Ablation successful for trigeminal neuralgia in pregnancy

(HealthDay)—Trigeminal neuralgia in pregnancy can be managed successfully by conventional radiofrequency ablation of Gasserian ganglion, according to a case report published online June 2 in Pain Practice.

Bhanu P. Swain, D.N.B., from Tata Main Hospital in Jamshedpur, India, and colleagues present the case of trigeminal neuralgia in a 25-year-old woman, who was well controlled with carbamazepine 400 mg. She presented at 10 weeks pregnant, and reported steadily increasing pain intensity and frequency during her pregnancy. At the time of presentation she had a visual analogue scale (VAS) score of 9 out of 10, and a score of 15 on the Patient Health Questionnaire-9.

The authors found that a percutaneous diagnostic mandibular nerve block, conducted with lignocaine using peripheral nerve stimulator, provided good pain relief for about 24 hours, but the pain returned at a lower intensity. Once the patient had crossed 13 weeks of pregnancy, they performed percutaneous radiofrequency ablation of trigeminal ganglion. The procedure was conducted with intermittent fluoroscopy; to minimize radiation exposure to the fetus, minimum possible spot images were taken. There was an immediate reduction in pain score from VAS 7 to 3 after the procedure. The patient was discharged home, and has reported being pain-free during follow-up.

"This novel association of trigeminal neuralgia and pregnancy warrants further studies to explore other treatment modalities and more importantly their safety in such a situation," the authors write.

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