23/Jun/2024

I had developed a facial spasm some years ago that eventually went away on its own.  Then, in 2015, the facial spasm came back with a vengeance.  What initially began as a mild eyelid flutter soon developed into a facial spasm running the length of the left side of my face.  It got so bad that I became very self-conscious and, when not at work, began to stay home more and more out of embarrassment.

In preparation for my daughter’s April 2016 wedding, I saw my eye doctor who injected Botox to help with the spam.  Unfortunately, that was not a successful solution.  After months of searching for the right doctor, I was happy to find one in my own backyard (St. Joseph’s Medical Center in Burbank, California).

Dr. Joung Lee examined me, looked at test results, and confirmed the diagnosis of hemifacial spasm.  He then recommended a microvascular decompression (MVD) – in simple terms, a “brain surgery” to relieve the pressure off of the facial nerve by inserting a Teflon felt between the offending artery and the nerve.  I was a nervous wreck but Dr. Lee was so compassionate and informative that he put me totally at ease, especially during my brief hospital stay.  His office staff and nurses are extremely cordial and helped me every step of the way.  (My procedure was done in September 2016).  The follow up since the procedure has been top notch. 

Today, I am happy to report that the surgery was 100% successful.  My only regret is not finding Dr. Lee sooner!

 


23/Jun/2024

My story is what they call a blessing in disguise. I was in a car accident not far from home one day.  I was hit from behind, and suffered a concussion.  This required an MRI, which revealed a meningioma. I was lucky to have been hit though, because the tumor was discovered while it was still relatively small.  However, it was in a very tricky location, at the base of the skull, attached to the cranial nerve (“vagus nerve”) responsible for vocal function, coughing and swallowing.

Once again, I was lucky for my misfortune, because the perfect surgeon for the procedure, Dr. Joung H. Lee, had just moved back to Los Angeles to look after his aging mother, a top expert who wrote numerous scientific articles and books on skull base surgery and meningiomas. Not only is he an expert in his field, he has an excellent bed-side manner.  In fact, his confidence in my full recovery fueled my confidence for the same. He even won over my mother, who can be skeptical of Western medicine. That was in 2014 (October 29).

Although it took several months for my voice to return to normal (actually better than before!), I feel Dr. Lee gave me a new lease on life, having been “cured” from a skull base meningioma. Today, I feel I am glad I went thru what I did to become the person I am today. Healthier, happier and more grateful for life’s natural beauties. Thanks, God… Dr. Lee and Dr. Lee’s mother!


23/Jun/2024

All trigeminal neuralgia patients should undergo medical therapy initially as many patients respond very well to medications.  Anti-seizure medications work well in treating trigeminal neuralgia.  The best medication for trigeminal neuralgia is Tegretol (Carbamazepine) which relieves trigeminal neuralgia in about 60% of patients initially.  Other trigeminal neuralgia medications include, either as a single agent or in combination, Dilantin, Neurontin, Baclofen and Keppra.  Success rates for these medications are in the range of 30-40%.

For many patients, toxicity (e.g. bone marrow and liver toxicity for Tegretol) and side-effects (drowsiness, dizziness, imbalance for all trigeminal neuralgia medications) are not insignificant, and when taking Tegretol, blood tests are required on a regular basis to monitor the liver and bone marrow functions as well as the blood drug level.

Medical therapy must be closely monitored to achieve the goal of pain relief while minimizing side-effects.  At times, when treating trigeminal neuralgia that is refractory to a single agent, a second (or third) medication may be added to adequately control trigeminal neuralgia as long as there is not a significant extent of side-effects.

 

 

 


23/Jun/2024

Epidemiology (“How common is it, and how is its distribution?”)

  1. The incidence of trigeminal neuralgia (“How common is it?”) is about 40/million population/year.
  2. Trigeminal neuralgia is more common in the female sex (F:M 1.7:1).
  3. Over 80% of trigeminal neuralgia patients are older than 50 years of age at the                           time of onset.
  4. 5-8% of trigeminal neuralgia patients have a brain mass (i.e. brain tumor or cyst) causing direct compression on the trigeminal nerve.
  5. 2-9% of trigeminal neuralgia patients have multiple sclerosis (MS).
  6. 2-4% of MS patients have trigeminal neuralgia.

Natural History

  1. 25% of patients experience spontaneous resolution after the initial episode(s), and experience trigeminal neuralgia recurrence months to years later.
  2. Approximately 50% of trigeminal neuralgia patients initially managed medically will eventually require surgical intervention due to:
    1. Failed medical therapy
      1. Ineffective medical therapy
      2. Significant side-effects
    2. Personal choice

Etiology (“What causes trigeminal neuralgia?”)

For patients other than those with MS or brain lesions found to be causing trigeminal neuralgia, the “vascular compression theory” is the popular one explaining the cause of trigeminal neuralgia in the majority of patients.  Aging leads to mild brain sagging as well as blood vessel elongation, hardening and dilatation, all of which lead to the nearby blood vessel(s) coming into direct contact with the trigeminal nerve.  This “vascular compression” on the trigeminal nerve leads to certain changes (“demyelination”) within the nerve, ultimately resulting in “short-circuiting” among nerve fibers, which in turn causes the trigeminal neuralgia’s typical electrical shock-like pain.


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