Trigeminal Neuralgia 2 nd Professionals Study Day Saturday 18 th June 2011 VENUE: Grand Connaught Rooms 61-65 Great Queen Street London WC2B 5DA COURSE ORGANISER: Professor Joanna M. Zakrzewska Chairperson of TNA Medical Advisory Board Clinical Lead for Facial Pain Unit UCLH NHS Foundation Trust, London COURSE ACCREDITATION: Verifiable CPD for dental practitioners Accredited by Royal College of Physicians London and Royal College of Anaesthetists 6 CPD points COURSE INFORMATION: This Study Day will run alongside the TNA s one-day conference for trigeminal neuralgia patients and their carers. It will thus provide attendees with an opportunity to hear first-hand from sufferers, and determine their treatment goals and how best they can be served. From our last conference in 2007, patients and professionals valued the interaction that this type of conference encourages. It enhances our ability to offer patient-centred care and helps to develop the expert patient who is much more likely to be satisfied with treatment outcomes. The aim of the programme is to increase healthcare professionals awareness of trigeminal neuralgia, especially its diagnosis and up-to-date management. From recent data produced by Hall et al (Pain, 2006) on the epidemiology of neuropathic pain in the UK, it would appear that trigeminal neuralgia is more common than previously thought in UK medical practices. Its incidence has been put at 26.8 per 100,000, whereas this was thought to be 4-6 in 100,000. However, a similar study done in Holland showed an initial incidence similar to the UK data but when the diagnosis was validated by experts the incidence fell to 12. Thus GPs tend to over diagnose the condition and are not aware of other potential causes of unilateral episodic facial pain. In a recent debate in the House of Commons (27 th July 2010), the Minister of State from the Department of Health assured the MPs that training needs would be addressed.
AIMS: Improve diagnosis and management of unilateral episodic facial pain. OBJECTIVES: At the end of the Study Day participants will be able to: 1. Identify the key diagnostic features of trigeminal neuralgia 2. Distinguish trigeminal neuralgia from other causes of episodic, unilateral facial pain 3. Distinguish between medical therapies used in management of trigeminal neuralgia as compared to other conditions 4. Review current surgical therapies for trigeminal neuralgia 5. Determine when to refer patients to secondary care and how decisions about treatment are made 6. Appreciate the difficulties patients have in getting a diagnosis, the impact the pain has on their lives and how a support group can help. FACULTY: Ms Jillie Abbott Prof Hugh Coakham Dr Alexander Crighton Chairman, TNA UK / patient Consultant Neurosurgeon, Bristol Consultant Oral Physician, Glasgow GP with Special Interest Chronic Pain, Bradford Consultant Neurosurgeon, London Consultant Neurosurgeon, London Consultant Oral Physician, London Suggested pre-course reading: 1. Orofacial Pain Zakrzewska J M Editor Oxford University Press 2009 ISBN 978-0-19-923669- 5 2. Insights, facts and stories behind trigeminal neuralgia Zakrzewska JM TNA Association Florida 2006: ISBN: 0-9672393-4-6 pp 403 available from TNA UK 3. Overcoming chronic pain Cole, Macdonald H, Carus C, Howden-Leach H Robinson 2005 ISBN 1-84119-970-2 4. TNA support group professionals pages http://www.tna.org.uk; 5. Guidelines for trigeminal neuralgia www.aan.com
PROGRAMME: Time Title Speaker 08.45-09.15 Registration and coffee 09.15-09.30 Welcome Prof J. Zakrzewska / Ms J. Abbott 09.30-09.45 Living with trigeminal neuralgia Patient 9.45 10.15 10.15-10.45 Common causes of unilateral facial pain Trigeminal autonomic cephalagias and patient histories Dr Alex Crighton 10.45-11.15 Break coffee 11.15-11.45 11.45-12.15 Trigeminal neuralgia aetiology, diagnosis and investigations Impact of TN on quality of life and management 12.15-12.45 Medical management 12.45 13.00 Discussion Panel 13.00 14.00 Lunch Jointly with patients 14.00 14.45 14.45 15.30 When to refer, decision making - patient, GP, specialist Surgical therapies for TN and discussion Patient / / Prof Hugh Coakham / 15.30-16.00 Break Tea 16.00-16.30 Support groups, giving explanations Ms Jillie Abbott / 16.30 16.45 Quiz on TN 16.45 17.00 Summing up and evaluations 17.00 18.15 18.30 21.00 Panel discussion - patients / carers / professionals - optional Drinks and dinner at additional cost All faculty / patients Open to all Price: 75 including lunch, tea and coffee, excludes evening meal (cost t.b.a.) though all are welcome by prior arrangement. For details of directions to conference venue, and for conference dinner and accommodation please see TNA website www.tna.org.uk.
SPEAKERS Professor Joanna M. Zakrzewska After obtaining dental (Kings College), medical (University of Cambridge) degrees and specialist training in oral medicine, Joanna Zakrzewska went on to specialize in orofacial pain. After gaining an MD for her work on trigeminal neuralgia she spent ten years as an academic at Queen Mary s, University of London, where she was awarded a personal chair. In 2007 Joanna Zakrzewska moved to UCLH, where she is Professor and consultant at the Eastman Dental Hospital, University College London Hospitals NHS Foundation Trust, London, UK. Here she heads up the largest UK multidisciplinary orofacial pain clinic. As the chair of the Medical Advisory Board for the UK Trigeminal Neuralgia Association and also a member of TNA s US Medical Advisory Board, she has been active in promoting patient involvement in research studies and acting as their advocate. Professor Zakrzewska has published more than 100 peer-reviewed articles, four books on facial pain and 15 chapters. Ms Jillie Abbott Currently chairperson of Trigeminal Neuralgia Association UK, previously Regional Support Group Co-ordinator for the TNA UK, Vice Chairman (2007). Attended numerous medical and scientific meetings, exhibiting the TNA display stand and literature to healthcare professionals, including: Association of British Neurologists, Society of British Neurological Surgeons, British Pain Society, MS Society, PMETB (Future Doctors), Department of Health/Work & Pensions. Set up and trained a Telephone Contact Support Team to handle incoming calls from TN sufferers and medics, and produced a detailed training manual. Responsible for quarterly newsletters sent to over 1,500 patients and HCPs. Organised the TNA UK s first two-day conference at Keele University for 100+ TNA members and carers, plus 50 HCPs (2007). Dr Alex Crighton Dr Crighton trained in Medicine and Dentistry at the University of Edinburgh and is a Consultant in Oral Medicine at Glasgow Dental Hospital. He holds an Honorary Senior Lecturer appointment at the University of Glasgow and lectures widely in Oral Medicine and the medical aspects of dental care. His clinical interests include facial pain and paediatric Oral Medicine. Professor Hugh Coakham Professor Coakham qualified at UCH London then trained in neurosurgery at the Guy s-maudsley Unit and was a fellow at Massachusetts General Hospital, Boston, USA. He was appointed as consultant to Frenchay Hospital and awarded the first Personal Chair in Neurosurgery by the University of Bristol. He developed an early interest in surgery of the skull base and cranial nerves. In the UK he has pioneered microvascular decompression for trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia. He has been involved in new operative approaches for skull base tumours and has taught on skull base dissection courses in the UK and USA. With Professor Love at Frenchay Hospital, he was the first to provide proof of Janetta's hypothesis that TN is usually due to electrical short circuits caused by a blood vessel compressing the trigeminal nerve. He learned the finer points of the microvascular decompression operation (MVD) in Japan and USA, and his MVD method which generally leaves the trigeminal nerve untouched by a teflon pad appears to give excellent results. Professor Coakham is one of the few surgeons to have his results independently assessed from the patients' viewpoint (by Professor Zakrzewska's team). The treatment of TN by "electrical injection"; radiofrequency lesion thermocoagulation (RFL) was developed in Boston by Professor W H Sweet who in 1977 personally taught Coakham his method which involves waking the patient from general anaesthetic (GA) during the procedure. The
technique is still used in most hospitals around the world. Realising that many patients found this wake-up period distressing, Professor Coakham modified the technique to avoid the wake-up time and found that his pain relief results remain similar to the original "wake-up" method (presented to the Society of British Neurological Surgeons, 2010). He has published numerous papers on the treatment of overactive cranial nerve syndromes and has co-edited a Textbook of Cranial Base Surgery which contains his chapter on the Surgical Technique of MVD. Frances Cole has been a GP since 1982 and works part-time in Huddersfield. She trained in cognitive behavioural therapy at Newcastle CT Centre in 1993-4. In 1996, she started the first UK multidisciplinary primary care pain rehabilitation service in Bradford, based on cognitive behavioural therapy principles. She continues to run this service and works in clinical health psychology at Bradford Teaching Hospitals, using CBT in a wide range of mental and physical health problems. She has developed a pain health needs assessment tool that won a NHS Modernisation award in 2005. She runs a range of workshops and training courses for primary care trusts in Yorkshire and the UK for primary care practitioners in CBT techniques for both mental health, chronic pain and long term health condition self management. She is a co-author of a CBT self-help guide, Overcoming Chronic Pain, part of the CBT based selfhelp guides published by Constable Robinson. She is a clinical lead for musculoskeletal disorders, pain and rheumatology at NHS Kirklees and NHS Bradford & Airedale. She is currently the chair of the British Pain Society Pain Management Programme Special Interest Group, whose current focus is on measuring patient outcomes and Pain Management Programme guidelines review. is a senior Lecturer at The Institute of Neurology and Honorary Consultant Neurologist at The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. He is the Clinical Lead of the Headache Group at The National Hospital for Neurology and Neurosurgery. Dr Matharu gained his BSc and MBChB from the University of Manchester in 1991 and 1994, respectively. He completed his general medical training in London leading up to obtaining the Membership of the Royal College of Physicians (MRCP) in 1998. He subsequently obtained a PhD at The Institute of Neurology, Queen Square, London on Structural and Functional Neuroimaging in Primary Headache Syndromes. He completed his residency in Neurology at The National Hospital for Neurology and Neurosurgery in 2007. Dr Matharu s major research interests include functional and structural imaging in primary headaches, trigeminal autonomic cephalalgias and neurostimulation for intractable headaches. Mr Wadley received his medical and postgradulate surgical training in Edinburgh, Liverpool and London. He was elected a Fellow of the Royal College of Surgeons of Edinburgh in 1994, studied for a MS research degree at University College London, passed his specialist neurosurgical exams and was elected FRCS(SN) in 2000. He obtained the Certificate of Completion of Specialist Training (CCST) in Neurosurgery in 2001 and was appointed Consultant Neurosurgeon at St.Bartholomew's and the Royal London Hospitals in 2001. He has also undergone subspecialist training in St Louis and Pittsburgh, USA. Since 2004 he has been Associate Clinical Director for Neurosurgery at Barts and The London and has close interests in teaching and medical education. He is also a council member and treasurer of the Neurosciences Section of the Royal Society of Medicine, a member of the Society of British Neurological Surgeons (SBNS) and a member of the Congress of Neurological Surgeons (USA). Research interests: Traumatic brain injury, trigeminal neuralgia and hemifacial spasm, gamma knife, Chiari malformations.