Trigeminal Neuralgia Management Utilizing Vestibular Rehabilitation and Immune Regulation
-
1
Bagnell Brain Center, United States
Background: 40 year old female patient presents with seven year history of right sided trigeminal neuralgia pain. She described the pain as stabbing, excruciating and debilitating. Self graded assessment of brain functionality revealed impulsivity, emotional instability, and difficulty making decisions, perseveration, dry mouth and eyes, dysphagia, chronic digestive complaints, anxiety, photophobia, and memory problems. The patient had microvascular decompression craniotomy surgery one year ago but has had no improvement following surgery. Patient was prescribed Tegretol to take daily.
Findings: Discovery 24 channel QEEG (Eyes closed)elevated delta in FP2, elevated theta in midline at Fz and Cz, elevated alpha and beta frequency in absolute power measures at O2 (>2 standard deviations from normative values). Lab testing revealed elevated Epstein Barr Viral (EBV) loads compared to normal values. Capsid Ag (IGG) was 1.26 H compared to the normal of less than 0.90. Nuclear AG (IGG) value was 3.27 compared to normal of less than 0.90. Commensal Bacterial PCR revealed elevated levels of some strains of bacteria in comparison to others. CoQ10 was low compared to normative values. Homocysteine cardiovascular levels were high. T3 total(64ng/dL) and Vitamin D (29ng/ml) was low. Clinical Test of Sensory Integration (CTSIB) Biodex Biosway revealed increased sway on all parameters (>2 SD below normative values). Significant findings from the physical exam revealed right dysmetria during finger to nose testing and bilateral thenar percussion myotonia.
Methods: Patient specific treatment consisted of repetitive Peripheral Somatosensory Stimulation (rPSS) that was applied to V3 branch of Trigeminal nerve. Gaze stability exercises including passive vestibulo-ocular reflex relative to right anterior canal, right complex activities of the upper extremity and lower extremity out of phase were performed. Leftward pursuits and Optokinetic stimulation, and antisaccades tasks was performed during treatments. Interactive Metronome (IM) training for 10 sessions, 12-18 minutes in length over the 5-week period were implemented. These sessions consisted of hand clapping to metronome activity and standing/ seated stepping with both feet to metronome activity at 54 beats per minute (BPM). The participant performed these tasks over increased time intervals beginning at 2.6 minutes per session and reaching a maximum of 18 minutes. At the end of the 5-week period, the patient returned to retest the CTSIB and the saccadometer. A followup QEEG was also performed. Results: CTSIB Biodex Biosway post testing following 18 treatments revealed decreased sway index from 3.02 to 1.71 with eyes closed on perturbed surface (43.4% improved), EO/Firm surface (62.1% improved), EC/Firm surface (51.1% improved), EO/ Foam surface (33.8% improved). QEEG showed improved Alpha wave over the right hemisphere. The patient stated she had periods of being pain free following the treatment plan, the longest being one week duration. Best task average on the Interactive Metronome improved from 35 ms to 18 ms. Nutritional support was prescribed to support immune function.
Conclusion: These results demonstrate improvement in a case of Trigeminal Neuralgia. Further research is warranted in this field to support the use of a neurorehabilitation model using vestibular therapy, eye specific exercises, and immune evaluation.
Keywords:
Neuroscience,
Neurorehabilitation,
Trigeminal Neuralgia,
vestibular,
Immune System
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:
Irons
H,
Bagnell
MK and
Schmidt
M
(2018). Trigeminal Neuralgia Management Utilizing Vestibular Rehabilitation and Immune Regulation.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00039
Copyright:
The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers.
They are made available through the Frontiers publishing platform as a service to conference organizers and presenters.
The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated.
Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed.
For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions.
Received:
20 Nov 2017;
Published Online:
14 Dec 2018.
*
Correspondence:
Dr. Michael K Bagnell, Bagnell Brain Center, Miami, United States, bagnelldc@gmail.com