Peripheral streptomycin/lidocaine injections in the treatment of idiopathic trigeminal neuralgia. A preliminary report

Streptomycin-lidocaine injections for the treatment of postherpetic neuralgia: Report of three cases with literature review

The sudden, stabbing, paroxysmal pain of neuralgia is the fiercest agony that a patient may experience in his life. Many varied medical treatments and surgical procedures have been suggested in the literature for neuralgic pain. Most of the patients fail to respond to medical treatments or succumb to complications of total anesthesia owing to surgical procedures. Herein, we tried a new treatment modality in patients suffering from postherpetic neuralgia with appreciable success in all the three cases that are presented in this paper. Streptomycin sulfate dissolved in 2% lidocaine solution was deposited at the peripheral branches on the involved nerves targeting the trigger zones, given weekly once for a maximum of 6 week period and continued once in 2 weeks if symptoms persisted. All patients were followed-up for 1 year and there was a marked improvement on follow-up.

Role of transcutaneous electric nerve stimulation in the management of trigeminal neuralgia

BACKGROUND

Trigeminal neuralgia typically involves nerves supplying teeth, jaws and face of older females. Though the etiology is usually obscure, different treatment modalities have been tried for it viz. medicinal treatment, injection alcohol, peripheral neurectomy, rhizotomy, and microvascular decompression etc. Transcutaneous electric nerve stimulation (TENS) is an emerging and promising option for management of such patients.

AIMS AND DESIGN

The present study was designed with an aim to study the efficacy of TENS in management of trigeminal neuralgia.

MATERIALS AND METHODS

The study was conducted on 30 patients of trigeminal neuralgia confirmed by diagnostic nerve block. They were given bursts of TENS for 20-40 days over the path of the affected nerve and subsequently evaluated at 1 month and 3 month intervals by visual analogue scale (VAS), verbal pain scale (VPS), a functional outcome scales for main daily activities like sleep, chewing, talking, or washing face.

RESULTS

The results showed that, on VAS, the score decreased from 8.9 (Pre TENS) to 3.1 at 1 month and 1.3 at 3 months, and on VPS, the score decreased from 3.5 (Pre TENS) to 1.2 at 1 month and 0.3 at 3 months. Similarly, a considerable decrease in scores was seen on functional outcome scale for different activities. No side effects like irritation or redness of skin were seen in any of the patients.

CONCLUSIONS

Thus, TENS was found to be a safe, easily acceptable, and non-invasive outdoor patient department procedure for management of trigeminal neuralgia.

Local anesthetic blockade of peripheral nerves for treatment of neuralgias: systematic analysis

BACKGROUND

Nerve blocks with local anesthetics have been used in the diagnosis and treatment of neuralgias. Usually these blocks were administered in combination with corticosteroids and other drugs that can be effective by themselves. Although lasting benefits from nerve blocks in neuralgias have long been described, definitive evidence is lacking. We had the following objectives in this systematic review: to analyze the evidence behind the practice of peripheral nerve blockade with local anesthetics in patients with neuralgias and radicular pain syndromes; to assess the duration of pain relief after conduction block resolution; and to evaluate the effectiveness of the treatment of these syndromes with a series of blocks.

METHODS

We searched Medline, Embase, narrative reviews, and book chapters. Only articles published in English were collected. The list of 3347 identified articles was reduced to 39 articles that were read entirely, 12 of which met inclusion criteria.

RESULTS

Twelve included articles were analyzed. Each can be classified as a single case report or case series; there were no controlled studies among them. Nine reports assessed a single block outcome; all recorded pain relief beyond the duration of conduction blockade. Those 9 reports represented a total of 69 patients, 30 of whom had complete pain relief and 10 had relief ≥50%. Seven reports with the assessment of continuous pain ≥1 week after a single block reported complete or profound pain relief in 11 of 17 patients. All 3 reports with the assessment of a series of blocks in a large number of patients (total of 270) reported overall positive results.

CONCLUSION

Because all reviewed articles were only single case reports or case series, no reliable conclusion could be drawn concerning the effectiveness of nerve blocks with local anesthetics in neuralgia. However, 2 features of the analyzed reports-the large magnitude of the effect and the high consistency of the reported outcome-indicate that future research efforts are warranted.

Peripheral and gasserian ganglion-level procedures for the treatment of trigeminal neuralgia

This review discusses the various peripheral and ganglion-level procedures available for treating trigeminal neuralgia and summarizes specific success and complication rates for each technique.

METHOD

A review of the available literature.

RESULTS

It appears that expertly performed ganglion-level procedures (radiofrequency thermocoagulation, balloon compression, and glycerolysis) are more effective than peripheral procedures but neither approach can be relied on to produce long-term pain relief. All of these procedures are neurodestructive and can cause sensory loss and dysesthesia. Effective drug therapy may not be acceptable to some patients as adverse cognitive side effects are increasingly recognized.

CONCLUSIONS

Each patient should receive an informed and impartial account of the available surgical options. There is a need for prospective randomized controlled studies in procedure-naïve subjects to determine the optimal surgical management of trigeminal neuralgia.

Peripheral glycerol injections in the treatment of idiopathic trigeminal neuralgia: retrospective analysis of 157 cases

PURPOSE

This study presents the results of peripheral glycerol injections in patients with idiopathic trigeminal neuralgia.

PATIENTS AND METHODS

The patients who either failed to respond to drug therapy or developed serious side effects were treated by means of glycerol injections. Medical records and questionnaires on 157 patients treated between 1983 and 1996 were evaluated. The minimum follow-up period for each patient was 4 years.

RESULTS

The study population included 65 males and 92 females. The right side (112 patients, 71%) was affected more commonly than the left. The most common distribution was in the second and the third trigeminal divisions. The initial success rate was 98%. Pain recurred in 60 patients and was most frequently recorded between 25 and 36 months postinjection (28 of the 60 recurrences). These patients were successfully reinjected. At the end of 4 years, complete or almost complete pain relief was obtained in 154 patients.

CONCLUSIONS

Peripheral glycerol injection is a minimally invasive and useful technique to manage trigeminal neuralgia, with a high success rate and low incidence of morbidity.

Use of streptomycin-lidocaine injections in the treatment of the cluster-tic syndrome. Clinical perspectives and a case report

Trigeminal neuralgia and cluster headache syndrome are complex pain conditions of the craniofacial region. Both diseases can coexist in the same patient, comprising the cluster-tic syndrome. This article reviews the literature on this condition and reports a new case who responded well to peripheral streptomycin-lidocaine injections.

The effects of streptomycin on autotomy

Thirty-six rats with sciatic nerve transections and autotomy scores 1-2 were divided into 3 groups. Two groups were re-operated and injected with streptomycin sulphate or saline into the polyethylene tube around the neuroma. In the third group, streptomycin was injected at the sciatic nerve, extraneurally, proximal to the tube. Streptomycin injected into the polyethylene tube suppressed autotomy scores during the entire postinjection period. At the eighth postinjection week, none of the rats from this group reached the maximal autotomy score.

Trigeminal neuralgia--treatment of the third division by radiologically controlled cryoblockade of the inferior dental nerve at the mandibular lingula: a study of 31 cases

Cryoblockade of the peripheral nerve affected by trigeminal neuralgia is an established technique for treatment. Freezing the inferior dental nerve using C-arm image-intensification control, and a nerve stimulator to guide the slim Spembly Lloyd probe, offers an additional technique for treatment of a small number of patients with trigeminal neuralgia. This paper reports the results of 31 cryoblockades of the inferior dental nerve in 11 patients.

Peripheral streptomycin/lidocaine injections versus lidocaine alone in the treatment of idiopathic trigeminal neuralgia. A double blind controlled trial

Seventeen patients with long-lasting idiopathic trigeminal neuralgia (ITN) were treated with either five, weekly peripheral streptomycin/lidocaine (S/L) or lidocaine alone injections, in a double blind controlled study. Eight patients responded initially to the treatment in the S/L group and three patients in the lidocaine group. Pain recurred in four patients from the S/L group within two weeks and six months following the last injection. One patient from the lidocaine group remained pain-free for eight months. At the final assessment, three patients from the S/L group and two patients from the lidocaine group remained pain-free up to 30 months. Neither treatment affected sensory functions of the injected nerves. It is concluded that S/L injections are initially effective in the treatment of ITN. In the long term, however, their effects are similar to the effects of lidocaine alone.

Current concepts concerning the etiology and treatment of trigeminal neuralgia

Trigeminal neuralgia (tic douloureux) was first identified over three hundred years ago. Only recently have the causes of the disorder begun to be recognized and understood. The first attempts at treatment involved the neurotomy of peripheral branches of the trigeminal nerve. This procedure, along with neurectomy, ganglionectomy, rhizotomy, tractotomy, and injections of toxic substances into the ganglion and nerve branches were the main treatment modalities in years past. Although they exhibited marked success, they are fraught with complications, such as relapse, loss of facial sensation and motor control, infection, deafferentation pain, and a fairly high rate of mortality from the procedure. The current treatment modalities that result in a predictable success with minimal risk are microvascular decompression, percutaneous retrogasserian thermal rhizotomy, and percutaneous retrogasserian glycerol rhizotomy. Other procedures, such as balloon compression of the gasserian ganglion, cryotherapy, acupuncture, and drug therapy, are also being used with marked promise.

Peripheral glycerol injections in the treatment of idiopathic trigeminal neuralgia. A preliminary study

Thirteen patients with 17 nerves affected by trigeminal neuralgia underwent peripheral glycerol injections (PGI). Two nerves failed to respond to the treatment. The areas of 12 nerves have been pain free for between 6 and 26 months. Pain recurred in the areas of 6 nerves, 3-18 months following treatment. Three nerves were successfully reinjected. Decreased sensation was noticed in the area of 6 nerves. It appears that PGI can give comparable results to percutaneous retrogasserian glycerol rhizotomy with faster onset of pain relief and fewer complications. However, more clinical experience and longer follow-up periods are needed before definite conclusions can be reached.

The role of cryotherapy (cryoanalgesia) in the management of paroxysmal trigeminal neuralgia: a six year experience

One hundred and forty-five patients with paroxysmal trigeminal neuralgia were treated with cryotherapy and followed up from 1 month up to 6 years. The mean nerve relief pain period was 13 months for the long buccal, 17 months for the mental and 20 months for the infra-orbital nerves and patients regained normal sensation long before the return of pain.

Cryotherapy in the management of paroxysmal trigeminal neuralgia

Cryotherapy for the relief of pain is widely used in many conditions. The results of 83 cryotherapy sessions in 29 patients with paroxysmal trigeminal neuralgia are reviewed over a five year period. Sixty three per cent of treated nerves, 41% of patients were pain free over one year and there was no permanent sensory loss.