What to do when trigeminal neuralgia does not respond to treatment?
Aneuralgia (or neuralgia) of the trigeminal nerve It is a painful syndrome that leads to excruciating pain in the region of the face through which the trigeminal nerve passes.
Preventive treatment of trigeminal neuralgia should be continuous and there are several medication options. But there are many factors for a person not to respond to a treatment.
But there are many factors for a person not to respond to a treatment.
But why is my trigeminal neuralgia not controlled
First, it should be assessed whether the correct medication for Neuralgia has been prescribed, whether the right dose has been achieved and whether it has been used properly.
Remembering that it is not worth the thought “ah, but I know someone who took a medicine that ended the pain”..
This is because each person is different, responds differently to medications and neuralgia itself can be different.
But how to know if the medicine was correct and if the dose used was adequate?
The most indicated drugs for the treatment of trigeminal neuralgia are many.
Initially, drugs of a specific class are used, called anticonvulsants (no, you are not having a seizure, nor will you be just using these drugs).
The main ones are Carbamazepine (which have several brands, such as Tegretol); Oxcarbazepine (Oxcarb, Oleptal, Trileptal). Other medications such as Pregabalin, Gabapentin, Phenytoin (Hidantal), Lamotrigine, among others, can also be used.
The minimum dose (if it does not reach this dose, it is hoped that the medicine has not made it adequate) of the medicines is:
Carbamazepine: minimum dose: 400-600mg per day (divided into 2 or 3 intakes). The maximum dose is close to 2000mg per day.
Oxcarbazepine: minimum dose:600-900mg per day (divided into 2 intakes). Doses up to 2400mg per day (or more) can be used.
The main side effects of these medications are: Dizziness/vertigo; drowsiness, nausea, among others.
If the maximum dose has been reached, or the person has not tolerated the increase in medication – with limiting side effects (attention, the medication should only be stopped if the side effect is really limiting/preventing the treatment, as in most cases the symptom is transient and does not lead to functional limitations), the treatment should be reviewed.
Medications can be associated (more than one medication is used), botulinum toxin can be used, or if the patient has no contraindications, thesurgery. There are several types of surgery. Surgery, although it can cure the problem, should not be seen as a sure cure, but as a type of treatment, which is highly effective in controlling pain. What is expected is pain control, or an increase in the frequency of crises. Adverse effects can happen, but tend to be minor, such as tingling in the affected face area, which can persist for life (does not happen in most people).
If a person does not respond to a drug at the correct dose, even after adjustments are made, they are already a candidate for surgery. It is not necessary for the person to use several drugs to only then opt for surgery.
Abotulinum toxin it is an alternative for the preventive treatment of trigeminal neuralgia, mainly for those who do not want to undergo surgery. If the person has a good response to treatment, the application should be maintained every 3 months. The medicine can be used together initially, but botulinum toxin can be used as a single treatment.