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TIC DOULOUREUX, TRIGEMINAL NEURALGIA
 
This is another name for neuralgia of the fifth cranial nerve which is the one most liable to suffer in this way, because it covers a large area, is much exposed to external influences, and passes through numerous bony passages. The neuralgia may be due to the involvement of one or another of the nerve's three branches in some disease process, but in the most important and severe type it is a primary affection of its nerve ganglion (Gasserian ganglion, q.v.) which is situated within the cranial cavity. The condition may arise through the poison of infective diseases, especially influenza, and from carious teeth, inflammation or tumours in the bony parts through which the nerve passes, or disease in adjacent regions. The pain is generally very severe, and is often accompanied by a flow of tears on the one side with, perhaps, redness of the face and some swelling. The neuralgia is nearly always confined to one side.
The first branch is very commonly affected. There is then pain above the eye and sometimes in the eyeball and eyelids. If the second branch is involved the pain is in the cheek and temple; if the third, it is felt in the lower jaw, the tongue, skin and ear. The slight forms may be cured in a few weeks, others may last for years. The pain usually comes on spontaneously, is increased by any movement of the face muscles and is quieted by firm pressure.
 
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TIC DOULOUREUX: ITS CAUSATION
While local irritation of one of the branches of the trigeminal nerve may cause this severe neuralgia, more often the mischief is in the Gasserian ganglion, from which the branches emerge.
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Treatmeut must involve the remedy of any local disease in the teeth, bones of the face and jaw, eye and nose. Any toxins should be eliminated from the body and the general health and nutrition improved. Electricotherapy may be a valuable aid, but often fails as in other forms of neuralgia, soothing ointments, heat, counter-irritation, such as blisters, should be tried. Many drugs may alleviate the pain (quinine, arsenic, phenacetin and aspirin are the commonest. Morphia may have to be given in severe cases. Surgical interference may be necessary, especially of damaged teeth. Of late years injections into the nerve or its ganglion have been employed with success.
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EPILEPTIC NEURALGIA.
Of facial neuralgias arising from affections of the 5th cranial nerve (trigeminal neuralgia or tic douloureux) there are many varieties. Onc of these types is severe and periodic in nature. may appear in attacks every year at certain times and disappear in a few weeks or months. Atmospheric conditions in these cases seem important.. Some sufferers have such attack only every second year. In the most acutc case the pain is so violent that all treatment may prove unavailing and suicide result. These severe conditions, which specially occur in old age arc termed epileptic neuralgia.
The discovery and removal of any local disease which might be a source of irritation is the first step. Drugs and electric treatment may be of service. Injections of pure alcohol or procaine made at the site of emergence of the 5th nerve at the base of the skull have also proved useful.
 
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