One of the scariest things for a parent to go through is seeing their child in constant pain and not know what to do about it. For that matter, simply seeing your child go through life with a disease that is normally “reserved” for adults is very upsetting, especially if parents don’t know if there’s anything that can be done to change the circumstances.
Pediatric trigeminal neuralgia is a disease that causes facial pain, and while it may last for mere seconds at a time, the pain can be so intense in can cause the child to be temporarily incapacitated. Generally, it’s felt on one side of the jaw or cheek. Though the episode itself may not last long, some patients can feel a numbing or ache even a few days before an episode happens. The symptom does have a trigger – it happens when something makes contact with the cheek. Unfortunately, these triggers are things connected to everyday life, such as brushing teeth, eating, drinking, talking, and feeling a breeze or wind against the face. As the child grows up, the disorder often gets worse. Initially, the child can have an attack, but then it may disappear for a long time. Eventually though, the attacks will both get worse in terms of intensity and happen more frequently.
What causes pediatric trigeminal neuralgia?
There’s a particular nerve in your brain that is responsible for the ability to feel anything on your face. Have you ever experienced the feeling of “brain freeze’? Gotten slammed on the forehead by a baseball and said “ouch”? You could feel the pain because the trigeminal nerve distributes the sensation to your brain, which then redistributes the sensation to your face. It all happens in the blink of an eye, without any direct input from you. In the case of someone (adult or child) with trigeminal neuralgia, however, there is usually a blood vessel that puts pressure on the nerve as it’s on its way out of the brain. Because of the undue pressure, a protective coating that’s around the nerve wears away. This then causes inappropriate pain signals to be sent to the brain, causing it to think it’s in pain when it’s not.
Treatments for pediatric trigeminal neuralgia
There are a couple of different options. First, the doctors usually turn to medications. A noninvasive option is always the best to start with, because there are fewer risks of complications occurring. The medications normally given are in a class called anticonvulsant medicines, which are given to help prevent the nerve from firing unnecessarily. This alone can potentially solve some of the issues caused by trigeminal neuralgia. A group of antidepressants called tricyclic antidepressants can also be given, as they are also approved to treat pain.
However, especially as the disease progresses, medication may not be enough to manage the symptoms. There was a study done to see what the prognosis would be if surgery was done in the early stages to treat the disease instead of waiting. This surgery is known as microvascular decompression, and its goal is to protect the cranial nerves by using small Teflon sponges that are inserted by the surgeon to separate the nerve from the artery that is causing the pressure, thereby hopefully relieving the inappropriate nerve firings.
This study followed a group of patients who were between the ages of 3 and 18. The study found that almost all patients experienced complete pain relief after microvascular decompression surgery was completed. One patient didn’t experience complete pain relief, but the reduction was so significant the patient was then able to completely stop taking medication. Subsequent follow ups between a year and two years later with these patients showed that none of them had complications as a result of the surgery.
Previously, according to the study, there had been no data on the effectiveness of performing microvascular decompression surgery on children younger than 18. Although more studies need to be completed to prove this outcome, this option can potentially save children from experiencing any more pain than necessary. Sometimes, patients (and doctors) try to leave surgery as a last resort; however, we can see that potentially this surgical procedure could be considered as a first option to greatly improve the lives of children suffering from the severe pain caused by pediatric trigeminal neuralgia.
Steve Schadendorf, MD
Founding Medical Partner
Dr. Schadendorf is a board certified neurologist who specializes in vascular neurology at Bass Medical Group. Dr. Schadendorf is a Founding Medical Partner and Medical Director of the Neuromedicine Channel at Doctorpedia.