Trigeminal neuralgia treatment through Ayurveda

1. Welcome to the Interdepartmental
Cluster Seminar
DEPT. OF MANO VIJYAN EVUM
MANAS ROGA

2. Case Presentation
Presenter :
Dr Prabhakar Manu
2nd Year PG Scholar
Dept. of Manas Roga
Guide:
Dr Suhas Kumar Shetty
Professor
Dept of Manasa Roga

3. Vital Data
 Name : XYZ
 Age : 31 yrs
 Sex : Male
 Address : Tumkur
 Religion : Hindu
 Education: Graduation
 Occupation : NGO
(field officer)
 Marital status: Married
 IPD no : 11972
 Bed no : 23
 DOA : 16/4/16

4. Pradhana Vedana
1. Severe pain (Electric shock like) in the left
cheek area of the face, difficulty in chewing
hard food, lock jaw- 3 years
Increased since 1 week

5.  Aggravating factors – Cold stimuli, early morning
and after sunset.
 Relieving factors – Afternoon & hot climate

6. Vedana Vruttanta
 Patient was apparently normal 3 years back.
 As per the patient statement gradually he noticed
pain in the left cheek region of the face. Pain is like
electric shock . In cold season especially in Nov,
Dec, Jan he will feel more pain.
 Onset of pain was acute with gradual worsening
and episodic in nature without nausea and
vomiting.

7.  Then he consulted in NIMHANS , Bangalore in 2013.
They conducted MRI scan of brain revealed,
compression of trigeminal root by vascular loop on
left side and found compression in trigeminal nerve.
They prescribed medicine and he felt gradual
decreasement in the symptoms.
 Since last 1 week, pain has been increased
severely, earlier prescribed drug was taken but
symptoms not reduced.
 On 16th of this month he came to Manas opd with
same complaints and was advised admission.

8.  Poorva vyadhi vruttanta
N/H/O DM, HTN, infectious diseases, Disease
related to eye, ear & dental, head injury or surgery,
meningitis.
 Koutumbika vruttanta
Nobody in his close family circle is suffering from
similar diseases.
 Chikitsa vruttanta
T. Tegrital CR 400mg 1 BD since 3 years
Not Underwent any ayurvedic treatments before

9. Vayaktika Vruttanta
 Appetite – good
 Bowel – Regular (1-2/day)
 Micturition – (6-7 times/day) Straw colored urine
 Sleep – Disturbed due to pain
 Habits – 2-3 times tea/day
 Allergy – No allergy
 Diet - Mixed

10. Vital Signs
 BP - 130/90mmHg
 Temperature – 98.6o F
 Pulse rate- 84/min
 Respiratory rate – 16/min

11. Samanya Pareeksha
 Built: Moderate
 Nourishment: Moderate
 Pallor : absent
 Icterus : absent
 Cyanosis: absent
 Clubbing: absent
 Koilonychia : absent
 Lymphadenopathy: absent
 Edema: absent
 Facies : Normal

12. Ashtasthana Pareeksha
 Nadi – 86/min
 Mootra - Prakruta
 Mala - Prakruta
 Jihwa - Lipta
 Sabda – Spashta
 Sparsha - Anushnasheeta
 Drik - Prakruta
 Akriti – Madhyama (good posture)

13. Dasavidha Pareeksha
 Prakriti - VK
 Vikriti - Dosha- Vata Kapha
Dooshya- Rasa
 Sara - Madhyama
 Samhanana - Madhyama
 Pramana - Madhyama
 Satwa - Madhyama
 Satmya - Madhyama
 Aharasakti - Madhyama
 Vyayamasakti - Madhyama
 Vaya - Madhayama

14. Systemic examination
 RS – NVBS heard, no additional sounds
 CVS – S1,S2 heard, no murmur/clicks
 GIT – Soft, non tender, no organomegaly,
tympanic note on percussion.

15. CNS Examination
1.HMF –
 Pt is conscious, well oriented to time, place
and person.
 Recent and remote memory are intact.
 Speech is normal. No dysarthria.

16. CNS Examination
2.CRANIAL NERVES –
Olfactory Nerve (1st)
Optic Nerve (2nd)
Oculomotor Nerve (3rd)
Trochlear Nerve (4th)
Trigeminal Nerve (5th)- sensory loss in left cheek region+
Abducens Nerve (6th)
Facial Nerve (7th)
Vestibulocochlear Nerve (8th)
Glossopharyngeal Nerve (9th)
Vagus Nerve (10th)
Accessory Nerve (11th)
Hypoglossal Nerve (12th)

17. Trigeminal Nerve Examination

18. Mental Status Examination
 Attitude & Behavior – Cooperative
 Speech – Monotonous
 Mood – Mild Depressed
 Thinking – intact
 Judgment –intact
 Insight –intellectual
 Sensorial cognition – intact

19.  Report

20. Nidana Panchaka
 Nidana – Rooksha aahara and vihara,
ratri jaagarana, ati gamana
 Poorvaroopa - Nil
 Roopa – SENSORY-Suptata & shool in vaam mukhardha,
shool while charvana (Chewing),
MOTOR-Hanugraha (Lock Jaw)
 Upashaya – Ushna Vihara

21. Samprapti
Dosha- Vata Kapha Udbhava sthana –
Pakvasaya
Dushya – Rasa Sanchara sthana – Mukha
pradesh
Srotas – Rasa Agni – Dhatvagni vaishamya
Dushti – Vimarga
gamana, Sanga
Rogamarga – Madhyama

22. Differential Diagnosis- Modern Sciences
Bell’s Palsy Trigeminal Neuralgia
Causes temporary partial facial paralysis
in one side of the face
It is quite literally pain in the trigeminal
nerve or areas affected by the trigeminal
nerve.
Pain is rarely present in the face Electric shock like pain in part of the face
Affects only on one side of the face It can affect on both the sides
Cold exposure Certain factors severs to be trigger in
causing pain like brushing teeth, chewing
, eating , shaving etc.
Dysfunction of the 7th cranial nerve. One , two or all the three branches of the
nerve may be affected.

23. Differential diagnosis according to Ayurveda
Ardhavabhedaka Vataja Shirahshoola Anantavata
Ardha parshwa-Unilateral Severe pain in forehead Intense pain at manya
(carotid artery region)
Bheda, Toda, Shoola-
Pulsating, throbbing type
of pain
Giddiness Pain in nape of the neck
Pakshat, Dashahat,
Akasmat-Paroxysmal
Stiffness at shoulder and
neck
Twitching near cheecks
Prakasha Asahishnuta-
Photophobia
Lock jaw

24. Vyadhi Vinischaya
Adharvabhedaka/Anantavata
Chikitsa sidhanta
As per Acharya Vagbhatta Adharvabhedaka should
be treated as same as Vataja Shirahshool.

25. Diagnosis:
 Trigeminal Neuralgia or Tic douloureux
Trigeminal Neuralgia (TN) is a unilateral disorder
characterized by brief shock like pain which are abrupt in
onset and termination , limited to the distribution of one or
more divisions of the trigeminal nerve. The attacks are
initiated by non-painful physical stimulation of specific areas
(trigger points or zones) that are located ipsilateral to the pain.
Chewing, speaking , washing the face, tooth brushing , cold
winds or touching a specific ‘trigger spot’ . TN more commonly
affects females and patients over 50 years of age. The pain
rarely occurs bilaterally and never simultaneously on each
side.

26. Diagrammatic Representation

27. Treatment
Day Treatment Medicines Remarks
16/4/16 –
22/4/16
Mukhaabhyanga
+Nadi swedan
Nasya
Shiropichu
Dashmoola Yavagu
twice daily at 11:30am
& 3:30pm
Physiotherapy
Ksheerabala taila
Karpasthyadi taila
4drops – 4 drops
Shatapaka bala taila
Tab. BVC Gold
1 -0-1
Cap. Palsineuron
1- 0-1

28. Why Carbamazepine is first line of Treatment
 Antiepileptic drugs (AEDs) work well for trigeminal neuralgia
(TN) and have been known to do so since a study was
completed with phenytoin (PHE) in 1942 (Bergouignan) and
another with carbamazepine (CBZ) in 1962 (Blom). With 3
placebo-controlled crossover studies validating its efficacy in
trigeminal neuralgia, providing relief by roughly 75% versus
only 25% in the placebo arms (Killian, Nicol, Campbell),
carbamazepine is the best studied drug for this disorder and
the only one with US Food and Drug Administration (FDA)
approval in this setting.
 It will decrease the nerve firing and overactive neurons .
 Blom S. Trigeminal neuralgia: its treatment with a new
anticonvulsant drug (G-32883). Lancet. 1962 Apr 21. 1:839-
40.

30. Pathophysiology of Trigeminal Neuralgia:
the ignition hypothesis
 The ignition hypothesis of trigeminal neuralgia is based on recent
advances in the understanding of abnormal electrical behavior in
injured sensory neurons, and new histopathologic observations of
biopsy specimens from patients with trigeminal neuralgia who are
undergoing microvascular decompression surgery. According to the
hypothesis, trigeminal neuralgia results from specific abnormalities
of trigeminal afferent neurons in the trigeminal root or ganglion.
Injury renders axons and axotomized somata hyperexcitable. The
hyperexcitable afferents, in turn, give rise to pain paroxysms as a
result of synchronized afterdischarge activity. The ignition
hypothesis accounts for the major positive and negative signs and
symptoms of trigeminal neuralgia, for its pathogenesis, and for the
efficacy of treatment modalities. Proof, however, awaits the
availability of key experimental data that can only be obtained from
patients with trigeminal neuralgia.
 Devor M, Amir R, Rappaport ZH. Pathophysiology of
Trigeminal Neuralgia: The Ignition Hypothesis. The
Clinical Journal Of Pain 2002;18:4–13.

31. Ayurvedic Understanding of TN
 Shiras is the Kapha Sthana
 TN – Vata is aggreavated in Kapha sthana (shiras)
 Kapha and Vata is having sheeta guna and in TN sheetvatam
and chalatvam is increased.
 So treatment plan will be ,
 Kaphavrutta Vata Chikitsa
 Ushna virya dravya – later phase snigdha guna dravya
 Nasya Karma – Ushna virya aushadha

32. Some Ayurvedic Medicines in Ayurveda for TN
1. Kashayam
Rasonadi Kashayam
Rasna Dashmoola Kashyam
2. Churnam
Pippali churnam
3. Vati
Rasonadi Vati

33. Some Ayurvedic Medicines in Ayurveda for TN
 For Nasya
 Karpasthayadi taila
 Shadbindu Taila
 Kshira Dhumam
Bala kshira dhumam
Dashmula kshira dhumam
 Kavalam
Arimedadi taila

34. Aetiology
•A blood vessel presses against the root of the trigeminal nerve.
•Multiple sclerosis - due to demyelinization of the nerve. Trigeminal
neuralgia typically appears in the advanced stages of multiple sclerosis.
•A tumor presses against the trigeminal nerve. This is a rare cause.
•Physical damage to the nerve - this may be the result of injury, a dental or
surgical procedure, or infection.
•Family history (genes, inherited) - 4.1% of patients with unilateral
trigeminal neuralgia (affects just one side of the face) and 17% of those with
bilateral trigeminal neuralgia (affects both sides of the face) have close
relatives with the disorder. Compared to a 1 in 15,000 risk in the general
population, 4.1% and 17% indicate that inheritance is probably a factor.

35. Conclusion
 No specific disease mentioned in ayurveda relates
with TN.
 Based on the line of treatment of Vataja shirah
shoola chikitsa, it can be efficiently treated.
 Life style and dietary modifications are advised.

36. THANK YOU