DOI QR코드

DOI QR Code

삼차신경통 환자의 임상적 특성 분석

Clinical Features of Trigeminal Neuralgia

  • 한경림 (아주대학교 의과대학 마취통증의학교실) ;
  • 김의석 (아주대학교 의과대학 마취통증의학교실) ;
  • 김찬 (아주대학교 의과대학 마취통증의학교실)
  • Han, Kyung Ream (Pain Clinic, Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University) ;
  • Kim, Yeui Seok (Pain Clinic, Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University) ;
  • Kim, Chan (Pain Clinic, Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University)
  • 투고 : 2007.05.07
  • 심사 : 2007.11.05
  • 발행 : 2007.12.10

초록

Background: The diagnosis of trigeminal neuralgia (TN) is based on only clinical criteria. The purpose of this study was to estimate the clinical manifestations of TN patients treated at our pain clinic. Methods: A total of 341 patients with TN from Jan. 2004 to Dec. 2006 was evaluated the intensity, site, and onset of pain, facial sensation, duration of pain attack, pain free interval, triggering factors, and effects of the previous treatments with TN specific questionnaire and interview at the first visit of our pain clinic. Results: About 80% of the patients were over 50 years of age and 256 (75%) patients were women. Average durations from first attack of their pain and from current pain attack were 7 years and 16 weeks, respectively. The two most frequently involved trigeminal nerve branches were maxillary (40%) and mandibular (39%) branches. Three quarters of the total patients experienced only paroxysmal pain that lasted less than one minute. About 90% of patients had pain free period at least one time. Most common triggering factors were chewing (88%), brushing teeth (82%), washing face (79%), and talking (70%). Only 16 patients (5%) had no previous treatment and the others had more than one treatment, such as medication (68%) and interventional procedures (35%). The most common reasons for early discontinuation of carbamazepine were dizziness, ataxia, and vomiting. Conclusions: TN has specific clinical features of pain, which should be considered at diagnosis.

키워드

참고문헌

  1. Zakrzewska JM. Lopez BC: Trigeminal and glossopharyngcal neuralgia. In: Wall and Mclzack's textbook of pain. 5th ed. Edited by McMahon SB, Koltzcnburg M: Philadelphia. Elsevier/Churchill Livingstone. 2005, pp 1001-10
  2. Rasm ussen P: Facia l pain. III: a prospect ive study of the localization of facial pain in 1052 patients. Acta Ncurochir (Wien) 1991 ; 108: 53-63 https://doi.org/10.1007/BF01407667
  3. Rothman KJ, Monson RR: Survival in trigeminal neuralgia. J Chronic Dis 1973; 26: 303-9 https://doi.org/10.1016/0021-9681(73)90033-7
  4. Dandy WE: Concerni ng the cause of trigeminal neuralgia. Am J Surg 1934; 24: 447-55 https://doi.org/10.1016/S0002-9610(34)90403-7
  5. Loeser JD : Cranial neuralgias. In: Bonica' s management of pain. 3rd ed. Edited by Loeser JD: Philad elphi a. Lippincott Williams and Wilkins. 2001, pp 855-61
  6. Bookland MJ. Bagley CA. Schwarz J. Burger PC, Brem H: lntrucavcrnous trigeminal ganglion amyloidoma: case report. Neurosurgery 2007; 60 : E574 https://doi.org/10.1227/01.NEU.0000255361.32689.B3
  7. lizuka O. Hosokai Y. Mori E: Trigeminal neu ralgia due to pontine infarction. Neurology 2006; 66: 48 https://doi.org/10.1212/01.wnl.0000190260.41691.6d
  8. Cheng TM. Cascino TL. Onofrio BM: Comprehensive study of diagnos is and treatment of trigeminal neuralgia secondary to tumors. Neurology 1993; 43: 2298-302 https://doi.org/10.1212/WNL.43.11.2298
  9. Puca A, Meglio M. v eri R. Tamhurrini G. Tancred i A: Evaluation of fifth nerve dysfunction in 136 patients with middle and posterior cranial fossae tumors. Eur Neurol 1995; 35: 33-7 https://doi.org/10.1159/000117086
  10. Zakrzewska J, Hamlyn P: Facial pain in epidemiology of pain. Seattle, IASP Press. 1999. pp 171-202
  11. Katusic S. Beard CM, Bcrgstralh E. Kurland LT: Incidence and clinical features of trigeminal neuralgia. Rochester, Minnesota. 1945-1984. Ann Neurol 1990; 27: 89-95 https://doi.org/10.1002/ana.410270114
  12. Rasche D, Kress B, Schwark C, Wirtz CR, Unterberg A, Tronnier VM: Treatment of trigeminal neuralgia associat ed with multiple scleros is: case report. Neurology 2004; 63: 1714-5 https://doi.org/10.1212/01.WNL.0000142972.12040.44
  13. Manzoni GC. Torelli P: Epidemiology of typical and atypical craniofacial neuralgias. Neurol Sci 2005; 26(Suppl 2): 65-7
  14. Hooge JP. Redckop WK: Trigeminal neuralgia in multiple selerosis. Neurology 1995; 45: 1294-6 https://doi.org/10.1212/WNL.45.7.1294
  15. Stiles MA. Evans J: Trigeminal neuralgia. In: Intcrventional pain management Edited by Waldman SD: Philadelphia. Saunders Elsvier. 2007. pp 502-10
  16. Drangsholt M, Truelove EL: Trigeminal neuralgia mistaken as a temporomandibular disorder. J Evid Based Dent Prac 2001; 1: 45-55
  17. Burchiel KJ, Slavin KV: On the natur al his tory of trigeminal neuralgia. Neurosurgery 2000; 46: 152-4 https://doi.org/10.1093/neurosurgery/46.1.152
  18. Barker FG 2nd, Jannctta PJ, Bissonette DJ, Jho HD: Trigeminal numbness and tic relief after microvascular decompression for Iypical trigeminal neuralgia. Neurosurgery 1997; 40: 39-45 https://doi.org/10.1097/00006123-199701000-00008
  19. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 1996; 334: 1077-83 https://doi.org/10.1056/NEJM199604253341701
  20. Bederson JB, Wilson CB: Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg 1989; 71: 359-67 https://doi.org/10.3171/jns.1989.71.3.0359
  21. Burchiel KJ, Clarke H, Haglund M, Loeser JD: Long-term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg 1988; 69: 35-8 https://doi.org/10.3171/jns.1988.69.1.0035
  22. Tronnier VM, Rasche D, Hamer J, Kienlle AL, Kunze S: Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. Neurosurgery 2001; 48: 1261-7 https://doi.org/10.1097/00006123-200106000-00014
  23. Young JN, Wilkins RH: Partial sensory trigeminal rhizotomy at the pons for trigeminal neuralgia. J Neurosurg 1993: 79: 680-7 https://doi.org/10.3171/jns.1993.79.5.0680
  24. Li ST, Wang X, Pan Q, Hai J, Liu N, Shen F, et al: Studies on the operative outcomes and mechanisms of microvascular decompression in treating typical and atypical trigeminal neuralgia. Clin J Pain 2005; 21: 311-6 https://doi.org/10.1097/01.ajp.0000120790.69705.5b
  25. Pollock BE, Ecker RD: A prospective cost-effectiveness study of trigeminal neuralgia surgery. Clin J Pain 2005; 21: 317-22 https://doi.org/10.1097/01.ajp.0000125267.40304.57
  26. Pollock BE, Phuong LK, Gorman DA, Foote RL, Stafford SL: Stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 2002; 97: 347-53 https://doi.org/10.3171/jns.2002.97.2.0347
  27. Kondziolka D, Lunsford LD, Flickinger JC: Stereotactic radiosurgery for the treatment of trigeminal neuralgia. Clin J Pain 2002; 18: 42-7 https://doi.org/10.1097/00002508-200201000-00007
  28. Zakrzewska JM, Patsalos PN: Drugs used in the management of trigeminal neuralgia. Oral Surg Oral Med Oral Path 1992; 74: 439-50 https://doi.org/10.1016/0030-4220(92)90292-X

피인용 문헌

  1. Secondary Trigeminal Neuralgia Caused by Pharyngeal Squamous Cell Carcinoma - A Case Report - vol.26, pp.2, 2013, https://doi.org/10.3344/kjp.2013.26.2.177
  2. A Case Report of Bogigeopung-san Applied on Trigeminal Neuralgia vol.26, pp.3, 2013, https://doi.org/10.6114/jkood.2013.26.3.087
  3. 삼차신경통 환자에서 안와상 신경과 활차상 신경에 시행한 박동성 고주파술에 의한 치료경험 -증례보고- vol.22, pp.2, 2009, https://doi.org/10.3344/kjp.2009.22.2.167
  4. A Case of Abducens Nerve Palsy after Percutaneous Nerve Block for Trigeminal Neuralgia vol.54, pp.3, 2013, https://doi.org/10.3341/jkos.2013.54.3.524
  5. 삼차신경통에 대한 추나와 침 복합치료의 효과: 체계적 문헌고찰 vol.26, pp.4, 2016, https://doi.org/10.18325/jkmr.2016.26.4.37
  6. Atypical triggers in trigeminal neuralgia: the role of A-delta sensory afferents in food and weather triggers vol.34, pp.1, 2021, https://doi.org/10.3344/kjp.2021.34.1.66