Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Clinical Considerations of Trigeminal Neuralgia

삼차신경통 진단 및 치료의 중요 고려사항

  • Jeon, Young-Mi (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Tae, Il-Ho (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Choi, Jong-Hoon (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Ahn, Hyung-Joon (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Shim, Woo-Hyun (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Kwon, Jeong-Seung (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry)
  • 전영미 (연세대학교 치과대학 구강내과학교실) ;
  • 태일호 (연세대학교 치과대학 구강내과학교실) ;
  • 최종훈 (연세대학교 치과대학 구강내과학교실) ;
  • 안형준 (연세대학교 치과대학 구강내과학교실) ;
  • 심우현 (연세대학교 치과대학 구강내과학교실) ;
  • 권정승 (연세대학교 치과대학 구강내과학교실)
  • Published : 2007.12.30
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Abstract

Trigeminal neuralgia is defined as "a sudden, usually unilateral, brief stabbing recurrent pain in the distribution of one or more branches of the fifth cranial nerve" by the International Association for the Study of Pain(IASP). Trigeminal neuralgia is classified as an idiopathic trigeminal neuralgia with no apparent cause and a symptomatic trigeminal neuralgia which is caused by a structural lesion such as brain tumor. Over 80% of the tumors are meningioma, acoustic neuroma, and epidermoid tumors. Symptomatic trigeminal neuralgia can not be excluded even if old-aged patient does not have abnormal neurologic sign and symptom, and good response to pharmacotherapy. Therefore, initial examinations such as MRI or CT are essential to exclude symptomatic trigeminal neuralgia. When compared with CT, MRI, especially gadolinium enhanced MRI, has an increased sensitivity in the detection of intracranial lesions. The most effective medical treatment of trigeminal neuralgia is carbamazepine. The most common side effects of carbamazepine include drowsiness, dizziness, unsteadiness, nausea, anorexia. Hepatotoxicity, bone marrow depression are the most feared side effect of carbamazepine therapy but occurs rarely. It require periodic complete blood cell counts as well as hepatic and renal function tests. It has been recommended that complete blood cell counts is done every 2 weeks for the first 2months and then quaterly thereafter. Oxcarbazepine can be used if neutropenia occurs.

삼차신경통은 삼차신경의 하나 이상 분지에서 나타나는 안면 편측 통증 질환으로 짧은 찌르는 듯한 통증이다. 삼차 신경통의 가장 흔한 원인은 인접 삼차신경이나 삼차신경근 부위를 압박하는 혈관에 의하거나 특발성으로 나타나는 특발성 삼차신경통과 구조적 병소에 의해 나타나는 증후성 삼차신경통으로 분류된다. 증후성 삼차신경통은 수막종, 청신경종, 표피양암종 등이 주된 원인이며, 감각 결함, 운동 결함, 운동실조, 안구진탕 등과 같은 신경계 증상이 동반된다. 삼차 신경통의 치료는 크게 약물 치료와 외과적 치료가 있다. 이 중 가장 효과적으로 사용되는 약물은 Carbamazepine이며, 졸음, 현기증, 불안, 오심, 식욕부진 등의 다양한 부작용을 나타낼 수 있다. 특히 간독성, 골수 기능 억제 등의 위험한 부작용이 나타날 수 있으므로 주기적으로 혈액검사, 간 및 신장 기능 검사가 필요하다. 이에 삼차신경통의 임상 증례를 통해 증후성 삼차신경통과 특발성 삼차신경통의 예를 들어 진단과 치료를 시행함에 있어 여러 고려 사항들 중 특히 우리가 소홀히 하거나 간과하기 쉬운 중요 고려사항을 되짚어 보고자 한다.

Keywords

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