McGill疼痛问卷在三叉神经痛诊断和治疗中的应用

目的:通过采用McGill疼痛问卷(McGill pain questionnaire,MPQ)鉴别三叉神经痛,并观察射频热凝术的疗效,研究MPQ在面痛诊断上的重要性。方法:本研究共观察159例三叉神经痛患者,其中136例患有典型三叉神经痛(CTN),23例患有混合型三叉神经痛(MTN)。采用MPQ评估患者的疼痛,并观察其中124例术后患者疼痛的缓解情况。结果:CTN组的平均现有疼痛强度(PPI)值为4.20±0.34,MTN组的平均PPI值为3.50±0.57,明显低于CTN组(P0.001);与MTN患者相比,CTN患者在疼痛分级指数(PRI)-感觉项上报告了更高的强度(P0.001);两组间PRI-情感和PRI-评价项上有明显区别,CTN组的得分更高(P0.001);RFT术后CTN患者显示了高的立即疼痛缓解率,达到93.6%。MTN患者的结果没有CTN组的好,只有58.8%的患者疼痛明显缓解。结论:MPQ可以很好鉴别不同类型的三叉神经痛,鉴于射频热凝治疗两种三叉神经痛疗效的差异,使用MPQ在面痛诊断中有重要意义。     

麻痹性角膜炎21例报告

目的　总结并探讨麻痹性角膜炎的成因及治疗。方法　对21 例麻痹性角膜炎者,局部以抗炎、滋润、营养角膜类药物滴眼及庶眼法保护性治疗为主,配合全身的抗炎及维生素等药物治疗。结果　18 例治愈,3 例因继发角膜溃疡,4个月后形成角膜白斑,严重影响视力。结论　麻痹性角膜炎应以早期预防为主,发病后及时采取有效的治疗措施,防止造成严重的失明后果,并应随访观察到角膜失代偿期恢复为止,以防复发。     

Functional Imaging of the Trigeminal System: Applications to Migraine Pathophysiology

Background.—Based largely on data from animal models, migraine is hypothesized to involve changes in neural function in brain areas that mediate nociception—specifically, the trigeminal nerve, spinal trigeminal nucleus, and thalamus. These hypotheses about migraine pathophysiology can be tested directly in humans for the first time, with recent advances in functional neuroimaging techniques, which allow assessment of functional activity of specific brain areas. This article discusses the hypothesized role of the trigeminovascular pain system in migraine, reviews recent findings involving functional imaging of the human trigeminal system, and considers applications of functional imaging in the study of migraine pathophysiology. Functional neuroimaging is the only noninvasive approach for the objective measurement of changes in neural activity in humans. Functional magnetic resonance imaging has been applied to the measurement of neural activation of the trigeminal nociceptive system in healthy volunteers, and in patients with pain syndromes such as trigeminal pain. Conclusions.—The demonstrated utility of functional magnetic resonance imaging at elucidating, in a regionally specific manner, the functional and temporal changes in neural activity in the trigeminal nociceptive system, promises to make it a useful tool for the study of migraine pathophysiology and the evaluation of therapeutic interventions.     

Unilateral or "side-locked" migrainous headache with autonomic symptoms linked to night guard use

Night guards are commonly prescribed as a palliative measure for bruxism, temporomandibular joint symptoms, and associated disorders. We describe a patient with a 10- to 12-year history of night guard use with concurrent unilateral side-locked migrainous headaches with autonomic symptoms characteristic of trigeminal autonomic cephalgia. These headaches were refractory to numerous pharmacological interventions. Upon self-initiated cessation of night guard use, there was complete remission of headaches. We believe the headaches were initiated by night guard-initiated irritation of the trigeminal nerve and a trigeminal autonomic reflex resulting in unilateral migrainous headache with autonomic signs.     

Trigeminal neuralgia as the sole manifestation of an Arnold-Chiari type I malformation: case report

Arnold-Chiari type I malformations usually manifest clinically with short-lasting headaches typically involving the occipital-nuchal region and precipitated by the Valsalva maneuver, coughing, sudden postural change, or physical exertion. We describe the case of an adult patient who presented with symptomatic trigeminal neuralgia caused by an Arnold-Chiari type I malformation. Unlike previous cases, the malformation involved the trigeminal ophthalmic division alone.     

伽玛刀治疗原发性三叉神经痛疗效观察

Objective To evaluate the therapeutic efficacy of gamma knife in treatment of primary trigeminal neuralgia Methods Retrospectively analysis of 120 cases with primary trigeminal neuralgia treated by gamma knife in our department From Jan. 2003 to Mar. 2008 were performed. All cases were treated with the 4 mm collimator and targeted at the proximal nerve at the root entry zone located by MRI. The target dose varied from 80 -90 Gy. Results After a follow-up of 20. 0 ±4. 5 months, complete relief of pain occurred in 69 patients (57. 5%), 50% -90% relief in 34 (28. 3%), relief less than 50% in 12(10.0%) but no relief in 5(4.2 %).The efficient rate was 95. 8% . The common complications include numbness, absence of corneal reflex. 83 patients (69. 2%) experienced temporal facial numbness and 14 patients (11. 7%) reported continuous numbness after treatment of the gamma knife. Conclusions Gamma knife radiosurgery is a minimally invasive technique for the treatment of primary trigeminal neuralgia with few complications.     

伽玛刀治疗原发性三叉神经痛疗效观察

Objective To evaluate the therapeutic efficacy of gamma knife in treatment of primary trigeminal neuralgia Methods Retrospectively analysis of 120 cases with primary trigeminal neuralgia treated by gamma knife in our department From Jan. 2003 to Mar. 2008 were performed. All cases were treated with the 4 mm collimator and targeted at the proximal nerve at the root entry zone located by MRI. The target dose varied from 80 -90 Gy. Results After a follow-up of 20. 0 ±4. 5 months, complete relief of pain occurred in 69 patients (57. 5%), 50% -90% relief in 34 (28. 3%), relief less than 50% in 12(10.0%) but no relief in 5(4.2 %).The efficient rate was 95. 8% . The common complications include numbness, absence of corneal reflex. 83 patients (69. 2%) experienced temporal facial numbness and 14 patients (11. 7%) reported continuous numbness after treatment of the gamma knife. Conclusions Gamma knife radiosurgery is a minimally invasive technique for the treatment of primary trigeminal neuralgia with few complications.     

心理护理干预在射频温控热凝术治疗三叉神经痛的应用

目的调查三叉神经痛患者经射频温控热凝术治疗前后的心理状况,制定相应的护理干预措施。方法120例三叉神经痛患者分别于入院3天内、治疗2周后填写症状自评量表（SCL-90）,并与中国常模进行比较。结果三叉神经痛患者入院时躯体化、抑郁、焦虑、敌对、恐怖及偏执因子得分均高于常模（P〈0．05）,经心理护理干预后,患者躯体化、抑郁、焦虑、敌对、恐怖及偏执因子得分均较治疗前显著改善（P〈0．05）。结论三叉神经痛患者心理健康普遍较差,在射频温控热凝术治疗同时加强心理护理对患者有较好疗效。     

Identification of cytokines and signaling proteins differentially regulated by sumatriptan/naproxen

Objectives.— The goal of this study was to use protein array analysis to investigate temporal regulation of stimulated cytokine expression in trigeminal ganglia and the spinal trigeminal nucleus in response to co‐treatment of sumatriptan and naproxen sodium or individual drug. Background.— Activation of neurons and glia in trigeminal ganglia and the spinal trigeminal nucleus leads to increased levels of cytokines that promote peripheral and central sensitization, which are key events in migraine pathology. While recent clinical studies have provided evidence that a combination of sumatriptan and naproxen sodium is more efficacious in treating migraine than either drug alone, it is not well understood why the combination therapy is superior to monotherapy. Methods.— Male Sprague–Dawley rats were left untreated (control), injected with capsaicin, or pretreated with sumatriptan/naproxen, sumatriptan, or naproxen for 1 hour prior to capsaicin. Trigeminal ganglia and the spinal trigeminal nucleus were isolated 2 and 24 hours after capsaicin or drug treatment, and levels of 90 proteins were determined using a RayBio® Label‐Based Rat Antibody Array (RayBiotech, Norcross, GA, USA). Results.— Capsaicin stimulated a >3‐fold increase in expression of the majority of cytokines in trigeminal ganglia at 2 hours that was sustained at 24 hours. Significantly, treatment with sumatriptan/naproxen almost completely abolished the stimulatory effects of capsaicin at 2 and 24 hours. Capsaicin stimulated >3‐fold expression of more proteins in the spinal trigeminal nucleus at 24 hours when compared to 2 hours. Similarly, sumatriptan/naproxen abolished capsaicin stimulation of proteins in the spinal trigeminal nucleus at 2 hours and greatly suppressed protein expression 24 hours post‐capsaicin injection. Interestingly, treatment with sumatriptan alone suppressed expression of different cytokines in trigeminal ganglia and the spinal trigeminal nucleus than repressed by naproxen sodium. Conclusion.— We found that the combination of sumatriptan/naproxen was effective in blocking capsaicin stimulation of pro‐inflammatory proteins implicated in the development of peripheral and central sensitization in response to capsaicin activation of trigeminal neurons. Based on our findings that sumatriptan and naproxen regulate expression of different proteins in trigeminal ganglia and the spinal trigeminal nucleus, we propose that these drugs function on therapeutically distinct cellular targets to suppress inflammation and pain associated with migraine.     

Trigeminal neuralgia in wind musicians

The author reports 3 patients with trigeminal neuralgia whose pain was triggered by musical performance. Use of the muscles of embouchure activated the trigger zone when playing the clarinet, saxophone, flute, piccolo, trombone, or whistling. In each case, the location of the trigger zone was perioral, regardless of which division of the trigeminal nerve emanated pain. Trigeminal neuralgia is a particularly disabling affliction when it occurs in wind musicians.     

微血管减压术治疗原发性三叉神经痛手术体会

目的：探讨原发性三叉神经痛微血管减压的手术效果及其影响因素。方法：选择正规药物治疗无效的三叉神经痛患者行核磁共振检查,排除继发性病因引起三叉神经痛的患者,对30例原发性三叉神经痛患者行微血管减压术。结果：28例患者术后疼痛立即消失,1例患者症状明显缓解,1例无效,无死亡患者,有效率为97%,随访1年有1例复发。结论：术前核磁共振检查能否发现责任血管,对手术和术后效果影响大;但同时与术者的经验和显微操作熟练程度密切相关。     

Refractory migraine and chronic migraine: pathophysiological mechanisms

Migraine is a complex disorder of the brain whose mechanisms are only now being unravelled. It is common, disabling, and economically costly. Brain imaging has suggested a role for the brainstem. While the disorder is almost certainly inherited, the degree to which this contributes to a treatment refractory state is not clear. Indeed, no specific structural or pharmacological explanation can be seen from the data as they have been generated. It is clear that patients with more frequent headache are very likely to go on to even more frequent headache, but again these data are complex. A challenge going forward is to establish the biology of these very challenging patients who undoubtedly have substantial disability.     

Trigeminal Neuralgia. Clinical Manifestations of First Division Involvement

A series of 19 patients with what originally had been diagnosed as a first division (V₁) trigeminal neuralgia was collected. The inclusion criteria were severe, rather short-lasting pain attacks within the V₁ area, combined with trigger mechanisms. There were 10 women and 9 men, and the mean age of onset was 57.8 years. Fifteen of 16 with adequate information on attack duration had paroxysms of a "few seconds'" duration or less, whereas 10 patients had paroxysms lasting ≥2 seconds. In an exceptional case, only "more long-lasting" attacks (greater than 30 seconds' duration) were experienced.
In regard to autonomic phenomena, lacrimation was most frequently present (in a total of 8 patients; 3 rather regularly, 5 more irregularly). The combination of lacrimation, conjunctival injection, and rhinorrhea was present in only 2 (of 19), and in neither of them in a major way. Typically, autonomic phenomena occurred during the later stages of disease and during particularly severe and long-lasting attacks. Seven of 14 with adequate information also had nocturnal attacks. Initially, a more or less complete carbamazepine effect was reported by 10 of 13 patients. Precipitation mechanisms were the same as with second and third division tic, but were mainly located within the V₁ area, particularly initially.
A comparison with SUNCT syndrome has been made. SUNCT is a predominantly male disorder, with only exceptional attacks of ≥10 seconds' duration, and generally with attacks of 15 seconds or longer. Autonomic symptoms and signs are more pronounced than in V₁ tic. Carbamazepine generally provides minor, if any, benefit in SUNCT. The present work strongly indicates that the two disorders are essentially different.     

Cluster-tic syndrome

A case of cluster-tic syndrome is presented. A 51-year-old man developed pain attacks corresponding to the second branch of the trigeminal nerve. After treatment with 1200 mg carbamazepine daily, the attacks disappeared. Full remission was achieved, and carbamazepine therapy was continued. Pain attacks of a quite different character then appeared; their clinical picture corresponded to cluster headache. After treatment with cyproheptadine, the cluster headache attacks ceased, but 2 days later, before the discontinuation of the treatment, the attacks of trigeminal neuralgia reappeared. Treatment with carbamazepine was started again, and there was remission of the trigeminal neuralgia after several weeks.     

Coexistence of TACS and trigeminal neuralgia: pathophysiological conjectures

BACKGROUND: Trigeminal autonomic cephalgias (TACs) and trigeminal neuralgia are short-lasting unilateral primary headaches whose study is providing insights into craniofacial pain mechanisms. We report on 2 patients in whom trigeminal neuralgia coexists with the TACs paroxysmal hemicrania and SUNCT. CONCLUSION: Coexistence of trigeminal neuralgia with various TAC forms suggests a pathophysiological relationship between these short-lasting unilateral headaches.