三叉神经痛与带状疱疹后神经痛.ppt

三叉神经痛与三叉神经痛与 带状疱疹后神经痛带状疱疹后神经痛 (trigeminal neuralgia&post-herpetic neuralgia,TN&PHN)Here is a piece of article extracted from health&disease information on July 13,2006 Neuralgia Neuralgia is sharp,severe,shooting pain along a nerve or group of nerves.The pain of neuralgia usually comes and goes.Neuralgia can affect adults of any age,although some types are more common after middle age.Neuralgia is caused by irritation or damage to a nerve,although the cause of the irritation is often not known.The type of neuralgia that occurs depends upon which nerve is affected and the reason it is irritated.Irritation can be caused by an infection,such as tooth decay,the herpes zoster virus(shingles),or nasal infections;eye strain;systemic diseases;arthritis;exposure to cold;a pinched nerve;injury;or even poor diet.Diagnosis To diagnosis neuralgia,your doctor will take a complete medical history and perform a physical examination.He or she will suspect neuralgia based upon the location of your pain and its characteristic symptoms.Your doctor will look for an underlying cause of your symptoms.For example,if you have facial pain,your doctor will evaluate other possible causes such as problems with the jaw,teeth,or sinuses.He or she will also check whether a tumor or aneurysm is putting pressure on a nerve.Therapies Antiseizure drugs,such as carbamazepine and phenytoin,are often used to suppress pain associated with glossopharyngeal,trigeminal,and postherpetic neuralgias because they slow down the nerve signals at certain nerve terminals.Postherpetic neuralgia can also be treated with antidepressants,topical pain relievers,transcutaneous electrical nerve stimulation(TENS),or a drug called capsaicin.In some cases,the nerve can be deadened with gamma rays,radio frequency waves,or glycerol injections.The nerve can also be cut or permanently destroyed.If neuralgia is caused by an artery or tumor compressing the nerve,or a pinched nerve,surgery may be needed to free the nerve.Alternative treatments include B-complex vitamin therapy,acupuncture,and herbal remedies that have been found to have anti-inflammatory effects.Self-care tips Although there is no way to prevent neuralgia,you can take steps to avoid attacks if you know what triggers them.For example,if your pain is in the facial or mouth area,avoid very cold or very hot food and drinks,dont chew your food on the side that is painful,dont eat extremely hard or crunchy foods,avoid splashing your face with very hot or cold water when washing,and rinse your mouth with water after every meal instead of using a toothbrush.If you have shingles,seeking treatment as soon as possible can reduce your risk of developing post-herpetic neuralgia.TN&PHN 三叉神经痛三叉神经痛(trigeminal neuralgia,TN)与带与带状疱疹后神经痛状疱疹后神经痛(post-herpetic neuralgia,PHN)是较为常见的两种神经病理性疼痛疾是较为常见的两种神经病理性疼痛疾病。二者同属于神经病理性疼痛，临床表病。二者同属于神经病理性疼痛，临床表现与治疗方案固有相似之处；二者发病机现与治疗方案固有相似之处；二者发病机理、疼痛表现又各有特点，因而治疗措施理、疼痛表现又各有特点，因而治疗措施亦有所不同。亦有所不同。TN&PHN 相相 同同 点点 临床表现：均表现为自发痛临床表现：均表现为自发痛(spontaneous pain)与诱发痛与诱发痛(evoked pain)；检查可有扳机；检查可有扳机点点(trigger points)疼痛范围内的皮肤痛觉过疼痛范围内的皮肤痛觉过敏敏(hyperalgia)及触诱发痛及触诱发痛(allodynia,又称痛又称痛觉超敏或痛觉异常觉超敏或痛觉异常)。治疗措施：均可采用抗癫痫药治疗措施：均可采用抗癫痫药(anti-seizure drugs,抗惊厥药抗惊厥药,anticonvulsants)、抗抑郁、抗抑郁药药(anti-depressive drugs)、阿片类镇痛药、阿片类镇痛药(opioids)、神经射频热凝毁损等治疗。、神经射频热凝毁损等治疗。TN&PHN 不不 同同 点点 区区 别别 TN PHN 发病机理发病机理 大部分病例为原发性。大部分病例为原发性。有些有半月神经节的退有些有半月神经节的退行性和纤维性改变，有行性和纤维性改变，有些是肿瘤或畸形血管压些是肿瘤或畸形血管压迫三叉神经。迫三叉神经。为水痘为水痘-带状疱疹带状疱疹病毒再次感染后遗病毒再次感染后遗疼痛。疼痛。性别年龄性别年龄 年龄多在年龄多在40岁以上，以中、老岁以上，以中、老年人为多。女性多于男性，约年人为多。女性多于男性，约为为32 年龄多在年龄多在50岁以上，以老岁以上，以老年人为多。男女比例约为年人为多。男女比例约为11 敏感药物敏感药物 卡马西平等抗癫痫药卡马西平等抗癫痫药 无特异性敏感药物无特异性敏感药物 神经毁损神经毁损 效果确切效果确切 有一定疗效有一定疗效 一、三叉神经痛一、三叉神经痛 trigeminal neuralgia,TN 三叉神经痛三叉神经痛 三叉神经痛分为原发性、继发性三叉神经痛两种。三叉神经痛分为原发性、继发性三叉神经痛两种。原发性三叉神经痛无明显原因，由三叉神经本身的潜原发性三叉神经痛无明显原因，由三叉神经本身的潜在病变引起，检查无神经系统体征的患者，部分为邻在病变引起，检查无神经系统体征的患者，部分为邻近正常血管压迫所致。近正常血管压迫所致。继发性三叉神经痛是指由于三叉神经节邻近组织病变继发性三叉神经痛是指由于三叉神经节邻近组织病变所引起的疼痛症状。多数有神经系统体征。原因包括所引起的疼痛症状。多数有神经系统体征。原因包括桥小脑角、三叉神经根或半月神经节部位的肿瘤、血桥小脑角、三叉神经根或半月神经节部位的肿瘤、血管畸形、动脉瘤、蛛网膜炎等异常组织压迫三叉神经管畸形、动脉瘤、蛛网膜炎等异常组织压迫三叉神经节，导致神经细胞营养障碍，神经纤维脱髓鞘，异常节，导致神经细胞营养障碍，神经纤维脱髓鞘，异常高频放电，表现三叉神经分布区疼痛症状。高频放电，表现三叉神经分布区疼痛症状。原发性三叉神经痛原发性三叉神经痛 原发性三叉神经痛病人的诊断可通过详细询问病原发性三叉神经痛病人的诊断可通过详细询问病人的病史、疼痛部位、疼痛性质等临床表现，另人的病史、疼痛部位、疼痛性质等临床表现，另外，通过检查发现多数病人因长期吃饭受影响而外，通过检查发现多数病人因长期吃饭受影响而全身情况较瘦弱。疼痛发作时表情痛苦，面部油全身情况较瘦弱。疼痛发作时表情痛苦，面部油腻，不愿讲话，即使在间歇期患者也不愿讲话或腻，不愿讲话，即使在间歇期患者也不愿讲话或很少讲话。但病人神经系统检查正常，三叉神经很少讲话。但病人神经系统检查正常，三叉神经各种感觉、运动及角膜反射，下颌反射均无明显各种感觉、运动及角膜反射，下颌反射均无明显的异常改变。部分患者因既往治疗造成颜面部局的异常改变。部分患者因既往治疗造成颜面部局部痛觉略减退，此点应与继发性三叉神经痛引起部痛觉略减退，此点应与继发性三叉神经痛引起的面部感觉减退相鉴别。影像学无异常改变。的面部感觉减退相鉴别。影像学无异常改变。三叉神经痛应具备下述特征三叉神经痛应具备下述特征 性别与年龄：年龄多在性别与年龄：年龄多在40岁以上，以中、老年人岁以上，以中、老年人为多。女性多于男性，约为为多。女性多于男性，约为32。疼痛部位：右侧多于左侧，疼痛由面部、口腔或疼痛部位：右侧多于左侧，疼痛由面部、口腔或下颌的某一点开始扩散到三叉神经某一支或多支，下颌的某一点开始扩散到三叉神经某一支或多支，以第二支、第三支发病最为常见，第一支者少见。以第二支、第三支发病最为常见，第一支者少见。其疼痛范围绝对不超越面部中线，亦不超过三叉其疼痛范围绝对不超越面部中线，亦不超过三叉神经分布区域。偶尔有双侧三叉神经痛者，占神经分布区域。偶尔有双侧三叉神经痛者，占3%。疼痛性质：如倒割、针刺、撕裂、烧灼或电击样疼痛性质：如倒割、针刺、撕裂、烧灼或电击样剧烈难忍的疼痛，甚至痛不欲生。剧烈难忍的疼痛，甚至痛不欲生。三叉神经痛应具备下述特征三叉神经痛应具备下述特征 疼痛的规律：三叉神经痛的发作常无预兆，而疼疼痛的规律：三叉神经