Pennsylvania School Teacher Treated Surgically for Trigeminal Neuralgia

Newswise — Two years ago, Sister Claire, an 82-year-old Catholic school teacher from the Philadelphia area, began experiencing early symptoms of trigeminal neuralgia. "I experienced unpredicted occurrences of pain in my lower jaw and face," recalled Sister Claire. "My primary physician at the time recommended Tegretol. Within a few weeks, the pain was gone."

Trigeminal neuralgia or tic douloureux is sometimes described as the most excruciating pain known to humanity. The pain typically involves the lower face and jaw, although sometimes it affects the area around the nose and above the eye. This intense, stabbing, electric shock-like pain is caused by irritation of the trigeminal nerve, which sends branches to the forehead, cheek, and lower jaw. It is usually limited to one side of the face.

Advanced age is a major risk factor for trigeminal neuralgia. The disorder is more common in women than in men and rarely affects anyone younger than age 50. Hypertension and multiple sclerosis are also risk factors. Trigeminal neuralgia is relatively rare. An estimated 45,000 people in the United States and an estimated one million people worldwide suffer from trigeminal neuralgia.

Sister Claire's story is one of the three winning entries in the Neurosurgical Patient Stories Contest, being featured during Neurosurgery Awareness Week (NAW). NAW kicks off this year from April 22-27 during the 74th Annual Meeting of the American Association of Neurological Surgeons (AANS) in San Francisco. "The goal of NAW is to help educate people about a wide range of neurosurgical conditions and diseases," stated Alex B. Valadka, MD, FACS, AANS spokesperson. "One of the most compelling ways to do this is to share real life stories of people who have experienced neurosurgical conditions firsthand," added Dr. Valadka.

In February 2005, Sister Claire's pain returned with greater intensity. "I experienced a lot of anxiety because I had no way of knowing when these painful episodes would occur," said Sister Claire. "Chewing, speaking, or swallowing all triggered the excruciating pain." Sister Claire continued to be treated for several months with various dosages of Tegretol. Unfortunately, she suffered many side effects including dizziness, poor balance and sluggishness. After two days of repeated nausea, she decided that the condition had escalated to an intolerable level.

A trip to the emergency room at Paoli Hospital led to a diagnosis of toxic medication overdose. After Sister Claire left the hospital, she went to her sister's home in Newtown, and subsequently was admitted to St. Mary Medical Center in Langhorne, where she stayed from May 9 until May 13. During this stay, she had two nerve block sessions, and was prescribed Motrin to help control the pain.

Sister Claire was referred to Mark McLaughlin, MD, a neurosurgeon at Princeton Brain and Spine Care in Langhorne. She entered St. Mary Medical Center on May 31. On June 7, Dr. McLaughlin performed microvascular decompression surgery on Sister Claire. "I determined that a blood vessel and nerve were touching and causing Sister Claire's pain," commented Dr. McLaughlin. "I placed an implant of Teflon between the blood vessel and nerve behind Sister Claire's right ear to eliminate this problem."

Microvascular decompression is one surgical method for treating this condition. It involves microsurgical exposure of the trigeminal nerve root, identification of a blood vessel that may be compressing the nerve, and gentle displacement of it away from the point of compression. While this is generally considered the most effective surgery, it is also the most invasive, because it requires opening the skull through a craniotomy. There is a small risk of decreased hearing, facial weakness, facial numbness, double vision, stroke, and even death.

Sister Claire was discharged from the hospital on June 13. "It took me a few months to get my energy back, and the area where my surgery was performed is still healing. But I am so grateful to Dr. McLaughlin and the other health care providers at St. Mary's for giving me my life back. I have returned to St. Matthew's Catholic School, where I am celebrating my 57th year of teaching, pain-free," remarked Sister Claire.

Detailed information is available on trigeminal neuralgia and other neurological conditions at: http://www.neurosurgerytoday.org/what/, under Conditions & Treatments. To locate a qualified neurosurgeon in your area, visit: http://www.neurosurgerytoday.org/findaneuro/.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 6,800 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada, or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain, and peripheral nerves.