Could This Be a New Treatment for Trigeminal Neuralgia?

Published on Jul 28, 2020

On this page:

What is trigeminal neuralgia?
Symptoms of trigeminal neuralgia
Standard treatments for trigeminal neuralgia
New treatment for trigeminal neuralgia
A case study for the new treatment

At Regenexx we’ve had lots of regenerative medicine firsts. Now that could include a new treatment for trigeminal neuralgia. Let’s dig in.

What Is Trigeminal Neuralgia?

Illustration of trigeminal nerve anatomy showing the nerves orgin in the brain and corresponding zones in the face

Vips_s/Shutterstock

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What Are the Symptoms of Trigeminal Neuralgia?

Trigeminal neuralgia causes episodes of severe, shooting or stabbing pain that may feel electrical. The attacks can be triggered by chewing, touching the face, talking or brushing the teeth (1). The pain can last a few seconds to several minutes and some patients have periods where they have no pain. Some attacks can last much longer. The pain may also be spasm like.

What Are the Standard Treatments for Trigeminal Neuralgia?

Before we get into reviewing a possible new treatment for trigeminal neuralgia. The traditional treatments fall into the following categories (2):

Medications
- Anticonvulsants: These include medicines that stabilize nerves. These are typically drugs like carbamazepine (Tegretol, Carbatrol, others), oxcarbazepine (Trileptal), lamotrigine (Lamictal) phenytoin (Dilantin, Phenytek), clonazepam (Klonopin), and gabapentin (Neurontin, Gralise, others).
- Muscle Relaxers:This includes baclofen (Gablofen, Lioresal).
Botox: This is a medication that can be injected into muscles that blocks the nerve input to muscles and help tightness, spasm, and pain.
Radiation
- Gamma Knife: This procedure uses the same machine used to treat tumors. A focused beam of radiation is directed at the root of your trigeminal nerve. This procedure damages the trigeminal nerve to try to reduce or eliminate pain. Side effects can include numbness in the face.
Image-Guided Procedures
- Rhizotomy: This is the destruction of the nerve. There are several types of procedures used:
  - Glycerol injection: A needle is guided to the area where the nerve exits the skull and glycerol is injected to destroy the nerve fibers. This will generally cause facial numbness.
  - Balloon compression: The doctor inserts a hollow needle to a part of your trigeminal nerve that goes through the base of your skull. The doctor inserts a catheter with a balloon on the end through the needle. The balloon is then inflated to damage the trigeminal nerve. Again, the face is often numb after this procedure.
  - Radiofrequency Ablation (RFA): The doctor directs a probe (which looks like a needle) to the area of the trigeminal nerve. The tip of the needle then heats up and destroys the nerve and again the face is often numb.
Surgery
- - Microvascular decompression: In this surgery, the surgeon relocates the nerve or removes blood vessels that are in contact with the trigeminal nerve root. The surgeon has to carve a hole in the skull to get to this area where the cranial nerve exits. This surgery has some risks, including damaged hearing, weakness in the facial muscles, numbness, or a stroke.

What Is the New Treatment for Trigeminal Neuralgia?

The problem with all of the treatments above is that they all destroy the nerve. Can we treat the nerve to help the damaged nerve repair itself? We’ve been doing this with damaged nerves for years by precisely injecting the healing growth factors from the patient’s own blood platelets around the nerve. Here’s what that looks like using ultrasound guidance in the median nerve in the wrist:

Using this technique we have treated carpal tunnel syndrome and nerve damage due to surgery at various sites.

A Case Study of New Treatment for Trigeminal Neuralgia

This patient had trigeminal neuralgia and had a previous RFA. She first saw Dr. Pastoriza (our fellow last year) and then transferred care to Dr. Markle. They both used precise ultrasound and x-ray guidance to inject high-dose platelet lysate (the growth factors from PRP). This is what she wrote to Dr. Markle:

“PRP for Trigeminal Neuralgia Update

My second PRP treatment was on June 16. This time Dr. Markle injected the PRP directly over the place where the nerve and blood vessel collide as well as along the nerve. When asked, he said that he wanted to see at least a 20 percent improvement. I prayed that God would help me to qualify it.

(1) I waited until July 7 to stop using the pain shield at night. After the first treatment, I had only a few days without pain. I was not exactly sure what to expect this time. It’s only been two weeks since I stopped using the pain shield, but I have no pain whatsoever. NONE, nada, zip, zero. The only sensation I’m experiencing is a little pressure over the “spot.” I’m over the moon with excitement!

I know it’s very early and I have no idea how long I’ll be pain free, I’m thankful and praising God. I’m sure you understand how huge this is for people who suffer with Trigeminal Neuralgia.

(2) There is a secondary issue. I mentioned this to Dr. Pastoriza in our first meeting. The first procedure I had was radio surgery where the nerve is damaged to block the pain signals. The pain disappeared, but the entire left side of my head was numb from the top of my head to my left ear to my chin. Not a bad trade off in order to be free of pain.

I was told this could last one to three years. Of course, I was hoping for the three years. At 13 months, my face was still very numb. I’d say about 10 percent feeling had returned. I was thinking when the pain returned it would come back slowly, but it came back like a freight train right through the numbness.

My point in belaboring this is that since I’ve had two PRP treatments the numbness has greatly receded. The numbness is confined to the area close to the spot on the affected TN nerve and moves directly down my face to my left lip. I’d say the numbness has receded 75 percent. This is a great improvement! I would expect that with further PRP treatments this will continue to improve.”

The upshot? Is this a new treatment for trigeminal neuralgia? We’ll need to wait for a few months to a year, but if we can save this patient from big neurosurgery that would be a big win! If that works, then we may be able to help many trigeminal neuralgia patients avoid the destruction of their nerves.

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References

(1) Weiss, A.L., Ehrhardt, K.P. & Tolba, R. Atypical Facial Pain: a Comprehensive, Evidence-Based Review. Curr Pain Headache Rep 21, 8 (2017). doi:10.1007/s11916-017-0609-9

(2) Manzoni GC, Torelli P. Epidemiology of typical and atypical craniofacial neuralgias. Neurol Sci. 2005 May;26 Suppl 2:s65-7. doi:10.1007/s10072-005-0410-0