Rudolf Scheremet

CT-stereotactic fibrinolysis of spontaneous intracerebral hematomas

CT-stereotactic fibrinolysis is an effective alternative to surgical and conservative therapies for intracerebral hematoma. The method consists of stereotactically puncturing and partially evacuating the hematoma. After fibrinolysis using urokinase, the residual hematoma is completely evacuated through a catheter inserted in the cavity of the hematoma. The operation is usually performed under local anesthesia. Stereotactic methods are safer and less invasive than other methods. Since October 1985, a total of 85 patients have been treated with this method in the Department of Stereotaxy and Neuronuclear Medicine at the University of Freiburg Medical School. Although 25 patients died (29.4%) during the mean follow-up period of 20 months, only 16 (18.8%) died in the acute postoperative phase or within the first 60 days after evacuation. Eighteen patients (21.2%) had died six months after the operation. The quality of life of the 60 surviving patients, as measured on the Karnofsky Scale at follow-up, was very good to good in 70% and moderate in 23.3%. Only 6.7% of the patients were so disabled that they required special care and assistance or had to be placed in a nursing home. The long-term results are thus very encouraging.

Hemidystonia due to a contralateral parietooccipital metastasis Disappearance after removal of the mass lesion

A patient presented with left-sided hemidystonia. CT revealed a contralateral parieto-occipital mass lesion compressing the basal ganglia, which were spared by the mass. After microsurgical resection of the tumor, which was verified histologically as a metastasis of a large-cell anaplastic carcinoma, the movement disorder dissolved completely.A patient presented with left-sided hemidystonia. CT revealed a contralateral parieto-occipital mass lesion compressing the basal ganglia, which were spared by the mass. After microsurgical resection of the tumor, which was verified histologically as a metastasis of a large-cell anaplastic carcinoma, the movement disorder dissolved completely.

Facial myokymia and spastic paretic facial contracture as the result of anaplastic pontocerebellar glioma.

The case of a 36-year-old man who sought treatment of right facial myokymia and spastic paretic facial contracture is reported. Computed tomography and magnetic resonance imaging revealed a tumor located in the right cerebellar peduncle and the right dorsal pons bulging into the fourth ventricle. After microsurgical partial resection of the mass, which was verified histologically as an anaplastic glioma, facial myokymia initially ceased. The vermicular rippling movements were less intense upon recurrence and could be controlled by low-dose dexamethasone in the further course, when magnetic resonance imaging showed an interstitial pontine edema after percutaneous radiation therapy. It is assumed that facial myokymia and spastic paretic facial contracture were generated by ectopic activity due to alterations in the microenvironment at the intrapontine portion of the axons of the seventh nerve caused by the compressive effect of the tumor and later by edema.

Facial myokymia due to acoustic neurinoma

The case of a 62-year-old female patient who presented with facial myokymia is reported. The patient had a 13-year history of progressive left-sided hearing loss. In further course, involuntary, wormlike, rippling movements of the left facial muscles developed. Computed tomography revealed a tumor located in the left cerebellopontine angle. Electrophysiologic examinations confirmed the diagnosis of facial myokymia. The tumor, which evolved from the eighth cranial nerve, was totally removed microsurgically. The tumor was histologically verified to be an acoustic neurinoma. Postoperatively, the patient had a facial nerve paralysis, and the facial myokymia was no longer present. The present case provides further evidence that facial myokymia may be triggered by alterations at one of various sites along the course of the motor axons of the facial nerve.

Sympathetic contribution to pain – need for clarification

Certain patients with a possible contribution of the sympathetic system to pain may not fit the definition of complex regional pain syndromes (CRPS), which raises the question of terminology for those patients. To further clarify the relationship between the sympathetic system and pain, apart from the need for placebo studies, there remains an urgent need for a satisfactory definition of the criteria for a complete sympathetic block. It also remains uncertain whether a change in the discharge pattern of sympathetic fibres underlies the changes in sympathetic organ function, often found in patients with CRPS.

Trigeminusneuralgie—wie erleben die Patienten ihre Krankheit

INTRODUCTION Effective treatment of patients with trigeminal neuralgia is often a long and complicated procedure. The symptoms of trigeminal neuralgia are clearly defined in most cases. Sudden and brief episodes of severe and stabbing pain (tic douloureux) occur, with pain usually starting from a trigger point. Recent reports suggest 80-90% suppression of pain with various treatment regimens, which seems to indicate that the diagnosis and successful treatment of the disorder are no longer a major problem. In fact, however, the intense suffering of patients and isolated reports in the literature suggest that there are still considerable diagnostic difficulties. Patients are referred from one specialist to another, in most cases without the necessary interdisciplinary cooperation, and countless interventions and attempts at therapy not only remain unsuccessful, but may cause serious adverse effects. METHODS The records of 120 trigeminal neuralgia patients in two different areas of Germany were analysed retrospectively. In addition, the course of the disorder from the initial symptoms up to the institution of effective therapy was documented by means of information obtained from the general practitioner or other physicians. The patients themselves were also interviewed about their history. RESULTS After a so-called pain career of 51/2 years, each patient had taken an average of 4,000 pills or capsules, 2,500-3,000 of which were carbamazine, lost 1-2 healthy teeth in attempts to treat the painful condition, undergone three or four maxillofacial or ENT operations, or been subjected to exeresis. The result is prolongation and exacerbation of suffering and an apparently hopeless situation. The financial burden on the patients and the health insurance companies is enormous. DISCUSSION Apparently there is a considerable need for more information about the clinical symptoms, cause, diagnosis and therapy of trigeminal neuralgia, especially as the symptoms are often no longer typical because they have become chronic or are the result of previous treatment. This is needed by all specialists involved, including dentists and general practitioners. In patients in whom clinical criteria suggest the diagnosis of trigeminal neuralgia, drug treatment should be initiated immediately in consultation with the neurologist or neurosurgeon. For cases in which drug treatment fails or resistance to the drug develops surgical treatments are available, such as non-destructive microvascular decompression or thermocoagulation of the gasserian ganglion.IntroductionEffective treatment of patients with trigeminal neuralgia is often a long and complicated procedure. The symptoms of trigeminal neuralgia are clearly defined in most cases. Sudden and brief episodes of severe and stabbing pain (tic douloureux) occur, with pain usually starting from a trigger point.Recent reports suggest 80–90% suppression of pain with various treatment regimens, which seems to indicate that the diagnosis and successful treatment of the disorder are no longer a major problem. In fact, however, the intense suffering of patients and isolated reports in the literature suggest that there are still considerable diagnostic difficulties. Patients are referred from one specialist to another, in most cases without the necessary interdisciplinary cooperation, and countless interventions and attempts at therapy not only remain unsuccessful, but may cause serious adverse effects.MethodsThe records of 120 trigeminal neuralgia patients in two different areas of Germany were analysed retrospectively. In addition, the course of the disorder from the initial symptoms up to the institution of effective therapy was documented by means of information obtained from the general practitioner or other physicians. The patients themselves were also interviewed about their history.ResultsAfter a so-called pain career of 51/2 years, each patient had taken an average of 4,000 pills or capsules, 2,500–3,000 of which were carbamazine, lost 1–2 healthy teeth in attempts to treat the painful condition, undergone three or four maxillofacial or ENT operations, or been subjected to exeresis. The result is prolongation and exacerbation of suffering and an apparently hopeless situation. The financial burden on the patients and the health insurance companies is enormous.DiscussionApparently there is a considerable need for more information about the clinical symptoms, cause, diagnosis and therapy of trigeminal neuralgia, especially as the symptoms are often no longer typical because they have become chronic or are the result of previous treatment. This is needed by all specialists involved, including dentists and general practitioners. In patients in whom clinical criteria suggest the diagnosis of trigeminal neuralgia, drug treatment should be initiated immediately in consultation with the neurologist or neurosurgeon. For cases in which drug treatment fails or resistance to the drug develops surgical treatments are available, such as non-destructive microvascular decompression or thermocoagulation of the gasserian ganglion.ZusammenfassungDie Behandlungswege bei Patienten mit einer Trigeminusneuralgie sind oft lang und kompliziert. Es vergehen Jahre, bis die Betrofferen zumindest zum Teil von ihrem Leid befreit werden. Die Gründe dafür sind schwer verständlich. Die Krankheit kann durch ihre klar definierten und charakteristischen Symptome meist sicher diagnostiziert werden. Die bekannte Trias, blitzartig einschießende kurze Schmerzattacken, ihre segmentale Zuordnung sowie das Vorhandensein eines Triggermechanismus wird immer wieder betont. Nachdem mit unterschiedlichen Behandlungsmethoden eine fast 80–90%ige Schmerzlinderung erreicht wird, sollten die Diagnose und die erfolgreiche Therapie der Erkrankung keine großen Probleme darstellen. Aber die praktischen Erfahrungen, die genauen Angaben und Klagen der von uns betreuten Patienten sowie vereinzelte Hinweise in der Literatur deuten eher auf das Weiterbestehen der problematischen Auseinandersetzung mit der Erkrankung hin. Anders können der relativ lange Leidensweg der Patienten mit qualvollem Marsch durch die verschiedenen medizinischen Fachdisziplinen—meist ohne interdisziplinäre Zusammenarbeit-, zahlreiche Fehleingriffe und Behandlungsversuche nicht hinreichend erklärt werden.Gegenstand der vorliegenden Arbeit ist die Aufzeichnung des diagnostischen und therapeutischen Weges der Patienten vom Beginn der ersten Symptome bis zur erfolgten effektiven Therapie. Zu diesem Zweck wurden die Unterlagen von insgesamt 120 Patienten mit Trigeminusneuralgie aus zwei weit voneinander entfernt liegenden Einzugsgebieten großer medizinischer Kliniken retrospektive analysiert und mit Angaben der Patienten sowie deren behandelnden Ärzte zusammengetragen. Nach 51/2 Jahren wurde nur bei 70% der Patienten eine akzeptable Schmerzlinderung bzw. Schmerzbefreiung erreicht. Während dieser Zeit hatte, statistisch gesehen, jeder Leidtragende im Durchschnitt etwa 4000 Tabletten oder Kapseln eingenommen—darunter 2500 Tabletten Carbamazepin. Er verlor 11/2 gesunde Zähne bei zahnärztlichen Behandlungsversuchen und wurde 3–4mal HNO- und/oder zahn-kieferorthopädisch operiert und mußte einige Exhairesen ertragen. Damit wird das Leid der Patienten nicht nur verlängert, sondern noch vertieft, und sie werden nicht selten in eine scheinbar aussichtslose Lage manövriert, in der sie meist mit ihren Beschwerden allein bleiben.Anscheinend besteht ein erheblicher Nachholbedarf an weiterer Aufklärung bezüglich Klinik, Pathogenese sowie adäquater Therapie der Trigeminusneuralgie. Dieser Nachholbedarf besteht in allen beteiligten Disziplinen einschließlich der praktizierenden Allgemeinärzte. Besonders die Rolle, Bedeutung und Möglichkeit einer echten interdisziplinären Zusammenarbeit bei der Behandlung der Schmerzpatienten—auch derjenigen mit Gesichtsschmerzen-, sollte prinzipiell in den Vordergrund gestellt werden.

[Trigeminal neuralgia-how patients experience their condition disease.].

INTRODUCTION Effective treatment of patients with trigeminal neuralgia is often a long and complicated procedure. The symptoms of trigeminal neuralgia are clearly defined in most cases. Sudden and brief episodes of severe and stabbing pain (tic douloureux) occur, with pain usually starting from a trigger point. Recent reports suggest 80-90% suppression of pain with various treatment regimens, which seems to indicate that the diagnosis and successful treatment of the disorder are no longer a major problem. In fact, however, the intense suffering of patients and isolated reports in the literature suggest that there are still considerable diagnostic difficulties. Patients are referred from one specialist to another, in most cases without the necessary interdisciplinary cooperation, and countless interventions and attempts at therapy not only remain unsuccessful, but may cause serious adverse effects. METHODS The records of 120 trigeminal neuralgia patients in two different areas of Germany were analysed retrospectively. In addition, the course of the disorder from the initial symptoms up to the institution of effective therapy was documented by means of information obtained from the general practitioner or other physicians. The patients themselves were also interviewed about their history. RESULTS After a so-called pain career of 51/2 years, each patient had taken an average of 4,000 pills or capsules, 2,500-3,000 of which were carbamazine, lost 1-2 healthy teeth in attempts to treat the painful condition, undergone three or four maxillofacial or ENT operations, or been subjected to exeresis. The result is prolongation and exacerbation of suffering and an apparently hopeless situation. The financial burden on the patients and the health insurance companies is enormous. DISCUSSION Apparently there is a considerable need for more information about the clinical symptoms, cause, diagnosis and therapy of trigeminal neuralgia, especially as the symptoms are often no longer typical because they have become chronic or are the result of previous treatment. This is needed by all specialists involved, including dentists and general practitioners. In patients in whom clinical criteria suggest the diagnosis of trigeminal neuralgia, drug treatment should be initiated immediately in consultation with the neurologist or neurosurgeon. For cases in which drug treatment fails or resistance to the drug develops surgical treatments are available, such as non-destructive microvascular decompression or thermocoagulation of the gasserian ganglion.IntroductionEffective treatment of patients with trigeminal neuralgia is often a long and complicated procedure. The symptoms of trigeminal neuralgia are clearly defined in most cases. Sudden and brief episodes of severe and stabbing pain (tic douloureux) occur, with pain usually starting from a trigger point.Recent reports suggest 80–90% suppression of pain with various treatment regimens, which seems to indicate that the diagnosis and successful treatment of the disorder are no longer a major problem. In fact, however, the intense suffering of patients and isolated reports in the literature suggest that there are still considerable diagnostic difficulties. Patients are referred from one specialist to another, in most cases without the necessary interdisciplinary cooperation, and countless interventions and attempts at therapy not only remain unsuccessful, but may cause serious adverse effects.MethodsThe records of 120 trigeminal neuralgia patients in two different areas of Germany were analysed retrospectively. In addition, the course of the disorder from the initial symptoms up to the institution of effective therapy was documented by means of information obtained from the general practitioner or other physicians. The patients themselves were also interviewed about their history.ResultsAfter a so-called pain career of 51/2 years, each patient had taken an average of 4,000 pills or capsules, 2,500–3,000 of which were carbamazine, lost 1–2 healthy teeth in attempts to treat the painful condition, undergone three or four maxillofacial or ENT operations, or been subjected to exeresis. The result is prolongation and exacerbation of suffering and an apparently hopeless situation. The financial burden on the patients and the health insurance companies is enormous.DiscussionApparently there is a considerable need for more information about the clinical symptoms, cause, diagnosis and therapy of trigeminal neuralgia, especially as the symptoms are often no longer typical because they have become chronic or are the result of previous treatment. This is needed by all specialists involved, including dentists and general practitioners. In patients in whom clinical criteria suggest the diagnosis of trigeminal neuralgia, drug treatment should be initiated immediately in consultation with the neurologist or neurosurgeon. For cases in which drug treatment fails or resistance to the drug develops surgical treatments are available, such as non-destructive microvascular decompression or thermocoagulation of the gasserian ganglion.ZusammenfassungDie Behandlungswege bei Patienten mit einer Trigeminusneuralgie sind oft lang und kompliziert. Es vergehen Jahre, bis die Betrofferen zumindest zum Teil von ihrem Leid befreit werden. Die Gründe dafür sind schwer verständlich. Die Krankheit kann durch ihre klar definierten und charakteristischen Symptome meist sicher diagnostiziert werden. Die bekannte Trias, blitzartig einschießende kurze Schmerzattacken, ihre segmentale Zuordnung sowie das Vorhandensein eines Triggermechanismus wird immer wieder betont. Nachdem mit unterschiedlichen Behandlungsmethoden eine fast 80–90%ige Schmerzlinderung erreicht wird, sollten die Diagnose und die erfolgreiche Therapie der Erkrankung keine großen Probleme darstellen. Aber die praktischen Erfahrungen, die genauen Angaben und Klagen der von uns betreuten Patienten sowie vereinzelte Hinweise in der Literatur deuten eher auf das Weiterbestehen der problematischen Auseinandersetzung mit der Erkrankung hin. Anders können der relativ lange Leidensweg der Patienten mit qualvollem Marsch durch die verschiedenen medizinischen Fachdisziplinen—meist ohne interdisziplinäre Zusammenarbeit-, zahlreiche Fehleingriffe und Behandlungsversuche nicht hinreichend erklärt werden.Gegenstand der vorliegenden Arbeit ist die Aufzeichnung des diagnostischen und therapeutischen Weges der Patienten vom Beginn der ersten Symptome bis zur erfolgten effektiven Therapie. Zu diesem Zweck wurden die Unterlagen von insgesamt 120 Patienten mit Trigeminusneuralgie aus zwei weit voneinander entfernt liegenden Einzugsgebieten großer medizinischer Kliniken retrospektive analysiert und mit Angaben der Patienten sowie deren behandelnden Ärzte zusammengetragen. Nach 51/2 Jahren wurde nur bei 70% der Patienten eine akzeptable Schmerzlinderung bzw. Schmerzbefreiung erreicht. Während dieser Zeit hatte, statistisch gesehen, jeder Leidtragende im Durchschnitt etwa 4000 Tabletten oder Kapseln eingenommen—darunter 2500 Tabletten Carbamazepin. Er verlor 11/2 gesunde Zähne bei zahnärztlichen Behandlungsversuchen und wurde 3–4mal HNO- und/oder zahn-kieferorthopädisch operiert und mußte einige Exhairesen ertragen. Damit wird das Leid der Patienten nicht nur verlängert, sondern noch vertieft, und sie werden nicht selten in eine scheinbar aussichtslose Lage manövriert, in der sie meist mit ihren Beschwerden allein bleiben.Anscheinend besteht ein erheblicher Nachholbedarf an weiterer Aufklärung bezüglich Klinik, Pathogenese sowie adäquater Therapie der Trigeminusneuralgie. Dieser Nachholbedarf besteht in allen beteiligten Disziplinen einschließlich der praktizierenden Allgemeinärzte. Besonders die Rolle, Bedeutung und Möglichkeit einer echten interdisziplinären Zusammenarbeit bei der Behandlung der Schmerzpatienten—auch derjenigen mit Gesichtsschmerzen-, sollte prinzipiell in den Vordergrund gestellt werden.

Trigeminusneuralgie—wie erleben die Patienten ihre Krankheit@@@Trigeminal neuralgia—how patients experience their condition disease: Eine Betrachtung Betroffener

INTRODUCTION Effective treatment of patients with trigeminal neuralgia is often a long and complicated procedure. The symptoms of trigeminal neuralgia are clearly defined in most cases. Sudden and brief episodes of severe and stabbing pain (tic douloureux) occur, with pain usually starting from a trigger point. Recent reports suggest 80-90% suppression of pain with various treatment regimens, which seems to indicate that the diagnosis and successful treatment of the disorder are no longer a major problem. In fact, however, the intense suffering of patients and isolated reports in the literature suggest that there are still considerable diagnostic difficulties. Patients are referred from one specialist to another, in most cases without the necessary interdisciplinary cooperation, and countless interventions and attempts at therapy not only remain unsuccessful, but may cause serious adverse effects. METHODS The records of 120 trigeminal neuralgia patients in two different areas of Germany were analysed retrospectively. In addition, the course of the disorder from the initial symptoms up to the institution of effective therapy was documented by means of information obtained from the general practitioner or other physicians. The patients themselves were also interviewed about their history. RESULTS After a so-called pain career of 51/2 years, each patient had taken an average of 4,000 pills or capsules, 2,500-3,000 of which were carbamazine, lost 1-2 healthy teeth in attempts to treat the painful condition, undergone three or four maxillofacial or ENT operations, or been subjected to exeresis. The result is prolongation and exacerbation of suffering and an apparently hopeless situation. The financial burden on the patients and the health insurance companies is enormous. DISCUSSION Apparently there is a considerable need for more information about the clinical symptoms, cause, diagnosis and therapy of trigeminal neuralgia, especially as the symptoms are often no longer typical because they have become chronic or are the result of previous treatment. This is needed by all specialists involved, including dentists and general practitioners. In patients in whom clinical criteria suggest the diagnosis of trigeminal neuralgia, drug treatment should be initiated immediately in consultation with the neurologist or neurosurgeon. For cases in which drug treatment fails or resistance to the drug develops surgical treatments are available, such as non-destructive microvascular decompression or thermocoagulation of the gasserian ganglion.IntroductionEffective treatment of patients with trigeminal neuralgia is often a long and complicated procedure. The symptoms of trigeminal neuralgia are clearly defined in most cases. Sudden and brief episodes of severe and stabbing pain (tic douloureux) occur, with pain usually starting from a trigger point.Recent reports suggest 80–90% suppression of pain with various treatment regimens, which seems to indicate that the diagnosis and successful treatment of the disorder are no longer a major problem. In fact, however, the intense suffering of patients and isolated reports in the literature suggest that there are still considerable diagnostic difficulties. Patients are referred from one specialist to another, in most cases without the necessary interdisciplinary cooperation, and countless interventions and attempts at therapy not only remain unsuccessful, but may cause serious adverse effects.MethodsThe records of 120 trigeminal neuralgia patients in two different areas of Germany were analysed retrospectively. In addition, the course of the disorder from the initial symptoms up to the institution of effective therapy was documented by means of information obtained from the general practitioner or other physicians. The patients themselves were also interviewed about their history.ResultsAfter a so-called pain career of 51/2 years, each patient had taken an average of 4,000 pills or capsules, 2,500–3,000 of which were carbamazine, lost 1–2 healthy teeth in attempts to treat the painful condition, undergone three or four maxillofacial or ENT operations, or been subjected to exeresis. The result is prolongation and exacerbation of suffering and an apparently hopeless situation. The financial burden on the patients and the health insurance companies is enormous.DiscussionApparently there is a considerable need for more information about the clinical symptoms, cause, diagnosis and therapy of trigeminal neuralgia, especially as the symptoms are often no longer typical because they have become chronic or are the result of previous treatment. This is needed by all specialists involved, including dentists and general practitioners. In patients in whom clinical criteria suggest the diagnosis of trigeminal neuralgia, drug treatment should be initiated immediately in consultation with the neurologist or neurosurgeon. For cases in which drug treatment fails or resistance to the drug develops surgical treatments are available, such as non-destructive microvascular decompression or thermocoagulation of the gasserian ganglion.ZusammenfassungDie Behandlungswege bei Patienten mit einer Trigeminusneuralgie sind oft lang und kompliziert. Es vergehen Jahre, bis die Betrofferen zumindest zum Teil von ihrem Leid befreit werden. Die Gründe dafür sind schwer verständlich. Die Krankheit kann durch ihre klar definierten und charakteristischen Symptome meist sicher diagnostiziert werden. Die bekannte Trias, blitzartig einschießende kurze Schmerzattacken, ihre segmentale Zuordnung sowie das Vorhandensein eines Triggermechanismus wird immer wieder betont. Nachdem mit unterschiedlichen Behandlungsmethoden eine fast 80–90%ige Schmerzlinderung erreicht wird, sollten die Diagnose und die erfolgreiche Therapie der Erkrankung keine großen Probleme darstellen. Aber die praktischen Erfahrungen, die genauen Angaben und Klagen der von uns betreuten Patienten sowie vereinzelte Hinweise in der Literatur deuten eher auf das Weiterbestehen der problematischen Auseinandersetzung mit der Erkrankung hin. Anders können der relativ lange Leidensweg der Patienten mit qualvollem Marsch durch die verschiedenen medizinischen Fachdisziplinen—meist ohne interdisziplinäre Zusammenarbeit-, zahlreiche Fehleingriffe und Behandlungsversuche nicht hinreichend erklärt werden.Gegenstand der vorliegenden Arbeit ist die Aufzeichnung des diagnostischen und therapeutischen Weges der Patienten vom Beginn der ersten Symptome bis zur erfolgten effektiven Therapie. Zu diesem Zweck wurden die Unterlagen von insgesamt 120 Patienten mit Trigeminusneuralgie aus zwei weit voneinander entfernt liegenden Einzugsgebieten großer medizinischer Kliniken retrospektive analysiert und mit Angaben der Patienten sowie deren behandelnden Ärzte zusammengetragen. Nach 51/2 Jahren wurde nur bei 70% der Patienten eine akzeptable Schmerzlinderung bzw. Schmerzbefreiung erreicht. Während dieser Zeit hatte, statistisch gesehen, jeder Leidtragende im Durchschnitt etwa 4000 Tabletten oder Kapseln eingenommen—darunter 2500 Tabletten Carbamazepin. Er verlor 11/2 gesunde Zähne bei zahnärztlichen Behandlungsversuchen und wurde 3–4mal HNO- und/oder zahn-kieferorthopädisch operiert und mußte einige Exhairesen ertragen. Damit wird das Leid der Patienten nicht nur verlängert, sondern noch vertieft, und sie werden nicht selten in eine scheinbar aussichtslose Lage manövriert, in der sie meist mit ihren Beschwerden allein bleiben.Anscheinend besteht ein erheblicher Nachholbedarf an weiterer Aufklärung bezüglich Klinik, Pathogenese sowie adäquater Therapie der Trigeminusneuralgie. Dieser Nachholbedarf besteht in allen beteiligten Disziplinen einschließlich der praktizierenden Allgemeinärzte. Besonders die Rolle, Bedeutung und Möglichkeit einer echten interdisziplinären Zusammenarbeit bei der Behandlung der Schmerzpatienten—auch derjenigen mit Gesichtsschmerzen-, sollte prinzipiell in den Vordergrund gestellt werden.