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Winter 2005 Novalis® Team Cures Intense Facial PainDoris Rose is on her way out to walk her two small dogs—Toby, a Yorkshire terrier, and Mason, a Northern Border terrier. As usual, they’ll have company. When Ms. Rose and the dogs walk, her two cats, Ginger and Velvet, go along too.  “At first (the pain) only happened two or three times a day. But over time it got much worse. I couldn’t eat, sleep or shower.” Doris Rose, with Toby and Mason. Ginger and Velvet, the cats, are in hiding. “It’s the funniest thing to see them all strolling together,” Ms. Rose said. Ms. Rose, 73, has a new appreciation of simple pleasures like family walks. For several years she was almost unable to function due to incapacitating facial pain from a condition called Trigeminal Neuralgia (TN). But after doctors at AAMC successfully treated her with noninvasive Novalis stereotactic radiosurgery, her pain is gone and she can go about her normal activities. Ms. Rose’s episodes of TN began over three years ago when she started to have recurring stabbing pains on the right side of her face. The pain radiated from her nose to the top of her head, and seemed to come and go for no reason. “At first (the pain) only happened two or three times a day. But over time it got much worse. I couldn’t eat, sleep or shower,” Ms. Rose recalled. That’s characteristic of TN, a disorder of the trigeminal nerve, one of the largest nerves in the head. The trigeminal nerve sends impulses to the brain from the face, jaw, forehead,and around the eyes. But sometimes the nerve root is compressed by blood vessels touching the brain stem. Over time the nerve may receive abnormal impulses and become hyperactive. This can cause the spasms and excruciating pain of TN. TN may be triggered by such everyday activities as talking, feeling a breeze on the face, or chewing and swallowing. Episodes usually last for several seconds and recur regularly throughout the day. “I couldn’t even put lipstick on, that’s how bad the pain was,” Ms. Rose said. For months she was virtually confined to her home, afraid to drive or go out in public and depressed and frustrated that the treatments she’d tried hadn’t helped. “I took medications, tried acupressure, and had five nerve blocks.” Finally her personal physician suggested she consult with Dr. Timothy Burke, a neurosurgeon at AAMC. Dr. Burke suggested treatment with Novalis. Novalis stereotactic radiosurgery and radiotherapy combines many small radiation beams coming from different directions to converge on a single site. A high dose of radiation is precisely focused on the area to be treated, while damage to surrounding tissues is minimized. Ms. Rose’s treatment was coordinated and administered by Dr. Ashish Chawla, a radiation oncologist at AAMC’s DeCesaris Cancer Institute.  “The pain began to diminish almost right away. Within a month it was gone and it hasn’t come back.” A happy Doris Rose, front center, with her trigeminal neuralgia Novalis team: (l-r) Deborah Nielson, R.N., Robert Siddon, Ph.D., Diane Breedon, R.T., Timothy Burke, M.D., Ashish Chawla, M.D, Navigator Kaelyn Kappeler Dr. Chawla recalled Ms. Rose’s situation. “The pain was rated at 10 out of 10(the worst possible) and had persisted for several years,” he said. “After a single high dose of radiation with Novalis targeted at the nerve in her brain, her pain completely went away within four weeks and she has remained completely pain-free since then, with virtually no side effects.” Ms. Rose agreed. After her treatment with Novalis, she said, “The pain began to diminish almost right away. Within a month it was gone and it hasn’t come back.” Dr. Chawla said that, based on AAMC’s experience with using Novalis on TN patients and on other research, “it is safe to say that Novalis provides a reasonable alternative to invasive surgery for [TN] patients.” According to Kaelyn Kappeler, navigator for the DeCesaris Institute, using Novalis for TN requires extremely accurate radiographic imaging of the nerve itself. “Fortunately AAMC neuroradiologist Dr. Tim Eckel developed an MRI of the brain protocol that allows us to visualize the trigeminal nerve, which is an extremely tiny target to hit,” said Ms. Kappeler. Almost a year after her treatment, Ms. Rose is making up for lost time. She is traveling, working as an auditor of hospital records and spending time with her family (grown children Joe and Brenda live in the area). She is so happy with her outcome that she is actively telling others with TN about her experience with Novalis. “Everyone involved in my treatment was just wonderful,” Ms. Rose said. “My thanks go out to all of you at Anne Arundel Medical Center. Because of you I can smile again.” |
