• Journal of Korean Neurosurgical Society
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• 제52권1호
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• pp.42-47
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• 2012

Objective : The aim of this prospective study was to demonstrate the influence of some factors on the prognosis of microvascular decompression in 37 patients with trigeminal neuralgia. Methods : The results of microvascular decompression (MVD) in 37 patients with trigeminal neuralgia were evaluated at 6 months after surgery and were compared with clinical and operative findings. Results : The sex of the patient, the patient's age at surgery, the side of the pain, and the duration of symptoms before surgery did not play any significant roles in prognosis. Also, the visual analogue scale (VAS) of the patient, the duration of each pain attack, and the frequency of pain over 24 hours did not play any significant roles in prognosis. In addition, intraoperative detection of the type of conflicting vessel, the degree of severity of conflict, and the location of the conflict around the circumference of the root did not play any roles in prognosis. The only factors affecting the prognosis in MVD surgery were intraoperative detection of the site of the conflict along the root and neuroradiological compression signs on preoperative magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA). Conclusion : These findings demonstrated that if neurovascular compression is seen on preoperative MRI/MRA and/or compression is found intraoperative at the root entry zone, then the patient will most likely benefit from MVD surgery.

• Annals of Clinical Neurophysiology
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• 제19권2호
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• pp.145-147
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• 2017

Trigeminal neuralgia (TN) is generally characterized by lancinating, unilateral, paroxysmal pain occurring in the distribution of the fifth cranial nerve. TN is diagnosed clinically based on the typical patient history, negative findings in a neurologic examination, and the response to medication. Idiopathic TN is the most common type, but TN can result from vascular malformation, compression, trauma, neoplasm, multiple sclerosis, or inflammation. We report a TN case diagnosed as recurrent trigeminal neuritis of the maxillary branch confirmed by magnetic resonance imaging.

• The Korean Journal of Pain
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• 제20권2호
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• pp.181-185
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• 2007

Background: The first pain clinic opened in korea in 1973 at Yonsei University Hospital, however, since then the number of pain clinics has gradually increased, as has the number of patients visiting them. This increase in patient has caused concerns about the way in which pain is managed, therefore, we conducted a retrospective review of data according to the sex, age and disease in an attept to aid us in planning for the future of our pain clinic. Methods: We analyzed 1,282 new patients who had visited our pain clinic and 828 inpatients who were admitted to our pain clinic between March 2006 and February 2007. Results: The most frequent age group was in the sixties in outpatient and in the seventies in inpatient. In addition, the incidence of disease in new patients and inpatients was as follows: in new patients, lumbar herniated intervertebral disc 16.5%, hyperhidrosis 12.3%, cervical disc disorder 10.5%, acute herpes zoster 8.2%, postherpetic neuralgia 7.9%, and trigeminal neuralgia 7.0%; in admitted patients, acute herpes zoster 17.6%, trigeminal neuralgia 15.6%, lumbar herniated intervertebral disc 13.0%, postherpetic neuralgia 11.2%, hyperhidrosis 9.8%, and complex regional pain syndrome 7.0%. Conclusions: The patients visiting our pain clinic have presented with a wide variety of diseases. This improved care reflects an effort to expand our fields not only to the management of outpatients but also inpatients, as well as to the treatment of new fields of disease. In the future, We need to manage various pain patients not only in outpatients but also in inpatients to expand our field even through pain clinic is rapidly growing in Korea.

• International Journal of Oral Biology
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• 제37권3호
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• pp.121-129
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• 2012

Previous clinical studies have demonstrated that gabapentin, a drug that binds to the voltage-gated calcium channel ${\alpha}2{\delta}1$ subunit proteins, is effective in the management of neuropathic pain, but there is limited evidence that addresses the participation of glial cells in the antiallodynic effects of this drug. The present study investigated the participation of glial cells in the anti-nociceptive effects of gabapentin in rats with trigeminal neuropathic pain produced by mal-positioned dental implants. Under anesthesia, the left mandibular second molar was extracted and replaced by a miniature dental implant to induce injury to the inferior alveolar nerve. Mal-positioned dental implants significantly decreased the air-puff thresholds both ipsilateral and contralateral to the injury site. Gabapentin was administered intracisternally beginning on postoperative day (POD) 1 or on POD 7 for three days. Early or late treatment with 0.3, 3, or 30 ${\mu}g$ of gabapentin produced significant anti-allodynic effect in the rats with mal-positioned dental implants. On POD 9, in the mal-positioned dental implants group, OX-42, a microglia marker, and GFAP, an astrocyte marker, were found to be up-regulated in the medullary dorsal horn, compared with the naive group. However, the intracisternal administration of gabapentin (30 ${\mu}g$) failed to reduce the number of activated microglia or astrocytes in the medullary dorsal horn. These findings suggest that gabapentin produces significant antinociceptive effects, which are not mediated by the inhibition of glial cell function in the medullary dorsal horn, in a rat model of trigeminal neuropathic pain.

• 혜화의학회지
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• 제10권1호
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• pp.259-268
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• 2001

As mentioned above, I have acquired some valuable results about medical treatments with acupuncture for "Trigeminal neuralgia" after studying oriental medical books. 1. The course of medical treatments with acupuncture was, first of all, applying general ones, and then, assisting ones based on occuring area of pain and the cause. 2. For general treatments, "Chok-yangmyong-Wi-Kyong", distributed widely on the face, was used in great numbers. The order, according to the number of using times, of spots for acupuncture was Ha-kwan(11 times), Hap-kok(10), Chan-juk(7), Hyop-geo, Tae-yang, Sa-baek(individually 6). 3. For assisting treaments based on occuring area of the pain, spots of the Kyong-rak, passing through occuring area of the pain, and Kyong-woe-ki-hyol were used in great numbers. 4. The order was O-je, Chan-juk, Yang-baek(individually 8), Tae-yang(5) for the pain of first branch of the trigeminal nerve; Sa-baek(12), Kwan-ryo(6), Go-ryo(5) for the pain of second one; and Hyop-geo, Ha-kwan(individually 6), Dae-young, Hyop-seung-jang(individually 5). Seung-jang(4). 5. For assisting treatments based on the cause, "One-hyol(原穴)", "Rak-hyol(絡穴)" and "5-soohyol(五輸穴)" were used in great numbers. 6. The order was Pung-ji(10), Hap-kok(9), Woe-kwan(5) for "Woe-Kam(外感)"; Nae-jong(12), Tae-chung(10), Chok-sam-ri(7) for "Kan-Wi-Hwa-Seung(肝胃火升)"; Tae-gue(7), Sam-um-kyo, Pung-ji(individually 2) for "Ho-Hwa-Sang-Seung(虛火上升)"; Pung-ryung(4) for "Pung Dam-Jo-R ak (風痰阻絡)"; Kyok-su(2) for "Ki-Che-Hyol-Ho(氣滯血虛)".

• Restorative Dentistry and Endodontics
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• 제33권5호
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• pp.452-456
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• 2008

Herpes zoster는 varicella zoster 바이러스에 의해 발생하는 급성 바이러스성 감염질환으로 삼차신경의 분지들을 침범할 수 있다. 치성동통과 유사한 증상을 보이는 43세 남자 환자가 내원하였으며 임상 및 방사선 검사 후에도 명확한 원인을 발견할 수 없었다. 피부과의사에 의해 삼차신경의 세 번째 분지에 발생한 herpes zoster로 진단되었고 항바이러스 치료를 시행하였다. 2개월 뒤, 환자의 피부 병소 및 동통은 대부분 사라졌으나 반흔조직은 다소 남아있었다. 진단과정 중 임상가는 구강안면부 동통이 herpes zoster와 연관될 수 있다는 가능성을 숙지하여야 할 것이다.

• The Korean Journal of Pain
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• 제11권1호
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• pp.101-104
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• 1998

Backgrouds: Twent five years have passed since the opening of the first pain clinic in korea, in 1973 at Yonsei University Hospital. The number of pain clinics are gradually increasing in recent times. It is important to plan for future pain clinics with emphasis on improving the quality of pain management. Therefore we reviewed the patients in our hospital to help us in planning for the future of our pain clinic. Methods: We analyzed 2656 patients who had visited our Kim Chan Pain Clinic, accordance to age, sex, disease, and type of treatment block, from July 1996 to August 1997. Results: The prevalent age group was in the fifties, 27.3%, seventy years and older compromised 9.2%. The most common disease were as follows: lower back pain(46.2%); cervical and upper extremities pain(23.1%); trigeminal neuralgia(7.2%); and hyperhydrosis(5.8%) Both nerve blocks and medication were prescribed as treatment. Lumbar epidural block(16.3%) and stellate ganglion block(15.6%) were the most frequent blocks performed among various nerve blocks. Among nerve block under C-arm guidance, lumbar facet joint block(24.4%) and lumbar root block(22.5%) were performed most frequently. Trigeminal nerve block(18.4%), thoracic(17.0%) and lumbar sympathetic ganglion block(11.4%) were next most prevalent blocks performed frequent block. Conclusions: Treatments at our hospital were focused on nerve blocks and medications prescriptions. Nerve blocks are of particular importance in the diagnosis and treatment of chronic pain. However in future, to raise the quality of pain management, we need to fucus on a multidisciplinary/interdisciplinary team approach.

• Journal of Korean Neurosurgical Society
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• 제50권5호
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• pp.446-452
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• 2011

Objective : We retrospectively investigated the long-term results of percutaneous radiofrequency thermocoagulation (RFT) using fluoroscopic image-guidance for treatment of trigeminal neuralgia. Methods : A total of 38 patients diagnosed and treated with RFT as an idiopathic trigeminal neuralgia were investigated. To minimize the risks related to conventional technique based on cutaneous landmarks, and to eliminate the need to frequent reposition of cannula, we adopted a technique of image-guided fluoroscopic cannulation of the foramen ovale. To minimize sensory complication following thermal lesion, our target response was a generation of a lesion with mild to moderate hypalgesia rather than dense hypalgesia. Results : The immediate pain-relief was achieved in all patients underwent RFT. With mean duration of follow-up of 38.2 months (range,12-72), 11 (28.9%) experienced recurrence of pain. The mean timing of recurrence was 26.1 months (range,12-46). A 42.7% recurrence rate was estimated by Kaplan-Meier analysis for the 38 patients at 46 months; 20.2% within 2 years, 29.1% within 3 years. In the long-term, 27 patients (71%) and 6 patients (15.8%) showed Barrow Neurological Institute (BNI) score I and BNI score II responses. Three (7.9%) patients was assessed as BNI score III, 2 patients (5.3%) showed BNI score IV response. As a complication, troublesome dysesthesia occurred in 3 of 38 patients (7.9%), however, there was no permanent cranial nerve palsy or morbidity. Conclusion : These results indicates that RFT under fluoroscopic image-guided cannulation of foramen ovale is a safe, effective, and reliable means of treating trigeminal neuralgia.

• 대한치과의사협회지
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• 제45권12호통권463호
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• pp.728-732
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• 2007

• International Journal of Oral Biology
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• 제35권3호
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• pp.75-81
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• 2010

The present study investigated the role of ERK in the onset of mechanical and cold allodynia in a rat model of compression of the trigeminal ganglion by examining changes in the air-puff thresholds and number of scratches following the intracisternal injection of PD98059, a MEK inhibitor. Male Sprague Dawley rats weighing between 250 and 260 g were used. Under anesthesia, the rats were mounted onto a stereotaxic frame and received 4% agar ($10\;{\mu}l$) solution to compress the trigeminal ganglion. In the control group, the animals were given a sham operation without the application of agar. Changes in behavior were examined at 3 days before and at 3, 7, 10, 14, 17, 21, 24, 30, and 40 days after surgery. Compression of the trigeminal ganglion significantly decreased the air-puff thresholds. Mechanical allodynia was established within 3 days and persisted over postoperative day 24. To evaluate cold allodynia, nociceptive scratching behavior was monitored after acetone application on the vibrissa pad of the rats. Compression of the trigeminal ganglion was found to produce significant cold allodynia, which persisted for more than 40 days after surgery. On postoperative day 14, the intracisternal administration of $1\;{\mu}g$ or $10\;{\mu}g$ of PD98059 in the rat model significantly decreased the air-puff thresholds on both the ipsilateral and contralateral side. The intracisternal administration of $10\;{\mu}g$ of PD98059 also significantly alleviated the cold allodynia, compared with the vehicle-treated group. These results suggest that central ERK plays an important role in the development of mechanical and cold allodynia in rats with compression of the trigeminal ganglion and that a targeted blockade of this pathway is a potential future treatment strategy for trigeminal neuralgia-like nociception.