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Two years ago, Sister Claire, an 82-year-old Catholic school teacher from the
Philadelphia area, began experiencing early symptoms of trigeminal neuralgia.
"I experienced unpredicted occurrences of pain in my lower jaw and face," recalled
Sister Claire. "My primary physician at the time recommended Tegretol. Within
a few weeks, the pain was gone."
Trigeminal neuralgia or tic douloureux is sometimes described as the most excruciating
pain known to humanity. The pain typically involves the lower face and jaw,
although sometimes it affects the area around the nose and above the eye. This
intense, stabbing, electric shock-like pain is caused by irritation of the trigeminal
nerve, which sends branches to the forehead, cheek, and lower jaw. It is usually
limited to one side of the face.
Advanced age is a major risk factor for trigeminal neuralgia. The disorder
is more common in women than in men and rarely affects anyone younger than age
50. Hypertension and multiple sclerosis are also risk factors. Trigeminal neuralgia
is relatively rare. An estimated 45,000 people in the United States and an estimated
one million people worldwide suffer from trigeminal neuralgia.
Sister Claire's story is one of the three winning entries in the Neurosurgical
Patient Stories Contest featured during Neurosurgery Awareness Week (NAW).
NAW kicked off this year from April 22-27 during the 74th Annual Meeting of
the American Association of Neurological Surgeons (AANS) in San Francisco. "The
goal of NAW is to help educate people about a wide range of neurosurgical conditions
and diseases," stated Alex B. Valadka, MD, FACS, AANS spokesperson. "One of
the most compelling ways to do this is to share real life stories of people
who have experienced neurosurgical conditions firsthand," added Dr. Valadka.
In February 2005, Sister Claire's pain returned with greater intensity. "I
experienced a lot of anxiety because I had no way of knowing when these painful
episodes would occur," said Sister Claire. "Chewing, speaking, or swallowing
all triggered the excruciating pain." Sister Claire continued to be treated
for several months with various dosages of Tegretol. Unfortunately, she suffered
many side effects including dizziness, poor balance and sluggishness. After
two days of repeated nausea, she decided that the condition had escalated to
an intolerable level.
A trip to the emergency room at Paoli Hospital led to a diagnosis of toxic
medication overdose. After Sister Claire left the hospital, she went to her
sister's home in Newtown, and subsequently was admitted to St. Mary Medical
Center in Langhorne, where she stayed from May 9 until May 13. During this stay,
she had two nerve block sessions, and was prescribed Motrin to help control
the pain.
Sister Claire was referred to
Mark McLaughlin, MD, a neurosurgeon at Princeton Brain and Spine Care in
Langhorne. She entered St. Mary Medical Center on May 31. On June 7, Dr. McLaughlin
performed microvascular decompression surgery on Sister Claire. "I determined
that a blood vessel and nerve were touching and causing Sister Claire's pain,"
commented Dr. McLaughlin. "I placed an implant of Teflon between the blood vessel
and nerve behind Sister Claire's right ear to eliminate this problem."
Microvascular decompression is one surgical method for treating this condition.
It involves microsurgical exposure of the trigeminal nerve root, identification
of a blood vessel that may be compressing the nerve, and gentle displacement
of it away from the point of compression. While this is generally considered
the most effective surgery, it is also the most invasive, because it requires
opening the skull through a craniotomy. There is a small risk of decreased hearing,
facial weakness, facial numbness, double vision, stroke, and even death.
Sister Claire was discharged from the hospital on June 13. "It took me a few
months to get my energy back, and the area where my surgery was performed is
still healing. But I am so grateful to Dr. McLaughlin and the other health care
providers at St. Mary's for giving me my life back. I have returned to St. Matthew's
Catholic School, where I am celebrating my 57th year of teaching, pain-free,"
remarked Sister Claire.
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