A suicidal disease?

Recently, actor Salman Khan spoke about him suffering from a facial nerve disorder and that he underwent elaborate treatment for it in the US. “I was suffering from this nerve problem called Trigeminal Neuralgia. So I couldn’t talk. Had to talk like that (speaking with his mouth slightly closed) and huge amount of pain,” the 51-year-old actor said in a video posted online. He also said that the pain is so excruciating that many patients have even contemplated suicide. Khan first opened up about suffering from the condition in 2011 and has been battling it for quite some time now. Read on to know more...

What is it?

“Trigeminal Neuralgia is mostly a one-sided painful disorder that is characterised by brief episodes of electric shock like pain. Its onset and end is spontaneous,” describes Dr Ruchika Sood, Orofacial Pain Consultant, Neocare Headache and Facial Pain Center, Sai Snehdeep Hospital. Trigeminal Neuralgia is also known as ‘the suicide disease’ however, she clarifies that it’s an expression used to express the intensity of the sharp pain one feels.

Trigeminal Neuralgia is often incorrectly referred to as a Facial Nerve Disorder. “Trigeminal Neuralgia can be called a Facial Pain Disorder but it’s misleading to call it Facial Nerve Disorder. There are 12 Cranial Nerves (nerves that emerge directly from the brain). The fifth nerve is called Trigeminal Nerve and it has three branches covering almost the entire face. Neuralgia is abrupt intense intermittent pain that can happen with any nerve.

When this happens with any of the branches of Trigeminal Nerve, it is called as Trigeminal Neuralgia. The seventh nerve is called Facial Nerve and when problems occur with this nerve, that’s when it’s appropriate to call it Facial Nerve Disorder,” she clarifies. She adds that there are other types of neuropathic (nerve related) disorders with Trigeminal Nerve and Facial Nerve both. Also, there are three variants of Trigeminal Neuralgia: Classical Trigeminal Neuralgia, Trigeminal Neuralgia and Symptomatic Trigeminal Neuralgia.

Symptoms and diagnosis

The pain of Trigeminal Neuralgia is so severe that one is compelled to see the doctor at the earliest. It has an electric shock like shooting/stabbing pain. One attack lasts from a few seconds to two minutes but can be rapidly followed by another attack. Spontaneous remission periods (pain-free periods) do exist and as the duration of disease increases, these keep getting shorter, informs Dr Sood adding that light touch or brushing or shaving or air can trigger pain. 

Dr Samir Parekh, Neurosurgeon, Fortis Hospital, says that the pain on face occurs mostly on the left side. “Most commonly, pain is felt near the nose up to the ear, second most common area is near the eye and in rare cases, near the lower lip. It can be very painful and the patient can feel like committing suicide just so that the pain halts (not actually commit suicide). Sometimes, a patient may go into depression. As for the diagnosis, MRI of the brain can help in diagnosis. Usually, it is a clinical diagnosis by the nature of pain,” he says.

Who are prone to it?

The most common age group is 50 to 70 years. The incidence increases with age. Peak age of onset is between 50 to 60 years. The gender ratio of women to men is 2:1. As for medical history, the known co-morbid condition is Multiple sclerosis, inform Dr Sood who comes across two to three cases per week. 

Dr Parekh who has seen almost hundred patients says that it’s quite a common disorder. His patient demographic is between the age group of 30 to 50 years. Mostly seen among females along with diabetes and brain tumour. He adds, “In many cases, patients are not aware of the disorder and head to the dentist to treat dental caries or teeth removal, and so the actual problem is not solved. It’s only when the facial pain is unbearable, and they experience multiple episodes in a day that they come to a neurologist or neurosurgeon.”

Causes

One of the accepted theories is that it is caused by the compression of the Trigeminal Nerve root close to the brain stem by a tortuous blood vessel. Because of this, the touch nerve fibres do cross talking with pain nerve fibres causing shock like intermittent sharp pain characteristic of Trigeminal Neuralgia, says Dr Sood.

Treatment

The first line of treatment is medical management with the use of anti-epileptic drugs. The drugs have to be adjusted as per dosage and choice of combination of medicines based on the medical history and presenting complaints of the patient. Most of the medicines used for management have side-effects with time ranging from kidney function issues, electrolyte imbalance, changes in WBC (white blood cell) count, depending on patient’s medical history. Surgical treatment is opted when medical treatment doesn’t work, for example, brain surgery. Also, Radiofrequency Thermocoagulation (RTFC) by which some part of the nerve is suppressed, says Dr Sood.