EUROMEDICA  Hanover 23-24  Mai 2011	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover

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Multiple approach in the treatment of trigeminal neuralgia (TN) as written in many books does not meet the satisfaction of many clinicians. New research in the method of treatment is carried out in two directions: аccomplishing therapeutic treatment as a result of the usage of the new drugs and their combinations and the discovery of new surgical methods of the trigeminal nerve.

Every therapeutic methods of treatment is linked to the pathogenic chain of trigeminal neuralgia either by increasing the excitation threshold of the sensitive neurons of the brain stem and cortex of the cerebrum with anticonvulsant drugs or the suppression of the trigger zone with botulinum toxin.

The basic link where the formation of pathologic nidus demyelination (neurovascular conflict) takes place is not under the influence of therapeutic method. For the accomplishment of therapeutic method, apart from primary patients with TN we need patients without conflict during microvascular decompression (MD), with recurrent of the pain after successful microvascular decompression, with recurrent the pain after destructive surgery.

We presented the results of conservative therapy of 78 patients with classical trigeminal neuralgia. 64 out of the patients were treated with (accepted Patency of Russian Federation No 2227028) effect on the components of the pathogenesis of the disease: truncal and cortical foci of pathologically increased stimulation and on the focus of demyelinization in the region of the neurovascular conflict. 14 patients were treated with the effect on the 3 components of the pathological chain. To the method presented in Patency No 2227028 there were also added application of the trigger zones, anesthetics with the aim of excluding them. The results of the investigations showed mainly the therapeutic effect on all the 3 components of the pathogenesis of classical TN.

Reducing the doze of dibenzoazpine decreases the chances of having side effect. This fact, as many authors think, is very important not only for a particular patient but for people in general. Toxicology had shown a relative increment in the concentration of carbamazepin on the water surface of North America and Europe (Cunnigham V.L at al, 2010). Alongside with epileptic patients, patients with TN taking carbamazepin for a long time will have the greater part of the drug in their exosystem.

Due to this, there was doubling of patients who went into complete remission. Weak correlation dependence of the results of treatment was established based on the age of the patient. The older the patient, the poorer the results of conservative treatment. If it is not possible to achieve full remission of the disease within the period of 3-4 months, the patient undergoes spiral computed angiography. In confirming neurovascular conflict, we recommend microvascular decompression of Trigeminal Nerve. Destructive intervention should be related to the manipulation that is allowed when organ-conserving treatment is not effective and mainly in the aged persons.

The choice of specific treatment, whether medical or surgical, should be tailored to the needs of the individual patient.