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Thursday, October 23, 2014
Is trigeminal neuralgia associated with MG?
I have recently been given a probable diagnosis of generalised MG and commenced on Mestinon with good effect. However, about four years ago I started to get chronic pain in the left eye investigations revealed nothing - MS,aeurysms and cranial masses were excluded. As the MG symptoms progressed the pain in my left eye started to occur in the right eye and then developed into a neuralgic pain mainly on the left side of my face. My neck and skull are also sensitive to touch at certain points. I am still awaiting results of a chest CT. This pain seems to be triggered after activity as well as cold,hot fluids ect. The pain generally resolves only when I rest. Could you please advise?
This sounds perfectly horrible and I am sorry. There is no specific association between the myasthenia gravis and the trigeminal neuralgia. These are two very different diseases. Myasthenia is painless, and you sound like you are having neuralgic symptoms.
One could postulate that there is an autoimmune process in your system, and for some reason it is manifesting at two levels of the peripheral nervous system for you (nerve and neuromuscular junction). This could be associated with a disease like sarcoid or a disease associated with cancer (we call this paraneoplastic). What if you actually have multiple cranial neuropathies? Another thought is the association of thyroid disease with both, especially because some thyroid diseases will effect the eye muscles and change the orbit, where some of the nerves of facial sensation run. One last thought is the thought that some infections, like herpes virus, are thought to contribute to trigeminal neuralgia, but would only make sense if they were suppressing your immune system.
A lumbar puncture to make sure there is no evidence of inflammation in your central nervous system has probably already been done.
I wish I had better advice. Good luck.
Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati