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NEUROHUMORAL ASPECTS OF TRIGEMINAL NEURALGIA
Rashidov Muhsin Narzi o’g’li
Bukhara State Medical Institute named after Abu Ali Ibn Sino
Tel : +998911329697
MukhsinRashidov
@gmail.com
Relevance of the topic
. Trigeminal neuralgia is the most common and best
known type of prosopalgia. In terms of frequency of occurrence, trigeminal
neuralgia is second only to facial nerve pathology, accounting for 7-12% of all
cases of facial pain. The high incidence of the disease, the intensity of the pain
syndrome, the complexity of diagnosis and treatment, especially in outpatient
practice, determine the significance of this pathology, both in scientific and
practical terms (Vein A.M., 1994-1998; Karlov V.A., Savitskaya O.N., 1980-1990;
Yakhno N.N., 1998; Loeser J.D., 1998). Over the past decades, numerous studies
have been conducted on various aspects of trigeminal neuralgia, but this problem
still has many controversial and unresolved issues related primarily to its main
sections - etiology, pathogenesis and principles of therapy. Thus, all
pathophysiological components of the pain syndrome remain undisclosed, in
particular, there is no consensus on the significance of neurohumoral processes and
the role of immunological reactions in the implementation of the algic phenomenon
(Grechko V.E., 1990 - 2001; Osipova V.V., 1998; Sweet J., 1999; Mathew N.T.,
2002). As a consequence of insufficient study, there is often low efficiency of the
treatment, therefore, trigeminal neuralgia is characterized by the formation of
chronic and resistant forms of the disease (Luzin M.N., 1990 - 2002; Prithoi R;
1998; Talasko N., 2001).
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Continuation of the study of the pathogenesis of trigeminal neuralgia, the
search for and testing of new methods of correction, optimization of therapeutic
effects seem relevant, which created the prerequisites for conducting this study.
Purpose of the study.
The purpose of this work is to improve the quality of diagnosis and treatment
of patients with trigeminal neuralgia based on the study of the neurohumoral and
immunological features of the disease.
Research objectives.
1. Based on a comprehensive examination, identify the features of the clinical
manifestations of trigeminal neuralgia in patients with different course of the
disease. 2. To study the state of general and local immunity in patients with
trigeminal neuralgia and its dynamics during pathogenetic treatment.
3. To study the state of the opioid and sympathoadrenal systems, as well as
the level of prostaglandins of group E in trigeminal neuralgia.
4. To develop a comprehensive treatment program for patients with trigeminal
neuralgia based on the obtained research results.
5. To evaluate the effectiveness of the developed comprehensive treatment
programs in patients with trigeminal neuralgia.
Scientific novelty of the study.
We have clarified the mechanisms of pain formation in patients with
trigeminal neuralgia, for the first time revealed the dependence of the nature of the
course and severity of the disease on changes in the cellular and humoral immunity
system, hormonal spectrum and the content of a number of biologically active
substances. For the first time, a close relationship between the state of the immune
status and changes in the metabolism of neurotransmitters in patients with
trigeminal neuralgia has been shown. The presence of a disorder in the synthesis of
prostaglandins of the E series and the state of the sympathoadrenal system in
trigeminal neuralgia has been established.
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For the first time, a method of complex pathogenetic therapy has been
developed, substantiated and applied for the treatment of patients with trigeminal
neuralgia. The method is based on the use of drug therapy, including drugs for
normalizing the functional state of the central trigeminal structures,
psychopharmacotherapy, antihypoxants and vascular therapy, angioprotectors and
neurometabolics, immunocorrective therapy of local and general immunity,
acupuncture, measures for oral sanitation, rational psychotherapy, which made it
possible to influence various links in the pathogenesis of the disease. For the first
time, accessible summary indicators have been proposed that allow us to evaluate
the immediate results of therapy for trigeminal neuralgia, to clarify the significance
of negative predictors of therapy effectiveness for this pathology - the dynamics of
the visual analogue scale (VAS) and the results of the "quality of life" test. Practical
significance.
The new data obtained on the mechanisms of pain formation in patients with
trigeminal neuralgia, changes in the cellular and humoral immunity system and the
content of a number of biologically active substances allow us to objectify the
diagnosis and can be used as a basic component in the development of individual
programs of complex treatment.
The use of complex treatment programs developed on the basis of the obtained
examination results helps to improve the quality of treatment of patients with
trigeminal neuralgia.
Key provisions submitted for defense.
1. Patients with acute paroxysmal and chronic variants of the course of
trigeminal neuralgia are characterized by differences in metabolic shifts: in the
paroxysmal course of the disease, there is activation of the opioid, sympathoadrenal
systems, arachidonic acid metabolism along the cyclooxygenase pathway towards
the formation of prostaglandins of the E series, while in the chronic variant of the
course, inhibition of prostaglandin production is observed. 2. In trigeminal
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neuralgia, there is a change in the immune status of patients in the form of
activation of local immunity with an increase in secretory immunoglobulin A and
selective immunodeficiency in the peripheral blood.
3. Between the indicators reflecting the state of the immune system,
sympathetic-adrenal and opioid systems in patients with trigeminal neuralgia, there
are correlation relationships, indicating a close relationship between the studied
processes that carry out metabolic, regulatory and adaptive functions and the state
of which obviously affects the nature of the course of the disease and the severity
of the pain syndrome.
4. The effectiveness of the treatment of patients with trigeminal neuralgia is
based on
the use
of
complex programs,
including
the
use
of
psychopharmacotherapy, immunomodulators, reflexology while monitoring the
indicators of the immune system and neurohumoral indicators.
PRACTICAL RECOMMENDATIONS.
1. To diagnose trigeminal neuralgia, a comprehensive examination is required,
with mandatory testing of the level of (3-endorphin, PGE, the hormonal spectrum
of the pituitary-adrenal and sympathoadrenal systems, and testing of humoral and
cellular immunity.
2. Improving the effectiveness and quality of treatment for patients with
trigeminal neuralgia is based on the use of comprehensive treatment programs
developed based on the results of the examination.
3. When assessing the effectiveness of treatment in patients with trigeminal
neuralgia, it is advisable to include the "quality of life" test in the complex of
clinical examination methods, since the test result is a summary indicator reflecting
changes in the patient's social self-esteem as a result of treatment.
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