A 65-year-old Female Diagnosed With Trigeminal Neuralgia Sees Full Resolution Of Symptoms From Treatment Using A Novel Brain-based And Vestibular Approach.
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Dr. Shannon Leon Functional Neurology, United States
Background
Trigeminal neuralgia (TN), or tic douloureux, is a rare pain condition that affects the trigeminal cranial nerve of the face. The condition’s symptoms of shock-like, electric pain can affect any number of the three cranial nerve distributions, and those most commonly affected are female and over the age of fifty. A female patient initially presents to our functional neurology clinic at age 65 with TN. Previous diagnostic imaging - MRI of brain and neck, CT of jaw, EMG/NCV of head and upper extremities - are all within normal limits. Prior physical therapy did not ameliorate symptoms. Prior prescription Trileptal worked “really well” for past pain but is not effective for TN symptoms. Comorbidities of patient’s TN include positional dizziness, bilateral second- and third-digit numbness, and recently two fungal infections in the jaw. Within two months of novel brain-based and vestibular treatment patient reports facial pain at nil and expressed gratitude for the restoration of her quality of life. Following a five year hiatus from appointments due to vibrant health patient returns to our functional neurology office owing to return of TN symptomatology. Patient reported, “Completely symptom-free,” following latest initial treatment using a novel brain-based, vestibular rehabilitative approach.
Methods
Detailed neurological examination is requisite for complete functional knowledge of patient presentation, regardless of number of prior visits. Our strategy of treatment for this patient remains consistent from her initial visit to her reevaluation for remission of TN symptomatology - a phenomenological, brain-based approach.
Initial evaluation: Neurological examination revealed vitals on right side to be 167/94 BP, 73 BPM, 97% oxygen saturation, and left side 163/94 BP, 73 BPM, 97% oxygen saturation, pH 6.5, pinwheel sensation equal bilateral in upper and lower extremities and trigeminal V1, V2, V3, vibration sensation equal bilateral in upper and lower extremities, intermittent muscle twitching left V2 and V3, muscle stretch reflexes 2+ bilateral in upper and lower extremities, corneal reflex in right is absent and in left is sluggish, gag reflex brisk bilateral, present left thenar myoclonus, tongue deviation to right when protruded, anterior two-thirds of tongue equal sensation bilateral, decrease smell in left, slow capillary refill (5 seconds) left hand, internally rotated right upper extremity, ptosis right side, blepharospasticity is low frequency and bilateral, hypotropia right side, hypermetric saccades leftward, convergence insufficiency due to initial right ocular exodeviation, palatoparesis left side, pyramidal paresis absent, Weber’s test lateralized right, nystagmus in resting position has leftward fast phase, finger-to-nose and alternating hand movements (arms extended and at 90 degrees flexion) are within normal limits, vestibulo-ocular reflexes are within normal limits bilateral, fundoscopic exam revealed bilateral vein to artery ratios are 3 to 1, otoscopic exam of tympanum in right is ‘pale’ and ‘well-visualized’, in left is ‘pink’ and ‘well-visualized’, and joint misalignment of the cervical, thoracic, and lumbar spinal regions.
Reevaluation at five years without interval treatment: Neurological examination revealed vitals on right side to be 126/76 BP, 76 BPM, and left side 124/77 BP, 76 BPM, increased left palpebral margin at rest, left eye convergence is mild at rest, ptosis on right side, hypermetric saccades leftward, finger-to-nose dysmetric on left, alternating hand movements have left sided dysdiadochokinesia, horizontal gaze fixation instability leftward, vertical gaze fixation instability rightward, pursuits with saccadic intrusions left- and rightward, peri-ocular motor tic during horizontal sinusoidal pursuits, otoscopic exam revealed mild redness of right external auditory canal and tympanic membranes are clear bilaterally, and minor subluxations of cervical spine.
This patient was treated, in every account, according to presenting phenomenology using a novel brain-based, multimodal treatment plan that included vestibular rehabilitation maneuvers, vestibulo-ocular re-training, specific eye movement therapies, and personalized at-home brain exercise therapies.
Results
Following initial visit to our functional neurology clinic, post-treatment examination reveals absent thenar myoclonus bilateral, normal capillary refill of upper extremities bilateral, bilateral hands are pink, dry and warm, finger-to-nose is normal, resting flexor tone is equal bilateral, full range of motion of C0/1/2, and normal sensation to facial distributions. Patient was seen two times per week for six weeks. At the conclusion of initial treatment plan patient reports her global suffering to be nil and that she is “symptom-free.” Upon remission of TN symptomatology and return to our functional neurology clinic following five-year hiatus from treatment at our clinic, patient again received specific oculomotor re-training, minor joint manipulation, and receptor-based treatment to effect a global improvement in her central integrative state; whereby she reports, following one treatment, that she is “completely symptom free.”
Conclusion
Trigeminal neuralgia and other pain syndromes that are failed by current conventional treatment strategies deserve a more encouraging prognosis. The human central nervous system has an extensive armamentarium of inputs, outputs, and collaterals with which to survive and adapt, and pain is a common fovealization for clinicians to begin their objective understanding of a presenting individual. However, pain is an equivocal story and whole patient understanding requires a phenomenological approach in order to diagnose and treat location of lesion(s). A 65-year-old female presents to our functional neurology clinic diagnosed with trigeminal neuralgia and sees full resolution of symptoms. Further investigation is warranted for interventions involving brain-based therapies for trigeminal neuralgia and chronic pain syndromes.
Keywords:
Brain Based Rehabilitation,
Trigeminal Neuralgia,
Tic douloureux,
Dizziness,
Functional Neurology
Conference:
International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.
Presentation Type:
Poster
Topic:
Clinical Applications in health, disease, and injury to the nervous system
Citation:
Leon
S,
Case
M and
Langhough
J
(2018). A 65-year-old Female Diagnosed With Trigeminal Neuralgia Sees Full Resolution Of Symptoms From Treatment Using A Novel Brain-based And Vestibular Approach..
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00057
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Received:
30 Mar 2018;
Published Online:
14 Dec 2018.
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Correspondence:
Dr. Jason Langhough, Dr. Shannon Leon Functional Neurology, Woodbury, NY, 11797, United States, j.langhough@gmail.com