollable chronic orofacial pain. These methods may be curative - as a part of so called "reconstructive neurosurgery" stimulation of neural structures may be used as an alternative to surgical destruction of neural pathways.


Assuntos
Dor Crônica/terapia , Neuralgia Facial/terapia , Dor Facial/terapia , Estimulação Transcraniana por Corrente Contínua , Estimulação Magnética Transcraniana , Humanos
15.
Prog Neurol Surg ; 35: 18-34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33022684

RESUMO

The trigeminal nerve complex is a very important and somewhat unique component of the nervous system. It is responsible for the sensory signals that arise from the most part of the face, mouth, nose, meninges, and facial muscles, and also for the motor commands carried to the masticatory muscles. These signals travel through a very complex set of structures: dermal receptors, trigeminal branches, Gasserian ganglion, central nuclei, and thalamus, finally reaching the cerebral cortex. Other neural structures participate, directly or indirectly, in the transmission and modulation of the signals, especially the nociceptive ones; these include vagus nerve, sphenopalatine ganglion, occipital nerves, cervical spinal cord, periaqueductal gray matter, hypothalamus, and motor cortex. But not all stimuli transmitted through the trigeminal system are perceivable. There is a constant selection and modulation of the signals, with either suppression or potentiation of the impulses. As a result, either normal sensory perceptions are elicited or erratic painful sensations are created. Electrical neuromodulation refers to adjustable manipulation of the central or peripheral pain pathways using electrical current for the purpose of reversible modification of the function of the nociceptive system through the use of implantable devices. Here, we discuss not only the distal components, the nerve itself, but also the sensory receptors and the main central connections of the brain, paying attention to the possible neuromodulation targets.


Assuntos
Sistema Nervoso Central/fisiologia , Terapia por Estimulação Elétrica , Neuralgia Facial/fisiopatologia , Neuralgia Facial/terapia , Nociceptores/fisiologia , Percepção da Dor/fisiologia , Sistema Nervoso Periférico/fisiologia , Nervo Trigêmeo/anatomia & histologia , Nervo Trigêmeo/fisiologia , Humanos
16.
J Stroke Cerebrovasc Dis ; 29(12): 105364, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33039773

RESUMO

A 67-year-old man with a high position carotid plaque presented with severe pain in ipsilateral parotid region several days after carotid endarterectomy (CEA). The pain occurred at the first bite of each meal and resolved as further bite. We diagnosed the pain as first bite syndrome (FBS). FBS is infrequent but known as a complication associated with parapharyngeal space surgery. The pain is characterized by sharp pain in the parotid region associated with mastication. The cause is unclear but thought to the result from sympathetic denervation of the parotid gland, followed by parasympathetic nerve hypersensitivity. Only five cases associated with carotid endarterectomy (CEA) have been reported. We should be in mind that CEA for high position plaque is one of the risk factors to cause FBS associated with CEA. Neurologists and vascular surgeons as well as otolaryngologists should all be informed FBS as one of the complications after carotid endarterectomy.


Assuntos
Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Neuralgia Facial/etiologia , Mastigação , Dor Pós-Operatória/etiologia , Glândula Parótida/inervação , Sistema Nervoso Simpático/lesões , Idoso , Neuralgia Facial/diagnóstico , Neuralgia Facial/fisiopatologia , Humanos , Masculino , Dor Pós-Operatória/diagnóstico por imagem , Dor Pós-Operatória/fisiopatologia , Sistema Nervoso Parassimpático/fisiopatologia , Sistema Nervoso Simpático/fisiopatologia , Resultado do Tratamento
17.
Prog Neurol Surg ; 35: 162-169, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32992322

RESUMO

Motor cortex stimulation (MCS) has been used in the treatment of intractable neuropathic facial pain for nearly 30 years. While efficacy rates have been noted as high as 88% in some studies, considerable variability in treatment response remains. Additionally, MCS is often cited as providing diminishing relief over time, and there are few long-term studies on efficacy. Complications are generally mild and include infection, hardware complication, seizure, and transient neurological deficit. Despite relatively minimal use, MCS remains a viable treatment option for the appropriately selected facial pain patients that have proved refractory to conservative management.


Assuntos
Terapia por Estimulação Elétrica , Neuralgia Facial/terapia , Neuroestimuladores Implantáveis , Córtex Motor , Neuralgia/terapia , Terapia por Estimulação Elétrica/efeitos adversos , Terapia por Estimulação Elétrica/métodos , Humanos , Neuroestimuladores Implantáveis/efeitos adversos
18.
Prog Neurol Surg ; 35: 85-95, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32906137

RESUMO

Since the first successful use of high-frequency electrical stimulation of trigeminal branches for treatment of facial pain in 1962, neuromodulation techniques become well established but remain greatly underutilised. Most subsequent implantation techniques and commercial devices for peripheral nerve stimulation, available until the last decade, utilised frequencies in the range 1-100 Hz. With the commercial introduction of 10-kHz spinal cord stimulation, there has been renewed interest in peripheral applications of kHz frequency neuromodulation. High-frequency biphasic stimulation causes rapid onset, reversible conduction block in mammalian nerves which might be useful in human peripheral neuromodulation applications, but the conduction block induced at kilohertz frequencies may not be the only mechanism contributing to analgesia. We discuss likely mechanisms of action of high-frequency peripheral nerve stimulation and present several clinical examples of successful use of this modality in various facial pain conditions. A change to sub-threshold higher frequencies in the 10 kHz range adds a number of distinct advantages. The lack of paresthesias is welcomed by patients. The ability to place the stimulating electrode approximately 1 cm away from the targeted nerve has an anatomical and surgical advantage.


Assuntos
Terapia por Estimulação Elétrica , Neuralgia Facial/terapia , Dor Facial/terapia , Neuroestimuladores Implantáveis , Animais , Terapia por Estimulação Elétrica/métodos , Humanos
19.
Prog Neurol Surg ; 35: 141-161, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32906139

RESUMO

Electro-modulation of subcortical deep brain structures by surgically implanted electrodes is now standard evidence-based treatment for movement disorders such as Parkinson's disease and essential tremor and is approved for dystonia and obsessive-compulsive disorder under a humanitarian exemption. Historically, deep brain stimulation (DBS) for multiple indications has demonstrated acceptable complication rates, rare mortality, and reducing morbidity as the technology and the techniques of its application have advanced. DBS for the amelioration of pain has been performed since the early 1950s, and became widely used in the 1970s, when targeting the somatosensory thalamus was shown to be efficacious for intractable pain syndromes including facial pain. The technique fell out of favour in the late 1990s after 2 multicentre trials failed to meet end-point criteria. Since these trials, DBS for pain has remained for investigational or "off-label" use. Criticisms from previous literature have involved unsuitability of patient selection, as well as inconsistencies in neurosurgical technique. Clinical success with DBS for facial pain has been for the treatment of a variety of chronic neuropathic and nociceptive pain syndromes; including trigeminal neuropathy, post-herpetic neuralgia, deafferentation facial pain, "atypical" facial pain, cluster headaches and other trigeminal autonomic cephalalgias, as well as head and neck pathologies, most often which have been resistant to all other 1st- and 2nd-line medical and surgical treatments, when DBS has become a "last treatment option." An enhanced understanding of the mechanisms of action of DBS for pain will enhance outcome, and appropriately prescribe evolving novel nuclear brain targets.


Assuntos
Dor Crônica/terapia , Estimulação Encefálica Profunda , Neuralgia Facial/terapia , Neuralgia/terapia , Dor Nociceptiva/terapia , Humanos
20.
Prog Neurol Surg ; 35: 133-140, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32920555

RESUMO

Neuropathic facial pain can be exceedingly difficult to manage with conventional therapies. Since this pain may be excruciating and often debilitating and some patients do not respond or do not tolerate conventional treatments, the interest in neuromodulation therapies is increasing. One of the most commonly used neuromodulation therapies, spinal cord stimulation, has recently shown promise in treating facial pain. We reviewed the current literature to determine usefulness of spinal cord stimulation in management of refractory facial pain. Our review indicates that for some patients with intractable pain in portions of the face, cervical spinal cord stimulation may be effective at reducing pain.


Assuntos
Medula Cervical , Neuralgia Facial/terapia , Neuralgia/terapia , Estimulação da Medula Espinal , Humanos
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