Exclusive: What Is Suicide Disease That Salman Khan Had? Expert Explains Signs,Treatments, And Success Story

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Salman Khan underwent surgery in the US for trigeminal neuralgia, a condition causing severe pain in his head, cheeks, and jaw in 2011. This neurological disorder stems from the trigeminal nerve, which is responsible for transmitting sensations of pain, touch, and temperature from the face to the brain. The intense pain associated with this condition has led it to be nicknamed "suicide disease."

Recent reports highlight a distressing trend: even very young patients, as young as six years old, are grappling with this debilitating ailment.

According to a 2019 NCBI study, trigeminal neuralgia (TN) in India has an incidence of 4-5 per 100,000 people, and is more common in women than men. The study also found that TN is more prevalent in rural areas (52.4%) than urban areas (47.6%). The peak age of onset is between 50 and 70 years, but the disorder can also occur in children.

In a conversation with Boldsky, Dr Pratham Bysani, Senior Consultant Neurosurgeon at Vasavi Hospitals, shares signs of (Trigeminal Neuralgia) suicide disease, how to control it, and a success story.

What Is Trigeminal Neuralgia (Suicide Disease)?

Trigeminal neuralgia (TN), often dubbed the "suicide disease," is a chronic pain disorder that affects the trigeminal nerve (cranial nerve V). This nerve has three main branches that carry sensation from the face to the brain. In trigeminal neuralgia, these nerve pathways become disrupted, causing severe, sharp, or electric shock-like pain that typically affects one side of the face. The pain episodes can be triggered by everyday activities such as chewing, speaking, or even light touch.

This condition is notoriously difficult to diagnose and is often mistaken for migraines or other facial pain disorders. Trigeminal Neuralgia involves the trigeminal nerve, which branches from the area behind the ear and extends across the face, including the cheeks, jaw, lips, and nose. Pain can be localized to one of the nerve's branches-upper, medial, or lower-or, in rare cases, affect both sides of the face (bilateral trigeminal neuralgia).

'The term "suicide disease" reflects the extreme pain associated with TN, which often leads to suicidal thoughts and severe psychological distress. Patients frequently experience pain that spreads across the face and down the neck, triggered by even the slightest touch or breeze,' says Dr Bysani. 'The severity of TN, describing it as one of the most agonizing pain conditions, comparable to, or even surpassing, limb amputation or childbirth,' he says.

What Are The Symptoms Of Trigeminal Neuralgia (Suicide Disease)?

a. Severe Facial Pain

The hallmark symptom of trigeminal neuralgia is intense, episodic pain, usually localized to one side of the face. The pain can be described as stabbing, shooting, or electric shock-like and may last from a few seconds to several minutes.

b. Pain Triggers

Pain episodes can be triggered by activities such as brushing teeth, eating, talking, or touching the face. In some cases, even slight stimuli like a breeze or a gentle touch can provoke pain.

c. Pain Frequency

The frequency of pain attacks can vary widely. Some individuals may experience frequent, multiple episodes per day, while others might have pain episodes less often. The condition can sometimes be intermittent, with periods of relief in between episodes.

d. Unilateral Pain

Trigeminal neuralgia typically affects one side of the face, although bilateral cases are possible but less common. The pain usually affects the cheek, jaw, or the area around the eyes and forehead.

e. Accompanying Symptoms

In some cases, trigeminal neuralgia may be accompanied by facial muscle spasms or twitching. These spasms can occur along with or separate from pain episodes.

What Are The Causes Of Trigeminal Neuralgia

a. Nerve Compression

The most common cause of trigeminal neuralgia is compression of the trigeminal nerve, often by a blood vessel. This pressure can irritate the nerve and disrupt its normal function, leading to the pain characteristic of the condition.

b. Multiple Sclerosis (MS)

In some cases, especially in younger individuals, trigeminal neuralgia may be associated with multiple sclerosis. MS can cause demyelination (damage to the protective covering of nerves), leading to nerve pain.

c.Tumors

Rarely, tumors in the brain or near the trigeminal nerve can cause compression and result in trigeminal neuralgia.

d. Other Neurological Conditions

Other neurological conditions or diseases that affect the trigeminal nerve can also lead to trigeminal neuralgia, though these cases are less common.

e. Idiopathic

In some cases, no clear cause can be identified, and the condition is classified as idiopathic.

How Does Trigeminal Neuralgia Disrupt Daily Life?

'The intense pain of TN can severely disrupt daily life, leading individuals to avoid social interactions and routine activities like eating or talking. Many people with TN have reported losing jobs and experiencing marital difficulties due to the condition's debilitating nature. Symptoms can vary from brief, severe pain (TN1) to continuous pain (TN2), often accompanied by sensitivity to light and sound, nausea, and vomiting. Episodes of pain may recur with varying frequency and intensity,' says Dr Bysani.

'Diagnosing trigeminal neuralgia involves a process of elimination, as no single test can confirm the condition definitively. Physicians conduct thorough physical and neurological exams and use MRI scans to check for tumors compressing the trigeminal nerve. A response to anti-seizure medications or tricyclic antidepressants may also indicate TN,' he adds.

Diagnosis Of Trigeminal Neuralgia

Diagnosing trigeminal neuralgia typically involves a combination of clinical evaluation and imaging studies. A neurologist will assess the patient's medical history and symptoms, conduct a physical and neurological examination, and may order imaging tests such as MRI or CT scans. These imaging studies help rule out other potential causes of facial pain, such as tumors or structural abnormalities.

What Are The Treatment Options For Trigeminal Neuralgia?

'Several treatment options are available for managing TN. Medical management includes anticonvulsant medications, such as carbamazepine and gabapentin, which help control nerve firing, and tricyclic antidepressants like amitriptyline for pain relief. For patients who do not find relief from medications, surgical interventions may be necessary. Percutaneous procedures, such as balloon compression, glycerol injections, and radiofrequency ablation, offer temporary relief by damaging the nerve or its insulation. Stereotactic radiosurgery uses targeted radiation to create lesions that block pain signals, while neurectomy involves cutting nerve branches to prevent pain transmission. However, these methods may only provide temporary relief and can lead to recurring pain,' he said.

Also, 'Microvascular Decompression (MVD) surgery is considered the most effective long-term treatment. This procedure involves opening the skull, identifying the trigeminal nerve, and placing a cushion of Teflon between the nerve and the compressing blood vessel. MVD offers prolonged pain relief with a low risk of permanent facial numbness. Patients typically experience rapid pain relief and a short hospital stay,' adds Dr Bysani.

Trigeminal Neuralgia Success stories

'Despite its invasive nature, MVD is generally safe, though risks such as infection, hearing loss, facial numbness, and very rare complications like stroke may occur. Success stories, such as a recent patient who had been suffering from TN for six years and is now symptom-free, underscore the potential for significant improvement with appropriate treatment. Understanding and addressing trigeminal neuralgia is crucial for improving the quality of life for those affected by this severe pain condition,' Dr Bysani concludes.

Disclaimer: The information provided in this article is for general informational and educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or a qualified healthcare provider with any questions you may have regarding a medical condition.