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Saturday, July 14, 2012

TREATMENT OF TRIGEMINAL AUTONOMIC CEPHALGIAS: NEUROMUSCULAR DENTISTRY ALTERNATIVE TO IMPLANTED SUPRAORBITAL/SUPRATROCHLEAR NEUROMODULATION

A recent article in neuromodulation is a case study of five patients with implanted neuromodulators. The good news is that there is hope when all other treatments failures but there can be numerous complications as noted in pubmed abstract that follows. The devices must be removed for diagnostic MRI. Some patients required multiple applications but the systems were effective in major pain relief and reduction or elimination of opiod use.

Neuromuscular Dentistry offers a less invasive and frequently extremely effective alternative treatment. A diagnostic neuromuscular orthotic is retained by the lower teeth and alters the input to the trigeminal nervous system. The trigeminal nervous system acts as an input/output for our brain. Approximately 50 % of all brain input comes from the periodontal ligaments and the muscles of the trigeminal nervous system. Neuromuscular dentistry does utilize the use of a nonimplanted neuromuscular stimulator in the form of ULF TENS. This allows relaxation of trigeminally innervated muscles and the autonomic system follows suit. In computer lingo these headaches are I/O errors or input output erros. GARBAGE IN- GARBAGE OUT IS BAD INFO INTO COMPUTER GIVES BAD OUTPUT. Nociceptive inputs are eliminated with the diagnostic orthotic and stabilized. SPG (Sphenopalatine Ganglion blocks) Blocks are frequently used in combination with a neuromuscular orthotic when there is not rapid relief of all symptoms.

The beauty of the SPG Block is that it can be easily performed by patients to prevent episodes and does not require opiods or dangerous neurologic medications but utilizes lidocaine and administered by a hollow cotton swab.

I propose that a neuromuscular diagnostic orthotic should be considered a first linr treatment priot to invasive procedures. A sleep study should be used to rule out obstructive sleep apnea, hypopnea, UARS (upper airway resistance syndrome) and RERAs or respiratory related arousals that are frequently present in these patients and associated with their disorders.


PUBMED ABSTRACT:
Neuromodulation. 2012 May 2. doi: 10.1111/j.1525-1403.2012.00455.x. [Epub ahead of print]

The Treatment of Medically Intractable Trigeminal Autonomic Cephalalgia With Supraorbital/Supratrochlear Stimulation: A Retrospective Case Series.

Source

Pain and Wellness Center, Peabody, MA, USA; New England Regional Headache Center, Worcester, MA, USA; and The Center for Pain Relief, Charleston, WV, USA.

Abstract

Introduction:  This is a retrospective case series of five patients with intractable trigeminal autonomic cephalalgia (TAC) who were implanted with a supraorbital/supratrochlear neuromodulation system. Objectives:  The aim of this Institutional Review Board-approved study was to investigate the percentage of pain relief, treatment response, pain level, work status, medication intake, implantation technique, lead placement, programming information, and device use. Results:  Trial stimulation led to implantation of all five patients. All patients reported improvement in their functional status in regard to activities of daily living. The device was revised in two patients due to skin erosion. It was later reimplanted in both patients due to worsening of symptoms, again with good pain relief. The device was explanted in two other patients because of the need to perform a magnetic resonance imaging or implant an automatic implantable cardioverter defibrillator. The follow-up of the patients ranged between 18 months and 36 months, with a mean of 25.2 months. There was no change in work status. Following the implant, the Visual Analog Scale score was reduced to a mean of 1.6 from an initial mean score of 8.9. Three patients were completely weaned off opioid medications, while two patients continued to take opioid at a lower dosage. All patients experienced a decrease of the adjuvant neuropathic drugs. Conclusion:  Supraorbital/supratrochlear nervestimulation appears to be a promising modality for the treatment of patients with intractable TAC.

© 2012 International Neuromodulation Society.

PMID:
22551506
[PubMed - as supplied by publisher]

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posted by Dr Shapira at 7:47 AM

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