Neuralgia in an infant: signs, treatment

Neuralgia in newborns is an inflammation of the nerve, which leads to many unpleasant sensations, including severe pain syndrome. There can be many causes of neuralgia in children, and treatment directly depends on the etiology. Therefore, it is important to know about the possible manifestations of neuralgia in a child in order to notice and correctly diagnose the pathology in time.

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Epidemiology

Statistics on the prevalence of neuralgia indicate that this pathology is not diagnosed as often as it actually is. About 12% of all neuralgias in newborns are traumatic in nature, about 40% are secondary infectious neuralgias. In newborns, this pathology occurs with a frequency of 1 case per 1,300 healthy children, and 1 case of neuralgia per 17 children with neurological problems.

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Causes neuralgia in newborns

Every person, including children, has 12 pairs of cranial nerves. When it comes to neuralgia, these are the nerves that are most often affected, although spinal nerves can also be affected. Some of them are responsible only for sensitivity, some are responsible only for motor function, and some combine these two functions. When a nerve becomes inflamed, the nerve that is most superficial to the skin is most often involved in the process. In this case, the facial nerve, which has both motor and sensory fibers, is most often inflamed. This is important for understanding the clinical manifestations of this type of neuralgia.

But neuralgia can also be of any other nerves, including the intercostal and trigeminal nerves.

The causes of neuralgia in newborns can be very different. Trigeminal and facial neuralgia are the most common, and the etiological factors of neuralgia development in each individual case are slightly different.

Under normal conditions, any nerve departs from the brain stem and passes through the openings in the skull, innervating the skin, muscles, and organs. If there is any obstacle in the path of the nerve, this can cause compression and certain symptoms. Therefore, the causes of the development of different types of neuralgia can be central and peripheral. Central disorders occur with pathology of the brain stem.

The main causes of the development of peripheral trigeminal neuralgia include:

1. morphological changes in the spinal tract (atheromatous loop and arteriovenous malformation) – this not only disrupts the normal passage of impulses along the nerve, but also such formations lead to constant compression of the nerve in this area;
2. trigeminal ganglion and vestibulocochlear nerve neurinoma – is rare in newborns, but can occur;
3. Intracranial tumors in newborns can be congenital, which leads to compression of several nerves at once;
4. vascular pathology can lead to ischemia of the nerve or its branches, and aneurysms located near the nerve can cause compression syndrome;
5. maxillary sinus cyst;
6. congenital anomalies in the structure of the canals through which the branches of the nerve pass can lead to compression of the nerve and clinical manifestations of neuralgia;
7. pathology of the development of the upper jaw with an unclosed upper palate can lead to secondary neuralgia;
8. adhesions of the dura mater in the area of the trigeminal ganglion, as a consequence of infectious lesions of the meninges.

Recently, there has been an increase in the incidence of herpes infections, in particular, herpes virus infection of a child after birth. Therefore, the most common cause of neuralgia in newborns can be considered infectious factors, in particular herpetic lesions. This virus can penetrate the baby's body after birth and become fixed in the nerve ganglia. At a certain time, the virus is activated, and an inflammatory process develops with the involvement of the nerves. Most often, herpetic neuralgia develops with damage to the intercostal nerves.

Among other causes of neuralgia in newborns, there are often traumatic factors. Birth injuries with damage to the collarbone can cause a violation of the integrity of the nerve plexuses. This can lead to persistent symptoms of innervation disorder or neuralgia. Hypothermia is one of the factors that can also cause neuralgia, since the nerve in a newborn baby can be very superficial in relation to the skin, and the effect of low temperatures can lead to its inflammation.

In newborns, neuralgia is often caused by secondary inflammatory diseases. Otitis that is not diagnosed in time can lead to rapid spread of infection through the bone structures of the skull to the nerve fibers of both the trigeminal and facial nerves. This can cause neuralgia at first, and then purulent damage to the brain structures.

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Risk factors

Therefore, the risk factors for the development of neuralgia in newborn babies are as follows:

1. inflammatory diseases of the ear, eye, viral infections;
2. congenital defects of bone tissue structure;
3. infectious diseases in mother;
4. hypothermia;
5. birth injuries.

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Pathogenesis

The pathogenesis of the development of pain syndrome in neuralgia is that the etiologic factor leads to long-term and constant irritation of the nerve. As a result, local demyelination develops. Myelin is a substance that covers all nerve fibers and promotes normal conduction of nerve impulses. Long-term compression by a pulsating vessel, tumor, adhesions leads to atrophy of myelin-forming cells with subsequent thinning of the membranes around the axons, as a result of which the proximal part of the axon begins to grow and a neurinoma occurs. In this state, the nerve is very sensitive to direct mechanical irritation, which causes pain in the area of innervation, as well as a tendency to paroxysmal activity. As is known, such unmyelinated fibers are conductors of pain. As a result of demyelination, additional "artificial synapses" arise between unmyelinated fibers, which creates conditions for the formation of a "short circuit", as a result of which the nervous system responds to each irritation with a chain reaction in the form of high-frequency discharges in the cells of the posterior horns of the spinal cord. Clinically, this is manifested by a strong pain paroxysm. A large role in the occurrence of pain syndrome is given to the central nervous system, especially the pain-conducting neurons of the trigeminal nuclei of the brainstem. High-frequency discharges activate the substance of the posterior horns of the spinal cord, in turn, this causes hyperreactivity of pain neurons of the subcortical nuclei with the development of a neuralgic attack, which stops in the case of depletion of neurons of the brainstem. This phenomenon underlies paroxysmal neuralgic pain, which suddenly occurs in a child and is expressed very intensely. And it is this that explains the effectiveness of anticonvulsants that act on the activity of neurons of the brainstem.

Such features of pathogenesis indicate that, whatever the cause of neuralgia, the irritation of the nerve is always very strong and the pain syndrome is quite pronounced.

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Symptoms neuralgia in newborns

The first signs of neuralgia appear within a few hours after irritation of the affected nerve - there is a sharp, severe pain, short-lived, appears suddenly and disappears just as suddenly. The intensity of the pain is very high. But although this is the most important and key symptom of the disease, this complaint cannot be determined in newborn babies. The equivalent of such pain in newborns with neuralgia can be considered an attack of severe crying, which occurs sharply and also suddenly stops. Such an attack is characterized by the absence of pain at night. The maximum period of occurrence of pain paroxysms occurs in the morning.

Trigger areas are very typical for neuralgia. These are the areas in the innervation area, when irritated, this pain appears. Such areas can be located on the face (wing of the nose, corner of the mouth) or on the oral mucosa in the area where the affected nerve innervates the area of the mucosa. It is typical that these areas are very sensitive and even touching them causes a pain attack. In newborns, this symptom is very important and it is also present. You may notice that a child's loud cry appears only in a certain position, for example, during feeding. If the trigeminal nerve is affected, then irritation of the corner of the mouth with a nipple can cause an attack of acute crying in a newborn. This is one of the symptoms that can indicate neuralgia.

In addition to the pronounced pain syndrome, vegetative reactions (reddening of the face, burning of the skin) are often observed, which is explained by the irritation of excitation on the vegetative ganglia of the face. Such reddening of one half of the face or part of the face together with attacks of piercing screaming also indicates neuralgia.

When different nerves are affected, certain symptoms may be expressed more or less, but different types of neuralgia are accompanied by a pronounced pain syndrome, which remains an invariable manifestation. The stages of neuralgia development provide for a consistent development of symptoms. In this case, the child first begins to cry, then after a few hours, hyperemia of the skin may appear. If the facial nerve is affected, then the motor function of the facial muscles is impaired at the last stage.

The facial nerve innervates the facial muscles and also provides sensitivity to the tongue and oral mucosa. Therefore, if the facial nerve becomes inflamed, facial asymmetry can be noticed in the newborn. One corner of the mouth can be slightly lowered, the nasolabial fold can be smoothed out. Any disturbance of facial symmetry can be considered a symptom of trigeminal neuralgia.

Neuralgia caused by the herpes virus has some clinical features. Often, before the main clinical manifestations of the disease, a prodromal period develops. The child becomes lethargic, sleeps all the time, and the body temperature may rise slightly. During this period, the baby may not eat well. This condition can last two to three days. After this, pain appears, which is manifested by episodes of sharp crying in the newborn. At the same time, a vesicular rash appears on the skin in the area of the affected nerve. Small vesicles with transparent contents are located in a chain along the nerve fiber. This causes itching and burning in the child, therefore, it is accompanied by severe anxiety and screaming. Such a rash is characteristic of herpetic neuralgia.

Complications and consequences

The consequences of untreated neuralgia can be remote, because the disruption of myelination of the nerve can lead to a disruption of its structure, which can no longer be restored. This can cause hearing impairment in the child or cause disturbances in the sensitivity of the tongue. Complications can arise if neuralgia is not diagnosed for a long time or is diagnosed incorrectly. The child constantly screams and does not refuse food, since this is a trigger factor that increases the pain. This leads to rapid weight loss and deterioration of the condition.

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Diagnostics neuralgia in newborns

Diagnosis of neuralgia in newborns is carried out only by a pediatric neurologist. Therefore, if neuralgia is suspected, the child must be examined by a neurologist.

To establish a diagnosis, conduct differential diagnostics of facial pain syndromes, and determine the etiopathogenesis of the disease, it is necessary to study the somatoneurological status of the child using clinical, paraclinical, and laboratory research methods.

Great importance is attached to a thorough questioning of the mother: finding out complaints, studying the history of the development and course of the disease, as well as the conditions of the child's birth. When finding out complaints, attention is paid to the nature of the pain, localization, cyclicity, duration, the cause that caused facial pain. According to the child's mother, a violation of such functions as salivation, lacrimation is determined. During the collection of anamnesis, it is necessary to find out the details of the child's birth, whether there were any birth injuries or any infectious diseases in the mother. It is important to clarify when the child begins to cry and whether it is provoked by anything.

Then the child should be examined, paying special attention to facial expression, symmetry, skin color. It is necessary to pay attention to the corners of the mouth, nasolabial fold, eyes. Any symmetry disorders may indicate a violation of innervation. After this, palpation of the muscles is carried out, paying attention to muscle compaction, tension, spasms. Palpation should be carried out carefully, because this can provoke a pain attack in the child and identify a trigger zone in the area of the affected nerve. Examination of sensory functions in newborns is difficult, so a simple examination and palpation makes it possible to establish a preliminary diagnosis.

Instrumental diagnostics of neuralgia is of great importance for clarifying the diagnosis.

The classical electrodiagnostic method of muscles is used to determine the reaction to current stimulation. The data from this study allow us to determine the degree of damage to the peripheral motor neuron. This diagnostic method can be used already in a long-term process, when the restoration of the damaged nerve remains in question.

Muscles produce biopotentials, which can be used to judge their condition. Electromyography is used to diagnose this function. Biopotentials are recorded in various muscle states (active contraction, complete voluntary relaxation). The amplitude, frequency, and general structure of the myogram are assessed. An electromyogram makes it possible to judge the condition of motor neurons.

In more severe cases or if there is a suspicion of damage to a muscle of central genesis, there is a need to examine the brain using encephalography. On the electroencephalogram, both outside of a pain attack and directly during and after the attack, there are significant changes in the electrical activity of the brain. As a rule, these changes are of an irritative nature, stable changes of the synchronization and desynchronization type in pain syndromes as a result of damage to the cranial nerves themselves, especially the trigeminal.

For the diagnosis of neuralgia, especially in newborns with suspected congenital anomalies of the vascular structure, it is advisable to conduct a rheographic study. In neuralgia, signs of high tone of facial vessels, decreased blood filling, and difficulty in venous outflow are recorded. These changes are usually reversible.

Tests can be performed only for the purpose of differential diagnosis. If there is a suspicion of postherpetic neuralgia, then a blood test with a study for the herpes virus can be performed.

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Differential diagnosis

Differential diagnostics of neuralgia in newborns should be carried out especially carefully, since screaming during attacks of neuralgia is often confused with attacks of intestinal colic. Differential signs of pain in neuralgia are the appearance of episodes of screaming, which intensify during feeding the child, opening the mouth, facial movements or any other provoking movements. When it comes to colic, the child's scream is monotonous, lasts for several hours and is practically not calmed by anything. It is also important to differentiate neuralgia from symptoms of hypoxic damage to the central nervous system. With such ischemic damage, there are disturbances in muscle tone, hyperexcitability syndromes or oppression.

Treatment neuralgia in newborns

Treatment of neuralgia in newborns may be somewhat limited by the child's age, since many drugs are not used in the neonatal period. Therefore, some drugs may be used not in the acute period, but already in the recovery period.

The main method of treatment is pathogenetic, after a thorough examination of the patient and identification of the cause of the pain.

Emergency care for a pain attack consists of local or central anesthesia. For local anesthesia, novocaine and its analogues are used. In small children, they are more often limited to taking Paracetamol or Ibuprofen, which relieves pain and irritation.

1. Paracetamol is a drug that has moderate painkillers and pronounced antipyretic properties. The drug can be used to treat neuralgia pain in newborn babies: as a solution for injection during an acute attack, or as a syrup for further treatment. The dosage of the drug for injection is 0.1 milliliter, if used in syrup, then 10-15 milligrams per kilogram of weight is calculated. Side effects may be due to liver pathology in a child in the form of toxic effects.
2. Ibuprofen is a drug from the group of non-steroidal agents. It can be used from the neonatal period to relieve pain attacks during neuralgia. Dosage is 8-10 milligrams per kilogram of body weight. Side effects can be in the form of intestinal bleeding, effects on blood cells.

For central anesthesia, anticonvulsants are used, the use of which in newborns is limited.

Since swallowing is a strong trigger factor, suppositories with carbamazepine (0.1 g) are offered, which are quickly absorbed and therefore pain relief occurs faster. Drugs that act on the opiate mechanism of antinociception are used: sodium oxybutyrate, which can be used in children, depending on body weight.

They apply an effect on trigger areas: lubricate the skin of the face with 5% anesthesin or 5% lidocaine ointment, or an alcohol tincture of water pepper.

3. Anesthesin ointment is a painkiller for local use. If the exact source of the affected nerve is identified in a child, the drug can be used for external use. Method of application - apply one drop of ointment to the child's skin and rub with a cotton swab. Dosage - apply no more than twice a day. Precautions - use only after a sensitivity test on the skin of the leg, as there may be a pronounced allergic reaction. For such a test, dilute the ointment in half with water and apply a small drop to the skin, rubbing it. If after two hours there is no redness or other changes, then the ointment can be used.

In case of irritation of vegetative formations of the face, belloid, bellataminal, pyroxane, and spasmolitin are used.

Treatment of neuralgia of herpetic etiology has some peculiarities, since there are drugs that act specifically on this virus. Two directions in treatment are used: elimination of an acute attack and antiviral specific therapy.

In the neuritic (acute) stage of the disease, antiviral drugs are prescribed:

4. Zovirax is an antiviral drug that is active against herpes viruses. The dosage of the drug is 5-10 mg per 1 kg of body weight intravenously by drip in 100 ml of isotonic sodium chloride solution, or 0.4 g in tablets 2 times a day for 5-7 days, or in the form of an ointment for external use. Side effects may include depression of the nervous system, drowsiness, and impaired consciousness.
   • Valtrex (1000 mg 3 times daily for 7 days)
   • Bonafthon and Floreal in tablets or ointments for external use,
   • Deoxyribonuclease (0.2% solution for eye drops or inhalation for 10-12 minutes 2-3 times a day)
   • Interferon (for eye and nasal instillation, 2 drops 3-4 times a day).

For pain relief, dimexide with novocaine in a ratio of 1:3 is used for compresses, analgesics (2 ml of a 50% solution of analgin intramuscularly up to 2 times a day, baralgin). In case of severe pain syndrome, the introduction of lytic mixtures is indicated (2 ml of a 50% solution of analgin, 1 ml of a 1% solution of diphenhydramine, 2 ml of a 0.5% solution of novocaine, 1 ml of a 2.5% solution of aminazine).

It is not recommended to use drugs that improve nerve conduction (vitamins, proserin) in the acute stage of the disease, since they can cause the development of postherpetic neuralgia. There is also no point in using antibiotics, which further suppress the immune system and have no effect on viruses. The use of antibiotics can only be explained as a preventive measure against secondary infections in the presence of inflammatory diseases (pneumonia, tonsillitis).

In case of development of postherpetic neuralgia it is inappropriate to use anticonvulsants, because they are practically ineffective; dyes that do not have antiviral activity (methylene blue).

Vitamins can be used after the child has recovered to better accelerate nerve regeneration. Vitamins of group B are especially recommended.

Physiotherapy treatment can be widely used to restore the child's muscles before complications and muscle movement disorders begin. For this purpose, microcurrents are applied to the affected areas of the skin, as well as massage.

Folk remedies

1. Lilac and chamomile flowers are excellent pain relievers and reduce swelling that can form as a result of nerve compression. To prepare the infusion, take thirty grams of chamomile flowers and thirty grams of fresh lilac flowers. Pour hot water, but not boiling water, over the flower mixture and leave for two hours. After the infusion has cooled slightly, apply bandage compresses to the affected area.
2. Black radish can be used to relieve pain in the acute period. To do this, make juice from the radish and apply it to the site of irritation for several minutes in case of severe pain.
3. Burdock is good for relieving pain and swelling, especially in cases of birth injuries that lead to neuralgia. To prepare a compress, take one leaf of young burdock, dry it and add water pepper to it, which can be bought ready-made at a pharmacy. Mix the herbs in a one-to-one ratio and pour warm water over it overnight. In the morning, the infusion is ready to use as a compress.
4. Wormwood is a natural antioxidant and pain reliever. To prepare the infusion, you need to make a weak infusion. To do this, pour 10 grams of dry grass with a liter of hot water and leave for ten minutes. This solution can be applied to the projection of the affected nerve. The grass can cause allergic reactions in children, so you must first make sure that there is no allergy.

Herbs are also widely used to treat neuralgia, as many of them have an anti-inflammatory effect and improve nerve regeneration after compression or damage. Herbs for newborns should be used internally very carefully, so herbal compresses are preferred.

1. Motherwort and mint herb can be used to treat neuralgia as a tincture for internal use. To prepare, take 50 grams of both herbs and leave for two hours in hot water. You can give your child two drops of this tincture at night.
2. Sage leaves have a relaxing effect and relieve skin irritation in neuralgia and pain. In this case, sage baths are very useful for newborns. For such a bath, you need to take two bags of sage leaves and pour hot water over them so that it sits for ten minutes. After that, you can pour the infusion into the bath and bathe the child, lubricating the skin with fir oil after bathing, especially in the area of the nerve lesion.
3. Melissa infusion helps improve a child's sleep and relieves increased irritability due to neuralgia. To prepare, take dry lemon balm leaves and make tea. Give the child a teaspoon at night before bedtime.

Homeopathy in the treatment of neuralgia is especially effective in cases of residual effects of muscle dysfunction after neuralgia.

1. Magnesium phosphoricum is an inorganic homeopathic remedy that is a magnesium derivative. This drug is used to treat neuralgia, which is accompanied by muscle twitching, muscle tone disorders. The dosage of the drug for newborns is two granules three times a day. Side effects may include allergic reactions and severe itching.
2. Agaricus is a herbal homeopathic preparation that is widely used in pediatric practice. It is effective in the treatment of neuralgia, especially of the trigeminal nerve in newborns, which is accompanied by reddening of the skin of the face and changes in the facial muscles. The drug is used in granules and the dosage is four granules once a week, then two granules a day for three more months. Side effects can only occur if the dose is exceeded, then twitching of the child's facial muscles may occur.
3. Spigelia is a single-component organic drug used to treat neuralgia, especially with severe anxiety in children with associated bowel disorders and abdominal pain. The drug is often used to treat severe forms of postherpetic neuralgia. The dosage of the drug depends on the degree of disorders and, with minimal disorders, it is one granule per day. Side effects may include lethargy and decreased reflexes.
4. Kalmia is a homeopathic medicine used to treat complications after neuralgia - with decreased sensitivity or in case of long-term restoration of facial muscle function. The medicine improves peripheral conductivity of nerve fibers. The medicine is used in granules, two granules five times a day for five days, and then three granules twice a week. The course of treatment is 40 days. Side effects are very rare, may cause short-term loosening of stool.

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Prevention

Prevention of neuralgia development in newborn babies consists of avoiding sudden trauma, avoiding contact with people with herpes infection, and treating acute inflammatory diseases in time before signs of nerve damage appear. It is very important for the mother to maintain the correct temperature regime when caring for the child.

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Forecast

The prognosis for recovery is favorable with active and timely treatment. Less than 5% of children have complications after neuralgia, but nerve function can be restored fairly quickly with proper care and massage.

Although neuralgia in newborns is a rare disease, it is quite serious. Since there are very few specific symptoms of the disease, and the child cannot tell about severe pain, the pathology is often diagnosed quite late. Therefore, parents should pay attention to any changes in their child's condition and consult a doctor at the first signs.