Medication and surgical options.

My wife who was diagnosed with MS over 30 years ago, has been dealing with TN-MS off/on for about 20 years. At present her TN, right side V2, is under control with 400MG Carbatrol (200MG every 12 hours). Lyrica worked last fall until Jan 07 when she switched to Carbatrol that worked for previous episodes. Carbatrol is Carbamazepine as is Tegretol; however, with Carbatrol she seems to adapt to the fatigue side-effect faster. I can't explain the detail difference between Carbatrol and Tegretol except that the Carbatrol seems to be longer lasting and every 12 hours dosage is fine. Unlike her previous episodes (see below), the TN on the right side has come and gone.

From 1987 through 1994, my wife had TN-MS on the left side V2 & V3, that progressed to the point where she was on 1,600 MG Tegretol and at various times Lioresal/Baclofen and Dilantin. LONG story made short, she also had multiple surgical procedures including Glycerol injections (1st on lasted app. 1 year, 2nd failed) and peripheral nerve resections (cutting peripheral nerves in face). Unfortunately the peripheral nerves regenerate and pain returns. In 1994, after a GREAT DEAL of research and multiple surgical opinions, she had SUCCESSFUL major surgery to severe the V2 & V3 branch of the TN nerve through a small opening behind the ear. This is a permanent procedure and results in permanent facial numbness but does not affect motor function and the face does not droop. After 13 years, she is still pain free on the left side of her face. Of course it is critical to find a Neurosurgeon with SUCCESSFUL experience with this surgery for patients with TN-MS!!!

There is a lot of info on the Internet including TN support groups, although not focused on TN-MS. For example, www.facial-neuralgia.org, www.tna-support.org. NOTE, TN-MS is rarely caused by that "typical cause" that is mentioned in the TN sites, compression of the Trigeminal Nerve and therefore "Microvascular Decompression" is rarely an option when MS is involved.

Although not for the faint of heart, there is a great deal of info, including medications, in "Striking Back! The Trigeminal Neuralgia and Face Pain Handbook" by George Wiegel and Kenneth F. Casey, M.D. You can order the book through the TN Support Groups and other online bookstores.

NOTE: When reading books like this and other info on the Internet, REMEMBER than NOT everyone gets all the symptoms so don't panic if you read about someone that has more symptoms etc. than you do.

Hope this helps.