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The MMPI test, Hornblow and Kidson's visual-analog anxiety scale and two types of the painful "questionnaires" suggested by the authors were used to examine the status of emotional personality sphere in 61 patients with prosopalgias due to typical trigeminal neuralgia (n = 39), dental plexalgia (n = 13) and pulpitis (n = 9). It has been revealed that patients with typical trigeminal neuralgia demonstrate the predominance of the depressive syndrome, whereas dental plexalgia is mostly characterized by anxiety. Analysis of the semantic tests is very instrumental in helping the physician to deepen the idea of the structure of subjective sensations in facial pain. Meanwhile the indicators of the "daily pain scale" promote administration of the drugs from the standpoint of chronotherapy.

The paper relates the general principles of the treatment of trigeminal neuralgia by acupuncture. The authors' own research data are provided.

Cluster headache is a disputable and ill-defined problem of current neurology. The authors review data available on etiology, mechanisms of pathogenesis and therapy with special emphasis on biochemical and immunological disturbances; discuss nosology of the disease in the light of newly obtained evidence on its immunological aspects. An overall table of clinically justified treatments is presented.

The authors provide the results of an analysis of the interrelation between the immunologic and biochemical parameters in 6 groups of patients suffering from facial pains or headaches (a total of 153 patients). Significant correlations were revealed in the patients' groups with trigeminal neuralgia and periodic migrainous Horton's neuralgia. The main attention was concentrated on the following parameters: IgA in the serum, secretory IgA in the patients' saliva, % CD4 of lymphocytes and histamine concentration in the peripheral blood, concentration of beta-endorphin in the plasma, catecholamine content in the urine.

Altogether 85 patients with the painful syndromes in the facial and head areas were examined for secretion and transport of testosterone, the main androgen occurring in the body of adult man, by the blood proteins globulin- and albumin-binding sex steroids. All the women examined were in the menopause. The majority of the patients manifested hyperandrogenemia: a decrease in the concentration of sex steroids-binding globulin, rise of total testosterone and its free fraction in the blood serum as well as increase of the index of free androgens. Approaches to the correction of the revealed abnormalities and the role played by those abnormalities in the pathogenesis of the above-indicated diseases are under discussion.

Somatosensory evoked potentials, biochemical, immunological, pharmacokinetic and psychological research methods were used to examine 308 patients suffering from neuralgia of the trigeminal and glossopharyngeal nerves, neuropathy of the trigeminal nerve, neuralgias of the face and painful dysfunction of the temporomandibular articulation. New mechanisms of the pathogenesis of the diseases indicated were revealed. That made it possible to improve and devise new treatment methods.

The authors describe a new method of the treatment of patients with trigeminal neuralgias using electroconvulsive therapy. The method is based on the increase of beta-endorphin concentration as a result of electroconvulsive treatment. The treatment of 12 patients in accordance with the suggested method provided beneficial results and significant enhancement of the efficacy of therapy as compared to patients undergoing conventional treatment.

The authors describe the results of immunological examination of patients suffering from vegetative prosopalgias. A study was made of the initial status of immunity and of its dynamics after treatment. The majority of patients manifested an increase of immunoglobulin A concentration and activation of local humoral immunity. The treatment brought about a reduction of immunoglobulin A concentration in blood serum.

The authors examined electrical conductivity of acupuncture points on the face of 60 patients with trigeminal neuralgia. The results permitted the development of differential diagnostic criteria of trigeminal neuralgia of predominantly central and predominantly peripheral genesis.

A total of 66 patients with dental plexalgia have been examined and treated at the neurological dentistry department. A multiple-modality scheme for the treatment of this condition is suggested, whose basic methods are physiotherapeutic ones: longitudinal physiotherapy, diadynamic currents with a narcotic mixture, trimecain or lydase + analgin electrophoresis. The treatment was effective in the majority of patients.

Immunological investigation was performed in patients with trigeminal neuralgies and painful myofascial temporomandibular joint dysfunction before and after treatment. The data suggest a connection between the state of humoral immunity and the peculiarities of pain syndrome in trigeminal neuralgia and clinically related prosopalgies that was most probably due to different mechanisms of realization of pain syndrome.

Blood plasma beta-endorphin concentrations were measured in 87 patients with various facial and head pain syndromes: trigeminal neuralgia or neuropathy Horner syndrome and migraine, facial autonomic pains. beta-endorphin concentrations were measured before and after treatment. In the groups under investigation, the neuropeptide showed opposite changes in plasma levels after the therapy depending on the type of the syndrome.

A total of 104 patients with bilateral facial pain were examined at a specialized neurostomatological department. The authors analyze the main mechanisms of the development of bilateral facial pain in patients with an impaired system of the trigeminal nerve (trigeminal neuralgias, dental plexalgia, syndrome of the nosociliary nerve), as well as the characteristics of their clinical manifestations. A classification of bilateral prosopalgias is proposed. The criteria of their diagnosis with the use of clinical and electrophysiological methods of examination (EEG, REG, EMG, electrothermometry, esthesiometry, electrical excitability of the exit sites of the trigeminal nerve branches and radioisotopic examination of the muscular blood flow in the face with the help of 133Xe) are also presented. The main principles of the treatment of bilateral prosopalgias are outlined.

Acupuncture was used in 82 patients with trigeminal neuralgila. In 17 patients trigeminal neuralgia was predominantly of the central and in 65 of the peripheral genesis. Selection of points for acupuncture was based on the findings about electrical conductivity of symmetrical acupuncture points on the patient's face. The study has shown that the method of acupuncture in patients with trigeminal neuralgia should be used differentially. It is effective only in patients with peripheral trigeminal neuralgia.

Patients with migraines, Horton syndrome and autonomic pains were subjected to immunological investigation that revealed different degrees of local and general immunity disorders: increase in blood serum IfA and salival IgAc concentrations. These changes are believed to be capable of serving as diagnostic and prognostic indices.

As many as 145 patients with painful syndromes in the face and head underwent immunologic examination. They manifested certain changes in cellular and humoral immunity. An increase in the content of secretory IgA in the saliva and in the serum and a decrease of the concentration of IgM and IgG in the serum were detected in the majority of patients. In patients with NTN of mainly peripheral genesis and with Horton's syndrome, the concentration of IgE in the serum was significantly (P less than 0.01) elevated. The changes in the immunologic status, seen in patients after the treatment are discussed.

Forty-one patients with dyscirculatory encephalopathy complicated by a transient impairment of the cerebral circulation were examined in a neurological department. A comparative analysis of the findings obtained during comprehensive study of the cerebral circulation showed that in the overwhelming majority of cases (37 out of 41), the results of isotope angiography and rheography coincided and corresponded to the clinical findings. To a certain degree these methods complemented each other: rheoencephalography was more informative in the diagnosis of cerebral atherosclerosis and essential hypertension while radioisotope angiography allowed a more accurate determination of the area affected.

The treatment efficiency was compared to blood carbamazepine++ levels in patients with trigeminal neuralgia which were treated with the drug over a long period. The parameters displayed a good (r = 0.70) correlation that resulted in a tendency to increase treatment effect with carbamazepine++ plasma concentration increase. The treatment proved most efficient and side effect-free in a concentration range of 5 to 10 micrograms/ml. The data on blood carbamazepine++ concentrations may be helpful in designing a controlled course of treatment.

The levels of E-type prostaglandins were measured in patients with facial and headaches. The data on the prostaglandin levels suggest that the severity of pain syndrome should be taken into consideration in relieving the pain, and then the nosology should be considered. The use of drugs influencing the prostaglandin turnover in treating patients with facial and headaches is discussed.

Eighty-six patients with odontogenic lesions to the trigeminal nerve were examined in a neurostomalogical department. The authors describe the clinical manifestations and the pathogenetic treatment of such lesions.

The article considers characteristics of clinical manifestations of dental plexalgia, a new form of the disease related to impairment of dental plexuses. In a clinicophysiological study of 56 patients with dental plexalgia conducted at a neurostomatological department the authors used rheofaciography, thermometry and thermography of the face skin, esthesiometry, and electrodiagnosis of the oral mucosa. Electrodiagnosis of the oral mucosa helps to specify the diagnosis of dental plexalgia. The authors describe differential diagnosis criteria reflecting the peculiarities of the clinical picture of dental plexalgia which is characterized by the persistent pain in the area of the damaged plexus with peculiar irradiation which may be used for the diagnosis, rational etiopathogenetic therapy, prophylaxis, and prognosis of the disease.

Neuropathic, stomatological and instrumental examination was performed in 86 patients with trigeminal neuropathies admitted to a specialized dental neurological department. The disease was found clinically heterogeneous, requiring a systemic approach to its treatment based on current knowledge of the disease etiology.

Differential diagnostic criteria of trigeminal neuralgia predominantly of the central genesis and of odontogenic affections of the trigeminal nerve system have been worked out on the basis of studies of electric conductivity of acupuncture points of the face in 85 patients with affections of the trigeminal nerve system.

Thirty-nine inpatients of the neurostomatological department who had dental nerve neuropathy (DNN) due to maxillodental pathology or manipulations were examined. Specific etiological factors of DNN onset, clinical appearance and pathogenetic treatment are outlined.

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.

The paper presents the results of an immunological screening of patients with facial vegetative neuralgia, Horton's syndrome, and migraines prior to and following therapy. The patients with migraines were found to have an activated local humoral immunity. Those from all the groups showed lower serum immunoglobulin A concentrations after therapeutic interventions.

The results of treating 262 patients with vertebrogenic lumbosacral radiculitis are presented. The treatment was carried out with the help of a special device designed for stretching the spine.

On the basis of examining 65 patients in whom neuralgia of the trigeminal nerve was associated with pathology of the dento-maxillary system, the authors have developed differential diagnostic criteria and the pathogenetically substantiated treatment of odontogenic neuralgia of the trigeminal nerve.

Examinations of the muscle blood flow in the face have shown that this method may be used as one of the criteria in the objective evaluation of pain and for the follow-up of its severity in patients with trigeminal injury.