[Facial pains as symptoms of mental disorders]. / Litsevye boli kak proiavleniia psikhicheskikh rasstroistv.

One hundred seventeen patients, aged 16-75 years, with orofacial pains were studied. Borderline psychic disorders were detected in 106 cases, schizophrenia--in 11 cases. Facial pain was characterized by (1) polymorphism of sensations changing their site and duration, (2) absence of orofacial sensory deficits, (3) symptoms "mosaic"--a combination of separate signs specific for various "organic" facial pain, (4) absence of objective changes in oral cavity and facial region, (5) key role of psychoemotional factors in pain recurrence and intensification, (6) non-opioid analgesics and carbamazepine inefficacy. A systematics for facial pains of psychic genesis, comprising two groups of disorders, was elaborated. The first group includes facial pain and odontalgia in borderline psychic disorders--neurotic (somatoform, hypochondriac and hysteric) disorders, affective ones (mild depressive episodes and dystimia) and paranoic personality disorder. The second group comprises orofacial cenesthopathies in neurotic-like (schizotypal disorders) and paranoid types of schizophrenia.

[The pathogenetic mechanisms of paroxysmal trigeminal prosopalgias]. / Patogeneticheskie mekhanizmy paroksizmal'nykh trigeminal'nykh prozopalgii.

Clinical and experimental studies of formation of paroxysmal trigeminal pain are carried out in patients with typical trigeminal neuralgia (TN), TN with neuropathic disorders, TN concomitant with disseminated sclerosis, and symptomatic TN caused by vestibulo-cochlear neurinoma (VIII pair). Trigeminal, acoustic stem, and visual evoked potentials were recorded, electroencephalography (including mapping) and magnetic imaging were carried out. In experiments, bioelectric activity of the brain was recorded in rats with TN and neuropathy. Paroxysmal trigeminal prosopalgias are caused by various etiologic factors and involve mainly the sensory trigeminal radicles. Total systems' pathogenetic processes characteristic of this disease are described.

[Physical factors in the combined treatment of trigeminal prosopalgias]. / Fizicheskie faktory v kompleksnom lechenii trigeminal'nykh prozopalgii.

Multiple-modality treatment of 112 patients with odontogenic alveolar and trigeminal neuropathies and neuropathic complications after alcoholization is carried out. A differentiated approach to prescribing physical factors to patients with different types of prosopalgia is developed.

[Pathogenetic mechanisms and clinical peculiarities of trigeminal facial pain]. / Patogeneticheskie mekhanizmy i klinicheskie osobennosti trigeminal'nykh litsevykh bolei.

316 patients with extracranial, intracranial and intracerebral lesions of the trigeminal system were examined. Together with a neurologic observation, the examination included registration of trigeminal somatosensory, acoustic brain stem and visual evoked potentials as well as electroencephalography (including brain mapping) and magnetic resonance tomography of the brain. Etiologic factors, location of the damage and systemic pathogenetic mechanisms characteristic for the main types of both paroxysmal and nonparoxysmal facial pain were established. Peculiarities of the manifestations of trigeminal neuralgia, neuropathy and differential facial pain are discussed. A comparative analysis of peculiarities of an algesic syndrome in three forms of verified radiculopathies conditioned by the lesion of trigeminal, glossopharyngeal and cerebrospinal nerves was performed. An original classification of trigeminal facial pain is proposed.

[Clinical course and treatment of herpetic trigeminal ganglionic neuropathy]. / Klinika i lechenie gerpeticheskoi ganglionevropatii]

45 patients were observed in the periods of both acute herpes zoster and postherpetic neuralgia (PHN). In most of the patients herpetic eruptions were located in the areas of innervation of the first branch of the trigeminal nerve. In acute period of the disease there were used aciclovir, helepin or alpisarinum, antiherpetic immunoglobulin, deoxyribonuclease, non-narcotic analgetics were used. Of 28 patients residual PHN was observed in 6 cases, delayed PHN (during 3 months)--in 2 patients. The PHN development was characteristic for elderly patients, delayed request for medical care, concomitant diseases, eruptions with hemorrhagic component and secondary pyodermia and considerable residual sensory deficit. In therapy of PHN the most effective drugs were amitriptylin, non-narcotic analgetics, anticonvulsants as well as acupuncture and electroacupuncture. Relief of a typical deafferentation of pain syndrome was achieved by means of ultrasonic destruction of the trigeminal nucleus (one case). Early therapy of acute herpes zoster does not prevent completely PHN development, but it decreased considerably probability of its forming as well as the severity of its course.

[A differentiated approach to the choice of physiotherapy methods in trigeminal prosopalgia]. / Differentsirovannyi podkho k vyboru metodov fizioterapii trigeminal'nykh prozopalgii.

148 patients with trigeminal neuralgia, odontogenic neuropathies of the alveolar nerves, neuropathy of the main trigeminal nerves and their sensitive branches, neuropathic complications after alcoholization received individually selected physiotherapy in each prosopalgia in acute and subacute period. Adequate choice of physical factors and physiotherapy is dependent on careful examination of the patient with consideration of topical and pathogenetic features of the disease.

[Multimodal evoked potentials and central mechanisms of afferentation in trigeminal neuralgia]. / Raznomodal'nye vyzvannye potentsialy i tsentral'nye mekhanizmy afferentatsii pri nevralgii troinichnogo nerva.

Multimodal evoked potentials in patients with trigeminal neuralgia are analyzed in the paper. The comprehensive studies of cortical trigeminal somatosensory evoked potentials, visual evoked potentials, and brainstem auditory evoked potentials have revealed their changes that are indicative of the impaired central mechanisms of afferentation in patients with trigeminal abnormality. The findings are discussed in the light of the theory of generator mechanisms of neuropathological pain syndromes.

[Magnetic resonance tomography of the brain in a lesion of the trigeminal system]. / Magnitno-rezonansnaia tomografiia golovnogo mozga pri porazhenii trigeminal'noi sistemy.

26 patients with trigeminal disorders were examined in terms of magnetic resonance tomography. It was established that the trigeminal disorders occurred to be secondary and symptomatic in all patients. They were caused by various cranial and cerebral pathology mainly by voluminous changes of basal localization. The results of investigation testified that the magnetic resonance tomography application in atypical course of trigeminal pathology was quite useful to avoid different diagnostic mistakes and to create the most effective treatment strategy.

[A neurophysiological analysis of the sensory disorders in trigeminal nerve neuropathy]. / Neirofiziologicheskii analiz sensornykh narushenii pri nevropatii troinichnogo nerva.

52 patients with various types of trigeminal nerve neuropathy were examined in terms of trigeminal somatosensory evoked potentials (TSEP). The increase of latent periods and the decrease of N5-N33 amplitude components as well as disappearance of some separate components of this period were observed in patients with moderate facial pain and hypersthesia when sore side was stimulated. Meanwhile the alterations level of TSEP correlated with trigeminal hypesthesia severity. In a course of such stimulation all TSEP components disappeared in patients with severe sensory deficit and this turned out to be unfavourable prognostic sign pointing out the small perspectivity of conservative antianalgesic therapy. TSEP investigation in patients with trigeminal nerve neuropathy promoted objectivity of face and oral cavity sensory insufficiency that permitted to estimate both the alteration degree and algesic syndrome severity.

[Pathogenetic mechanisms and neurophysiological diagnosis of trigeminal neuralgia]. / Patogeneticheskie mekhanizmy i neirofiziologicheskaia diagnostika nevralgii troinichnogo nerva.

58 patients with trigeminal nerve neuralgia (TNN) were examined in terms of somatosensory evoked potentials (SSEP). The increase of latence as well as the decrease of contra- and ipsilateral SSEP components amplitude were observed in the interval N13-P45. Either bylateral hypersynchronization or desynchronization of SSEP were observed at affect side of face during TNN paroxismal period. It was believed that both variations of entrance of two currents of impulses which had been caused either by face electrostimulation or by pathological trigeminal irritation in brain cortex. The structural defect of trigeminal radix was considered to be the primary pathogenetic factor which became the cause of constant additional impulsation. The irritation processes became as a result the dominant ones in trigenal system forming in turn the generator of pathological increased irritation in nucleus complex mainly. The conclusion was made that dynamic SSEP investigations promoted to make more precise the damage localization as well as to estimate more objectively trigeminal hypperactivity in patients with TNN.

[Somatosensory evoked potentials in patients with lesions of the trigeminal nerve system]. / Somatosensornye vyzvannye potentsialy u bo'lnykh s porazheniem sistemy troinichnogo nerva.

These are results of comparison of clinical data and parameters of early components of somatosensory evoked potentials (SSEP) in patients with various pathological disorders in the trigeminal nerve system. The investigations evidenced that neurologic patients have different degrees of disorders in structural-functional organization of trigeminal nerve system resulting from the disease itself and previous therapeutic interventions. Some of the peculiarities of SSEP changes, e.g., their amplitude and/or temporal asymmetry under stimulation of the sites of intact and afflicted sides of the face are believed to correspond to pathological changes in trigeminal nerve system. These features can serve as diagnostic and prognostic tests.