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An analysis of cranial nerves from Nicholas André’s Mercury Water and Cauterizing Stones (1756) includes one of the earliest mentions of Tic Douloureux by name. In this work, André explores treatments like mercury-based remedies and cauterization. His observations contributed to early neurological understanding and influenced later studies on cranial nerve disorders.

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Trigeminal neuralgia, first termed "Tic Douloureux" by Nicholas André, has been a serious medical concern throughout history. In its classic form, it manifests as sharp, stabbing facial pain followed by periods of relief. However, this relief becomes a torment of its own, as sufferers live in constant fear of the next agonizing episode.

The first clinical documentation of the condition dates back to the 1600s, recorded by prominent physicians Dr. Johannes Michael Fehr and Elias Schmidt while serving as secretaries for the philosopher John Locke. Nearly a century later, André theorized that the ailment stemmed from a nerve in distress, classifying it as a convulsive disorder.

Around twenty years after André’s theory, Dr. John Fothergill examined fourteen patients and suspected them of having cancerous complications. He concluded that they all shared the same affliction and, in doing so, coined the term "Fothergill’s disease."

Source:

(1)

https://pubmed.ncbi.nlm.nih.gov/27324994/

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An illustration of Jean-Martin Charcot delivering his renowned lectures at Salpêtrière Hospital, where he trained a generation of neurologists. In these lectures, he shared his meticulous clinical records, analyzed neurological disorders, and hypothesized potential treatments, including experimental approaches like hypnosis.

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Jean-Martin Charcot: The Father of Neurology

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Jean-Martin Charcot: The Father of Neurology

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The Father of Modern Neurology, Jean-Martin Charcot (1825-1893), redefined the understanding of trigeminal neuralgia through his detailed clinical observations at Paris’s Salpêtrière Hospital in the late 19th century. His groundbreaking documentation laid the pathological foundation for future treatments, even exploring hypnosis as a possible therapy.

In his influential work, Lectures on the Diseases of the Nervous System, Charcot advanced emerging therapeutic ideas, providing a framework that allowed neurosurgeons like Sir Victor Horsley to expand upon his findings and develop surgical interventions.

Sources:

(1)

https://pmc.ncbi.nlm.nih.gov/articles/PMC3064755/

(2)

https://pmc.ncbi.nlm.nih.gov/articles/PMC11392517/

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The Horsley-Clarke stereotactic frame was developed in 1908 to precisely localize and target specific brain structures during surgery, laying the groundwork for modern stereotactic techniques. This major invention marked a pivotal advancement in the history of neurosurgery, revolutionizing the accuracy and effectiveness of brain surgeries.

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Sir Victor Horsley (1857-1916) is one of the most highly regarded figures in neurosurgical history, pioneering some of the first effective treatments for trigeminal neuralgia. At London's National Hospital for Neurology, he developed the intradural division of the trigeminal nerve root, a groundbreaking procedure that severed pain-transmitting fibers, offering relief to sufferers who might have otherwise faced unbearable agony, often leading to suicide.

His breakthrough not only established a surgical approach to pain management but also set a precedent for integrating scientific innovation with compassionate care, striving to provide solutions where therapeutic options were previously limited.

Sources:

(1)

https://pubmed.ncbi.nlm.nih.gov/11841730/

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The famous illustration of a nerve pathway in the central nervous system by Cajal. Using the Golgi silver staining method, Cajal was able to detail the structure of neurons and their connections, providing a foundational visual representation of the Neuron Doctrine.

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Ramón y Cajal: Mapping the Nervous System

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Ramón y Cajal: Mapping the Nervous System

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Santiago Ramón y Cajal revolutionized neuroscience with his Neuron Doctrine, unveiling the structure of nerve cells in the late 19th century, just as trigeminal neuralgia treatments became viable with the advent of antiseptic neurosurgery. His research highlighted the critical role of nerve anatomy and pain transmission in neurosurgery, providing a framework for guiding surgical interventions and targeting pain disorders like trigeminal neuralgia.

His work, Histology of the Nervous System published in 1899, transformed neurological theories into a precise science, bridging the microscopic world of neurons with clinical neurology and neurosurgery.

Sources:

(1) https://www.scientificamerican.com/article/the-father-of-modern-neuroscience-discovered-the-basic-unit-of-the-nervous-system/

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A historical picture of the use of the Bovie, a high-frequency alternating current device used to cauterize tissue and vessels in the brain. Cushing illustrates the first commercial usage of the unit on October 1st, 1926.

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Harvey Cushing: The Father of Modern Neurosurgery

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Harvey Cushing: The Father of Modern Neurosurgery

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Harvey Williams Cushing (1869-1939), the father of modern neurosurgery, revolutionized the treatment of trigeminal neuralgia by developing techniques that prioritized safety in early brain surgery. He was an early advocate for the use of local anesthetics and hemostasis, significantly reducing surgical mortality. Additionally, he refined stereotactic instruments to more precisely target nerve pathways, enhancing the effectiveness of neurosurgical interventions.

The discovery of the Cushing reflex in 1901 allowed him to mitigate risks during delicate procedures, improving patient outcomes. While he is best known for his innovations in brain tumor surgery, his research on pain pathways laid the foundation for modern, minimally invasive approaches to neuralgia.

On the technical front, Cushing’s introduction of the Bovie electrosurgical unit dramatically reduced neurosurgical mortality rates, lowering them from nearly 90% to single-digit percentages. His groundbreaking contributions continue to shape neurosurgery today.

Sources:

(1) https://library.medicine.yale.edu/news/electrosurgical-operating-room

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Using precise, non-invasive targeting, the Gamma Knife delivers radiation to disrupt pain signals while preserving the surrounding tissue. Developed in 1967, Dr. Lars Leksell's neurosurgery machine revolutionized the treatment of neurological disorders, especially for delicate conditions.

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Initial treatments now often involve anticonvulsants, which promote the stability of nerves and decrease the painful episodes. If further intervention is required, nerve blocks may also be applied for temporary relief, reducing the.

At the culmination of trigeminal neuralgia surgery, microvascular decompression (MVD) is the most effective procedure for pain relief. By repositioning and decreasing compression of the trigeminal nerve, the very cause of the condition is eliminated.

In cases where surgery may not be an option, the Gamma Knife is put to use. The machine allows doctors to disrupt the pain signals using highly focused beams, which have virtually no risk of infection or long recovery time due to no incision ever being made.

Sources:

(1)

https://pubmed.ncbi.nlm.nih.gov/38870050/#:~:text=Many%20new%20drugs%20have%20come,for%20therapy%20for%20trigeminal%20neuralgia.

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An update on pharmacotherapy for trigeminal neuralgia - PubMed

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In real-world clinical practice, about half of trigeminal neuralgia patients take more than one agent for prevention and combination therapy may be the optimal approach. Combination therapy might allow for lower doses of carbamazepine or oxcarbazepine, thus reducing the number and severity of potent …

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Harvey Cushing was born in Cleveland, Ohio on April 8, 1869, later to work under the incredibly illustrious surgeon William Halsted at John Hopkins Hospital as a faculty member and the head of the newly emerging specialty of neurosurgery. This photograph was taken within his study at the hospital in the early 20th century

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As the father of modern neurosurgery, Harvey Cushing (1869-1939) is regarded as the father of modern neurosurgery for no small reason. His attention to detail and meticulous technique turned what was a gruesome practice into the frontier of surgery.

His best-known work concerned the pituitary gland, becoming the first to analyze hormonal disorders like Cushing's disease, which is caused by an overproduction of cortisol due to a tumor in the aforementioned gland. His work led to the foundation of neuroendocrinology.

Overall, Cushing's contributions to the fields of neurosurgery and cranial nerve research make him an inalienable figure in the history of trigeminal neuralgia treatment.

Sources:

(1)

Harvey Cushing: A Life in Surgery