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Tic douloureux

Tic douloureux -- literally, "painful twitch" -- is a syndrome in which a burning pain zips down a nerve in the face without warning. Its causes are generally unknown, but it's most likely to affect people over the age of 50. It can be triggered simply by shaving or washing your face or eating something very hot or cold. Even a cold draft has been known to bring it on.

Doctors frequently prescribe anticonvulsant drugs such as Tegretol, and an experimental form of an old drug -- baclofen -- may also prove helpful. But when drug therapies fail or the side effects such as nausea, dizziness, fatigue and serious bone marrow problems can't be handled, it's time to consult a surgeon.

There are a number of surgical techniques that can relieve tic pain. But most involve trading off a degree of facial sensitivity for a degree of relief.

The most effective and least destructive technique, is microsurgical decompression, an operation in which a sponge is inserted between the trigerninal nerve, which controls facial sensation, and any neighboring vein, artery or bone that may be periodically putting pressure on the nerve. If it sounds as though no one is really sure whether or not nerve compression causes tic, that's because they aren't. But they do know that the procedure relieves pain in 78 to 90 percent of the people who undergo it. Unfortunately, the chance that pain will recur - as it does with other tic procedures - is one in ten.

And microsurgical decompression is major surgery, which means it's only for those in good health. Tic douloureux victims who are not in the best health, however, have other options. Transcutaneous electrical nerve stimulation (TENS) and radio-frequency coagulation -- a procedure that actually involves burning the trigeminal nerve's root -- are helpful in almost half the people on whom they're performed. And surgical injections of glycerol can relieve pain in 67 percent of tic douloureux victims. Recurrent pain is not unusual with any of these procedures.

Some doctors also continue to recommend alcohol injections or freezing, although these treatments require expert administration and are rarely effective for any length of time. Of course, sometimes even a day free of pain is worth the risk. Especially when that pain is triggered by washing your face.

     
     

A paralysed face ...

Persistent itching on the face and neck

Tic douloureux

 

 

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