The evolution of peripheral nerve treatment for trigeminal neuralgia - peripheral nerve surgery

Trigeminal neuralgia typically presents with a sudden and severe facial pain. Although peripheral nerve injection can produce good pain relief in the treatment of trigeminal neuralgia, their effect may not be permanent. Surgical treatment has always been an alternative for patients who do not respond well to medical treatment or, for those who are severely affected by the side effects of anticonvulsants. Unknown to most young healthcare providers, surgical treatment was the first line treatment at the turn of the 19th century till 1960s. This review narrates the evolution of peripheral nerve treatment for trigeminal neuralgia over the last 150 years

The evolution of peripheral nerve treatment for trigeminal neuralgia - peripheral injections

Trigeminal neuralgia presents as a characteristic severe painful condition that usually afflicts the area(s) innervated by the branches of the facial sensory nerves, especially the elderly females. The diagnosis can usually be made based solely on the presenting clinical signs and symptoms. Early literatures had revealed that there have always been two major means of treatment for trigeminal neuralgia; medical and surgical. Medical treatments involved systemic intake of various drugs or the topical applications of many different materials, not forgetting that bleeding and purging has been tried in the past. The introduction of anti-convulsants during thesecond World War had changed completely the way this painful condition was treated as this therapy later become the mainstay treatment for trigeminal neuralgia. Their beneficial effects, however may not be long lasting. This review summarises the evolution of peripheral nerve injection as a treatment for trigeminal neuralgia over the last 150 years

Liver Function Tests (LFTs)

Each liver function test by itself is neither highly sensitive nor specific but when interpreted together may provide the clinician with useful information about the patient's liver, and may also indicate other health issues such as malnutrition and bone disease

Bone Turnover Markers

Bone turnover markers (BTM) provide useful data to titrate the optimal dosing regimes for patients within 3–6 months as compared to 1–2 years using bone mineral density (BMD). Serum obtained under standardised conditions (fasting, early morning) should be tested using a precise automated immunoassay for a panel of bone markers that includes a resorption marker — C-terminal cross-linked telopeptide of bone collagen (CTX) — and formation markers — Procollagen Type 1 N-terminal Propeptide (P1NP) and Osteocalcin (OC)

Arterial Blood Gases

Arterial blood gases (ABG) results reflect underlying pathology and interpretation of the results are often compounded by ongoing disease processes and clinical interventions. While ABG specimens should be analysed immediately for optimal results the Clinical and Laboratory Standards Institute (CLSI) has recommended a window of 30 minutes at room temperature from blood collection to ABG analysis. A fresh and simple approach to interpreting ABG is provided

Thyroid Function Tests

A thyroid panel consisting of thyroid stimulating hormone (TSH) and free thyroxine (fT4) should form the first line of diagnostic tests; tri-iodothyronine (T3) — total or free may be needed occasionally. A TSH assay capable of detecting levels below 0.02mIU/L is required to differentiate the suppressed TSH levels typical in Graves' disease from subnormal levels seen in some geriatric patients, non-thyroidal illness, and patients on medications. Additional tests including thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), and TSH receptor antibody (TRAb) may be ordered to enable differential diagnosis when indicated. Serum thyroglobulin (Tg) may serve as a tumour marker for monitoring patients with differentiated thyroid cancer

Revisting Cerebrospinal Fluid (CSF) Examination

Routine cerebrospinal fluid (CSF) examination bears re-visiting as the body of knowledge has expanded and numerous new analytes touted as potential markers of CNS (central nervous system) diseases have emerged. Currently, visual assessment of CSF, microscopic examination for pathologic cells, and biochemical analysis for protein and glucose form the basis for routine CSF analysis. Further investigations that may be warranted include microbiology work-ups for CNS infections and immuno-detection for oligoclonal bands for multiple sclerosis. European guidelines for CSF analyses are available. CSF testing for other neurologic disorders (e.g. Parkinson's disease, Alzheimer's disease, and amyotrophic lateral sclerosis) while promising are not ready for prime time

Clinical Use and Measurement of Cardiac Troponin (cTn)

Cardiac troponins are cardio-specific and are widely used for the early diagnosis and triage of patients with acute coronary syndromes in conjunction with clinical history, electrocardiographic changes and imaging. Troponin is also useful for the prediction of outcomes in acute coronary syndromes, renal failure, sepsis, and critically ill patients. New developments in assay technology, designated as high sensitivity troponins, permit detection of lower levels of troponin in most healthy individuals, earlier diagnosis of myocardial infarction, and prognosis of stable coronary disease in the community

The Use of Procalcitonin in Clinical Practice

Procalcitonin (PCT) has emerged as the most promising marker of infectious inflammation. This development is critical to the practicing doctor dealing with febrile patients with suspected sepsis. An ideal biomarker would provide data for early diagnosis, differentiation of bacterial from non-bacterial causes of inflammation and information about the clinical course and prognosis of the disease. PCT is an early biomarker that is present within 3 to 4 hours of the triggering infection. An undetectable PCT level would efficiently rule out systemic infection. PCT may also be viewed as a marker of resolving infection as it has a half-life of about 22 hours, and its blood level correlates with bacterial load. Thus, PCT may be used as a clinical tool for early diagnosis, prognosis and therapeutic guide. Automated platforms with short assay times and service that is available 24 hours a day have enabled clinicians to obtain rapid reliable results for the early diagnosis and timely monitoring of appropriate pharmacotherapy. Clinicians should use PCT as an adjunct to clinical and other diagnostic criteria