my 20 year old daughter has symptoms of tn. when she got pregnant her symptoms got worse and more persistent. she went to a neurologist who made her an appt for an mri w/o contrast and prescribed some meds that we didnt think (along with her ob) were safe during pregnancy. she has had her baby who is now 8 months old and no longer breast feed so she went in for her mri today and the dr ordered it w/o contrast but at her mri appt she was told they couldnt see clearly and gave her dye. is this normal should we be worried?
The gold standard for MRI in cases of TN is the FIESTA MRI procedure done with sub-millimeter resolution and post-procedure 3-D reconstruction for images made both with and without contrast agent. The "dye" you are referring to might be gadolinium, one of the contrast agents used. From 17 years of reading in the literature of trigeminal pain, I've seen nothing to suggest that contrast agent causes patients any lasting damage or pain.
The anti-convulsant drugs are somewhat controversial in pregnancy, Mom. Some physicians consider these meds to comprise a hazard for the foetus. However, the medication trials data that I've read rather prominently feature the notification that no trials data are available to establish toxicity for an unborn child.
The following extract is from the Epilepsy Therapy Project. It applies primarily to women who HAVE seizures and are under treatment with Tegretol to control those seizures.
"In the United States, the Food and Drug Administration (FDA) assigns each medication to a Pregnancy Category according to whether it has been proven to be harmful in pregnancy. Tegretol is listed in Pregnancy Category D. This means that there is a risk to the baby, but the benefits may outweigh the risk for some women.
"In fact, a large majority of women who use Tegretol during pregnancy have normal, healthy babies. Certain types of defects are increased (especially if Tegretol is taken during the first 3 months of pregnancy) but they are still relatively uncommon. The risk of defects is higher for women who take more than one seizure medicine. Women with a family history of birth defects also have a higher risk.
"All women who are capable of becoming pregnant should take at least 0.4 mg (400 mcg) of the vitamin called folic acid every day because it helps to prevent one type of birth defect. (The most well-known of these is spina bifida, in which the spinal cord is not completely enclosed.) These defects are more common in the babies of women who take Tegretol during the first 4 to 6 weeks of pregnancy. If the doctor thinks a woman is at especially high risk, a much larger dose of folic acid-4 mg (4000 mcg) per day-may be recommended.
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See http://www.epilepsy.com/medications/b_tegretol_pregnancy
Regards and best,
R.A. "Red" Lawhern, Ph.D.
Resident Research Analyst, LwTN
ok and thank you very much
I’m sorry your daughter is having to go thru all if this. Many times MRI’s are ordered with and without contrast. I don’t think it’s alarming that they couldnt see the “without contrast” MRI clearly. I just think it means they 1. Aren’t doing it correctly or 2. sometimes with the contrast it makes a more clearer reading. They have done 3 MRI’s on me all with and without and nothing is ever found. I recently have been told its because they dont have the capabilities or knowledge to do the MRI’s correctly. I wonder how often this has happened to others. I pray you find answers soon and your daughter will be free from this pain.
Best wishes to you both,
Nicole
Thank you Nicole.
We got results back and my daughter has a tumor. She has a dr appt today
at 4. At this point we are both nervous & confused. Anyone have suggestions
On what questions we should ask?
Nikki said:
I’m sorry your daughter is having to go thru all if this. Many times MRI’s are ordered with and without contrast. I don’t think it’s alarming that they couldnt see the “without contrast” MRI clearly. I just think it means they 1. Aren’t doing it correctly or 2. sometimes with the contrast it makes a more clearer reading. They have done 3 MRI’s on me all with and without and nothing is ever found. I recently have been told its because they dont have the capabilities or knowledge to do the MRI’s correctly. I wonder how often this has happened to others. I pray you find answers soon and your daughter will be free from this pain. Best wishes to you both,Nicole
Questions to ask, Mom:
(1) Is the tumor operable?
(2) Is Gamma Knife one of the appropriate procedures for stopping the growth of the tumor in place?
(3) What are the risks to the patient, of any procedure that the neurosurgeon recommends?
(4) In what proportion of cases like your daughter's is the outcome positive, with a cessation of pain -- and for how long?
Regards, Red