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Dr. Mark
Dr. Mark, Neurologist (MD)
Category: Neurology
Satisfied Customers: 1985
Experience:  Neurosurgeon - Brain, spine, and peripheral nerve surgery
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Writing Sept. 15 in search of a specialist to help with me

Customer Question

writing Sept. 15 in search of a specialist to help with me trigeminal neuralgia. I live a distance away - so would like to know: how early I can hope to see a specialist, also how many visits does it take on an average to come up with a resolution (I realize that depends on the type of treatment. Also, if one would get a Botox shot - can that be effective if the neuralgia has progressed to inside my mouth -specifically teeth and gums.,
JA: Have you noticed any swelling in the gums? When was your last visit to the dentist?
Customer: I should have been more specific. I've had episodes of TN before - always starts temporal region (above right eye) -has before progressed into hair line - down toward gums. Other times have been sent to dentists, had x-rays along with exams yielded nothing - on a chance even had a tooth implant in lower left gum - even though I know TN doesn't affect left side - and the pain never goes to left side for me. My face is at this point sensitive on left side - to the point that wearing glasses is difficult - having a shower is problematic - the shooting pain of the water hitting my head makes me reluctant to wash my head as I shower;. This has come and gone a number of times in 10-15 years - once disappeared as I had spine surgery - when I remarked to my surgeon that that was a good part of surgery he responded that it would come back - has a couple times, not as bad as this time.
JA: Anything else in your medical history you think the doctor should know?
Customer: Not really - I did break my neck, but the problem had appeared before that. I've had lots of falls, use my walker - had had a neurologist who moved, haven't found another - need to. He was aware of my TN episodes. I'm 75 and a physical mess - joints primarily, have had 3 shoulder replacements as well as 3 previous shoulder surgeries - a number a surgeries on my back, and a knee replacement.
Submitted: 11 months ago.
Category: Neurology
Expert:  Dr. David replied 11 months ago.

Hello, this is Dr. David. I am reviewing your question now and will be with you momentarily.

Expert:  Dr. David replied 11 months ago.

TN is complex and you have to see a good neurologist and neurosurgeon and get a good brain MRI scan for evaluation.

medication like carbamazepine (Tegretol) often can help decrease TN pain

a botox injection won't help

but other sclerosing agents can help.

also gamma knife radiosurgery can help decrease TN pain.

if the Tegretol medication can help, you can see a neurologist every 2-3 months for evaluation.

if you need more specialized treatments, you will need to have more visits.

let me know if you have questions.

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