Dear Dr. Roach: My sister has trigeminal neuralgia, the “suicide disease.” Her quality of life is gone, and I fear her life soon may follow. Could you please address this horrible disease and your ideas for treatment?
Trigeminal neuralgia is a condition causing brief, recurrent episodes of facial pain, on one side of the face, that are described as electric shock-like. The pain follows the distribution of one of the three branches of the trigeminal nerve. The first branch includes the forehead and scalp, the second the upper jaw, and the third the lower jaw and ear. The pain typically lasts for a few seconds and rarely awakens people at night. It is an uncommon disease, becoming more common with older age.
Most cases of trigeminal neuralgia are caused by compression of the root of the nerve, usually by an artery or vein. The spasms of pain can be associated with involuntary muscle spasms, and can be triggered by touch, eating or other movements of the face. They may last a few seconds or up to two minutes, and tend to be worst near the onset.
The course of trigeminal neuralgia is extremely variable. Some people have relatively mild symptoms that go on for a few weeks, whereas in others the pain is described as among the most excruciating pain known, and can go on for months. After a time (weeks, months, years) of no pain, the symptoms may recur.
I don’t like the term “suicide disease,” because it implies that suicide is the only answer to this problem, and it is not. Further, there is a widely reported myth that half of people with longstanding trigeminal neuralgia will commit suicide; in fact, a study by Dr. Harvey Cushing, a pioneer in treating the condition, reported a 0.6 per cent suicide rate.
There are many treatments, but none works for everybody and it often takes many tries to find effective treatment. Anti-epilepsy drugs, especially carbamazepine (Tegretol) usually are the most effective. Muscle relaxants, such as baclofen, also can be beneficial. A neurologist usually is the most expert at treating this condition. For very severe, refractory cases, a neurosurgical procedure to relieve compression of the nerve root should be considered.
Help can be found at the following websites: livingwithtn.org, fpa-support.org and tnnme.com.
Dear Dr. Roach: I have been told that PSA readings can increase if the tests are conducted within 48 hours of riding a bicycle, having a digital examination or having sex.
My GP wanted me to have the PSA test immediately after my annual physical examination, which included the digital examination. Fortunately, I wasn’t up to following his orders at the time for some unknown reason and delayed the test for a week.
I wonder why the three conditions are not mentioned to patients prior to testing in order to get more accurate results on their PSA levels.
All of these activities can temporarily raise the PSA level, but the level of increase usually is quite small (less than half a point for people with low to normal PSA levels) and thus is unlikely to make a difference in the decision of what to do with the PSA result. It generally is not necessary to avoid these activities before a routine PSA test. However, if the level is borderline as to whether to do a biopsy, it is reasonable to refrain from these activities for two to three days before a retest.
Dr. Roach regrets that he cannot answer individual letters, but will incorporate them in the column whenever possible. Email questions to ToYourGoodHealth@med.cornell.edu