The Molecular Basis and Pathophysiology of Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a complex orofacial pain syndrome characterized by the paroxysmal onset of pain attacks in the trigeminal distribution. The underlying mechanism for this debilitating condition is still not clearly understood. Decades of basic and clinical evidence support the demyelination hypothesis, where demyelination along the trigeminal afferent pathway is a major driver for TN pathogenesis and pathophysiology. Such pathological demyelination can be triggered by physical compression of the trigeminal ganglion or another primary demyelinating disease, such as multiple sclerosis. Further examination of TN patients and animal models has revealed significant molecular changes, channelopathies, and electrophysiological abnormalities in the affected trigeminal nerve. Interestingly, recent electrophysiological recordings and advanced functional neuroimaging data have shed new light on the global structural changes and the altered connectivity in the central pain-related circuits in TN patients. The current article aims to review the latest findings on the pathophysiology of TN and cross-examining them with the current surgical and pharmacologic management for TN patients. Understanding the underlying biology of TN could help scientists and clinicians to identify novel targets and improve treatments for this complex, debilitating disease.     

红光联合护理干预及药物治疗糖尿病合并带状疱疹神经痛的疗效观察

目的:探讨红光照射联合护理干预及药物治疗糖尿病合并带状疱疹神经痛的疗效。方法:选取此类患者56例,随机分为观察组和对照组,各28例。对照组用更昔洛韦加泼尼松、甲钴胺片、维生素B1片进行治疗,观察组在对照组治疗的基础上加用红光照射,两组护理干预方法保持一致,2周后评价疗效。结果:对照组治愈率为32.1%,总愈显率为60.7%,观察组上述数据分别为64.3%、89.3%,观察组疗效显著优于对照组。结论:红光照射联合护理干预及药物治疗糖尿病合并带状疱疹神经痛疗效显著,值得临床推广。     

鼠神经生长因子治疗肺癌并发带状疱疹神经痛的临床观察

目的:观察鼠神经生长因子联合椎旁神经根阻滞治疗肺癌併发带状疱疹神经痛的临床疗效。方法:将40例具有典型带状疱疹神经痛表现的肺癌患者随机分为A组(实验组)和B组(对照组)各20例。治疗组给予鼠神经生长因子肌注1支每日一次+椎旁神经根阻滞每周2次;对照组给予椎旁神经阻滞每周2次。观察治疗后1周、2周疼痛指标及1月后的随访结果。结果:比较两组患者的疼痛指标及总体疗效,A组优于B组,有显著性意义P0.05。结论:鼠神经生长因子联合椎旁神经根治疗肺癌伴带状疱疹神经痛优于单纯椎旁神经阻滞治疗。     

半导体激光联合阿昔洛韦治疗带状疱疹临床疗效观察

目的:观察半导体激光治疗带状疱疹患者及带状疱疹后遗神经痛患者的疗效.方法:对92例带状疱疹患者包含18例带状疱疹后遗神经痛患者采用半导体激光照射治疗,同时给予阿昔洛韦药物口服或外用.5-10天后观察创面愈合情况及疼痛缓解情况.结果:疼痛缓解有效率68%,皮损愈合有效率90%.结论:半导体激光治疗带状疱疹及后遗神经痛患者不但可使创面快速愈合,还能有效地缓解疼痛.     

高压氧联合神经阻滞治疗带状疱疹后遗神经痛

目的:观察高压氧联合神经阻滞治疗带状疱疹后遗神经痛(post-herpetic neuralgia,PHN)的疗效.方法:100例PHN患者随机分为对照组50例(单纯神经阻滞治疗+约物治疗),治疗组50例(高压氧+神经阻滞治疗+药物治疗);治疗3个疗程后,观察两组患者一般状态及其积分;并采用视觉模拟评分法(VAs),分...     

显微手术治疗面肌痉挛合并三叉神经痛3例分析

目的探讨显微血管减压手术（MVD）治疗面肌痉挛合并三叉神经痛的临床效果。方法回顾性分析3例面肌痉挛合并三叉神经痛患者的诊治情况及术后疗效。结果 3例患者MRI检查及术中均见血管对面神经和三叉神经的压迫,给予微血管减压后,症状在术后3月内完全消失。无面肌瘫痪、听力下降及脑脊液漏等并发症发生。结论 MVD是治疗面肌痉挛合并三叉神经痛的有效治疗方法。术前MRI检查可明确诊断并指导手术。     

Multicriteria programming in medical diagnosis and treatments

This paper deals with a special case of multicriteria optimization problems. The problems studied come from the medical domain and are of a very important practical relevance. One of the problems refers to the ranking of treatments for the Trigeminal Neuralgia. The second problem refers to a hierarchy of risk factors for Bronchial Asthma. The most common way to deal with a multiobjective optimization problem is to apply Pareto dominance relationship between solutions. But in the cases studied here, a decision cannot be made just by using Pareto dominance. In one of the experiments, all the potential solutions are nondominated (and we need to clearly find a hierarchy of these solutions) and in the second experiment most of the solutions are nondominated between them. We propose a novel multiple criteria procedure and then an evolutionary scheme is applied for solving the problems. Results obtained by the proposed approach in a very simple way are same as the results (or even better) obtained by applying weighted-sum method. The advantage of the proposed technique is that it does not require any additional information about the problem (like weights for each criteria in the case of weighted-sumapproach).     

普瑞巴林联合氦氖激光理疗对带状疱疹后遗神经痛患者疼痛及睡眠质量的影响

目的: 探讨普瑞巴林联合氦氖激光理疗对带状疱疹后遗神经痛患者疼痛及睡眠质量的影响。方法: 将确诊为带状疱疹后遗神经痛（post herpetic neuralgia,PHN）患者84例分为两组,每组42例。对照组口服普瑞巴林治疗,研究组在对照组治疗基础上行氦氖激光照射治疗。对比两组患者临床症状改善情况、视觉模拟评分法（VAS）评分、匹兹堡睡眠质量指数量表（PSQI）评分。结果: 研究组疗效显著优于对照组,差异有统计学意义（Z=2.660,P<0.05）。治疗1周、2周、1月、2月、3月后,两组VAS评分较治疗前降低,研究组治疗后VAS评分显著低于对照组治疗后,差异有统计学意义（t=3.17、7.27、12.02、19.26、11.79,P<0.05）;两组PSQI评分较治疗前降低（P<0.05）;研究组治疗后PSQI评分显著低于对照组治疗后,差异有统计学意义（t=2.71、3.74、8.79、9.60、9.91,P<0.05）。结论: 普瑞巴林联合氦氖激光理疗能显著降低PHN患者疼痛值和提升睡眠质量,促进PHN患者临床症状改善。     

Stimulating GABAergic Neurons in the Nucleus Accumbens Core Alters the Trigeminal Neuropathic Pain Responses in a Rat Model of Infraorbital Nerve Injury

The nucleus accumbens core (NAcc) is an important component of brain reward circuitry, but studies have revealed its involvement in pain circuitry also. However, its effect on trigeminal neuralgia (TN) and the mechanism underlying it are yet to be fully understood. Therefore, this study aimed to examine the outcomes of optogenetic stimulation of NAcc GABAergic neurons in an animal model of TN. Animals were allocated into TN, sham, and control groups. TN was generated by infraorbital nerve constriction and the optogenetic virus was injected into the NAcc. In vivo extracellular recordings were acquired from the ventral posteromedial nucleus of the thalamus. Alterations of behavioral responses during stimulation “ON” and “OFF” conditions were evaluated. In vivo microdialysis was performed in the NAcc of TN and sham animals. During optogenetic stimulation, electrophysiological recordings revealed a reduction of both tonic and burst firing activity in TN animals, and significantly improved behavioral responses were observed as well. Microdialysis coupled with liquid chromatography/tandem mass spectrometry analysis revealed significant alterations in extracellular concentration levels of GABA, glutamate, acetylcholine, dopamine, and citrulline in NAcc upon optic stimulation. In fine, our results suggested that NAcc stimulation could modulate the transmission of trigeminal pain signals in the TN animal model.     

高位切断撕脱术治疗原发性三叉神经痛的临床研究（附66支／46例报告）

目的探讨高位切断撕脱术治疗原发性三叉神经痛（第Ⅱ、Ⅲ支）的临床疗效。方法46例（66支）原发性三叉神经痛患者在全身麻醉下,行口腔或健侧鼻腔插管。采用患侧口腔前庭及翼下颌韧带外侧切口,行上颌神经、下牙槽神经、颊长神经、舌神经高位切断撕脱术。结果术后控痛率达100％,术后随访4个月～5年,治愈30例,占65％;好转11例,占24％;无效而改用其他治疗5例,占11％。总有效率达89％。结论三叉神经高位切断撕脱术治疗原发性三叉神经痛安全、创伤小、临床治愈率高。