• The Korean Journal of Pain
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• v.34 no.3
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• pp.332-338
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• 2021

Background: Trigeminal neuralgia (TN) is one of the most painful disorder in the orofacial region, and many patients have suffered from this disease. For the effective management of TN, fundamental epidemiologic data related to the target population group are essential. Thus, this study was performed to clarify the epidemiological characteristics of TN in the Korean population. This is the first national study to investigate the prevalence of TN in Korean patients. Methods: From 2014 to 2018, population-based medical data for 51,276,314 subscribers to the National Health Insurance Service of Korea were used for this study. Results: The incidence of TN was 100.21 per 100,000 person-years in the year of 2018 in Korea, and the male to female ratio was 1:2.14. The age group of 51-59 years had the highest prevalence of TN. Constant increases in medical cost, regional imbalance, and differences in prescription patterns by the medical specialties were showed in the management of TN. Conclusions: The results in this study will not only help to study the characteristics of TN, but also serve as an important basis for the effective management of TN in Korea.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.1-9
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• 1989

• The Korean Journal of Physiology and Pharmacology
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• v.19 no.4
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• pp.349-355
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• 2015

We examined the effects of peripherally or centrally administered botulinum neurotoxin type A (BoNT-A) on orofacial inflammatory pain to evaluate the antinociceptive effect of BoNT-A and its underlying mechanisms. The experiments were carried out on male Sprague-Dawley rats. Subcutaneous (3 U/kg) or intracisternal (0.3 or 1 U/kg) administration of BoNT-A significantly inhibited the formalin-induced nociceptive response in the second phase. Both subcutaneous (1 or 3 U/kg) and intracisternal (0.3 or 1 U/kg) injection of BoNT-A increased the latency of head withdrawal response in the complete Freund's adjuvant (CFA)-treated rats. Intracisternal administration of N-methyl-D-aspartate (NMDA) evoked nociceptive behavior via the activation of trigeminal neurons, which was attenuated by the subcutaneous or intracisternal injection of BoNT-A. Intracisternal injection of NMDA up-regulated c-Fos expression in the trigeminal neurons of the medullary dorsal horn. Subcutaneous (3 U/kg) or intracisternal (1 U/kg) administration of BoNT-A significantly reduced the number of c-Fos immunoreactive neurons in the NMDA-treated rats. These results suggest that the central antinociceptive effects the peripherally or centrally administered BoNT-A are mediated by transcytosed BoNT-A or direct inhibition of trigeminal neurons. Our data suggest that central targets of BoNT-A might provide a new therapeutic tool for the treatment of orofacial chronic pain conditions.

• Journal of Korean Neurosurgical Society
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• v.41 no.6
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• pp.359-366
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• 2007

Trigeminal neuralgia is a condition associated with severe episodic lancinating facial pain subject to remissions and relapses. Trigeminal neuralgia is often associated with blood vessel cross compression of the root entry zone or more rarely with demyelinating diseases and occasionally with direct compression by neoplasms of the posterior fossa. If initial medical management fails to control pain or is associated with unacceptable side effects, a variety of surgical procedures offer the hope for long-lasting pain relief or even cure. For patients who are healthy without significant medical co-morbidities, direct microsurgical vascular decompression [MVD] offers treatment that is often definitive. Other surgical options are effective for elderly patients not suitable for MVD. Percutaneous retrogasserian glycerol rhizotomy is a minimally invasive technique that is based on anatomic definition of the trigeminal cistern followed by injection of anhydrous glycerol to produce a weak neurolytic effect on the post-ganglionic fibers. Other percutaneous management strategies include radiofrequency rhizotomy and balloon compression. More recently, stereotactic radiosurgery has been used as a truly minimally invasive strategy. It also is anatomically based using high resolution MRI to define the retrogasserian target. Radiosurgery provides effective symptomatic relief in the vast majority of patients, especially those who have never had prior surgical procedures. For younger patients, we recommend microvascular decompression. For patients with severe exacerbations of their pain and who need rapid response to treatment, we suggest glycerol rhizotomy. For other patients, gamma knife radiosurgery represents an effective management strategy with excellent preservation of existing facial sensation.

• Journal of Oral Medicine and Pain
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• v.45 no.2
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• pp.34-38
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• 2020

Multiple myeloma is malignant neoplasm of plasma cells. Mandible lesions are rarely the first symptoms of multiple myeloma. While sensory dysfunction and pain are the main symptoms of traumatic trigeminal neuropathy, the same oral symptoms can appear in cases of multiple myeloma with developed mandible lesions. In addition, if the radiological osteoporosis or lytic lesion is seen in older patients, further examination is required to find the cause of the symptoms. In this paper, we present a case that was tentatively diagnosed as traumatic trigeminal neuropathy after left third molar extraction, but later confirmed as multiple myeloma.

• Journal of Acupuncture Research
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• v.41 no.1
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• pp.69-73
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• 2024

This study evaluated a case of trigeminal nerve stimulation during acupotomy at a site 5 pun left of GV16. The study participant was a 52-year-old male suffering from upper neck pain and numbness, which was managed by acupotomy at a site 5 pun left of GV16. During acupotomy, the patient experienced unexpected numbness and stiffness of the left zygomatic bone. This area corresponds to the distribution of the maxillary nerve, which is the second branch of the trigeminal nerve. After approximately one month, symptoms of numbness and stiffness disappeared without rendering medical treatment. These side effects are presumed to be associated with the trigeminocervical complex and stimulation of the trigeminal nucleus within the spinal cord. Thus, during the acupotomy of the upper neck, especially at GV16, the needles should be inserted slowly, and the patient's response should also be monitored.

• Journal of Korean Neurosurgical Society
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• v.56 no.3
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• pp.278-280
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• 2014

A 66-year-old man presented with typical trigeminal neuralgia (TN). Magnetic resonance angiography (MRA) revealed a primitive trigeminal artery (PTA) that came into contact with the trigeminal nerve. Based on MRA, we performed microvascular decompression (MVD). In the operational field, we confirmed the PTA location and performed MVD successfully. Postoperatively, the patient's pain subsided without any complications.

• Journal of Korean Neurosurgical Society
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• v.40 no.3
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• pp.148-153
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• 2006

Objective : The authors conducted this study to present the long-term treatment outcomes [minimum 2 years] of Gamma knife radiosurgery[GKS] for trigeminal neuralgia[TN] and to demonstrate the correlation of treatment outcomes and the anatomical characteristics of TN. Methods : From 1997 to 2003, 44 consecutive patients suffering from medically intractable pain underwent GKS for TN. A single 4mm collimator was used with a median maximum dose of 80Gy [range $75{\sim}80Gy$] prescribed to the root entry zone of the trigeminal nerve. Median follow up duration was 30 months [range $24{\sim}78\;months$]. Anatomical measurements of trigeminal nerve in magnetic resonance images during GKS planning were correlated with clinical outcome. Results : Twenty-two patients [50%] achieved an excellent outcome [BNI grade I & II], 20 patients [45.5%] a good outcome [grade IIIa & IIIb], and only 2 patients [4.5%] a poor outcome [grade IV & V]. Eleven patients [25.0%] experienced pain recurrence after initial pain relief. Smaller volume of trigeminal nerve area irradiated more than 40Gy was significantly correlated with excellent outcome in both univariate and multivariate analyses respectively [P=0.033 and 0.040]. Conclusion : Anatomical considerations during the planning of GKS would be helpful for predicting clinical outcome in TN.

• Journal of Oral Medicine and Pain
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• v.40 no.1
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• pp.35-40
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• 2015

Purpose: This study aims to assess the psychological characteristics of patients with iatrogenic damage of the trigeminal nerve using Symptom Checklist-90-Revised (SCL-90-R). Methods: A total of 22 patients who visited the clinic of Department of Oral Medicine, School of Dentistry, Chosun University were evaluated in the months from December 2012 to December 2014. Patients were included in the study if they presented with reported sensory changes due to iatrogenic trigeminal nerve injury. A total of 37 control group who has no symptoms of pain and sensory change were included in the study. All participants filled out the SCL-90-R instrument to assess psychosocial symptoms. Results: The T-scores of most of the SCL-90-R symptom dimensions were within normal range (less than 55) in the patients and the control group. The patients group showed higher T-scores of SCL-90-R than those of the control group, with statistically significance of somatization, anxiety, psychoticism, and positive symptoms distress. Female patients group had higher Tscores of SCL-90-R than those of male patients group, but there was no statistical difference, except for the positive symptom global index. The chronic patients group showed higher Tscores of SCL-90-R than those of the acute patients group, but there was no statistical difference, except for the Positive symptom global index. Conclusions: According to the psychological assessment of iatrogenic trigeminal nerve injury patients using SCL-90-R, the patients group, as compared to the control group shows a significantly higher score for somatization, anxiety, and psychoticism. Therefore, assessment of psychological state would be considered to treat patients with iatrogenic trigeminal nerve injury.

• Journal of Korean Neurosurgical Society
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• v.29 no.5
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• pp.650-658
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• 2000

Objective : To evaluate the role of Gamma Knife radiosurgery in essential and tumor-related(secondary) trigeminal neuralgia, outcomes of radiosurgery and microsurgery were compared each other. Methods : Five patients with essential trigeminal neuralgia underwent stereotactic radiosurgical treatment with Leksell Gamma Knife and twenty five patients were treated with microsurgery during the same period(1994. 1-1997. 6). A 4-mm collimator was used and REZ or proximal portion of trigeminal nerve was targeted with maximal dose of 60-72Gy. The mean follow-up after radiosurgery was 39.4 months and that after microsurgery was 47.9 months. Results : At the last follow-up, four patients(80%) had excellent(pain free) or good(50-90% pain relief) outcomes, one(20%) had poor control after radiosurgical treatment. Twenty-three patients(92%) had excellent or good outcomes and two(8%) had poor results after microsurgery. Postoperative complications occurred in ten(40%) with microsurgery, but there were no complications in patients with Gamma Knife radiosurgery. Six patients with secondary trigeminal neuralgia received radiosurgical treatment directed at their tumors, and three patients were surgically treated. Three of six(50%) patients treated with Gamma Knife had pain relief while two of three patients with surgical treatment showed immediate pain relief. Post-treatment complications were developed in two of six radiosurgical patients and in one of three surgical patients. Conclusion : Gamma Knife stereotactic radiosurgery may be considered as a useful and alternative option for the treatment of essential and secondary trigeminal neuralgia owing to of its safety and less complications. The preliminary results obtained in our series appear encouraging, although the outcome is not so good as that of surgery.