I have put off writing this blog post a number of times. To be honest, it's not something that I like to think about, a luxury I sometimes have when my symptoms are not particularly severe. But it is a subject too important for me to continue to put off. So here goes.
I am one of the unlucky Sjogren’s patients who suffers from significant neuropathies; in my case multiple cranial neuropathies are the particular nemeses. In fact, for me, cranial neuropathies are perhaps the most difficult part of contending with Sjogren's syndrome. They can be exceedingly painful and are one the reasons SS has been so debilitating for me over the last several years.
While I know I am not alone in having these cranial nerve issues, I have also Iearned that, in some respects, I am the exception to the rule. For starters, depending on the study, approximately 30 percent of Sjogren's patients have neurological involvements of some kind. That broad group includes all neuropathies that impact the central, peripheral, and autonomic nervous systems. Multiple cranial neuropathies in particular are a relatively uncommon subset. One estimate places them at just 5% percent of those with neuropathies, which would mean less than 2% of the overall SS population. (I’m sure others will have seen other numbers, but the point is multiple cranial neuropathies are considered fairly rare with Sjogren’s.)
However, since at least I know I am not the only one out there with Sjogren's, Lupus, or other autoimmune diseases contending with cranial neuropathies, I thought I would start with some of the basics I have learned over the last few years. For starters, there are actually 12 cranial nerves. Making things more complicated, some belong to the peripheral nervous system (PNS) and others belong to the central nervous system (CNS). The short version is that these are many of the nerves that are involved in your face, head, eye, and ear. (If you’re interested, greater details on the specific functions of the twelve cranial nerves can be found here.)
With Sjogren’s (and other autoimmune diseases such as MS) the 5th cranial nerve or the trigeminal nerve is one of the most commonly involved in the disease process. This nerve has three main branches V1, V2, and V3 impacting the upper, middle, and lower sections of the face as shown below:
|Dermatone of Trigeminal Nerve|
By Madhero88 via Wikimedia Commons
Patients with trigeminal nerve involvement or trigeminal neuralgia often have severe pain running down the side of their face, lack of feeling, sensations of numbness or general abnormal feeling in their face. I realize that pain and numbness may sound contradictory, but it will make sense to anyone who has experienced it. Symptoms can be made worse by simple everyday activities that most people don't think about twice such as eating, being outside in the cold or wind, or even just touching the face. Unfortunately, trigeminal neuralgia is an extremely painful condition and can be difficult to control. Doctors recognize it as a condition of its own and often believe it to be untreatable; a terrible thing to hear for those of us who have it.
For me, the trigeminal nerve was the first of my cranial nerves to be affected by the disease. It started with a change in sensation on the right side of my face such that touching it became uncomfortable. It was as if my face had gone numb and progressively painful at the same time. Not a good feeling at all.
But that was just the start for me. After the trigeminal nerve, I had other cranial nerves become involved too. I had problems with the 7th cranial nerve, which impacted my facial movement and caused hemi-facial spasms. As a result of its involvement, at times I was unable to move my face or open my eye. My 8th cranial nerve, which is responsible for hearing and balance, also joined the dysfunctional nerve party. I experienced (and at times still do have) extreme ear pain, sensitivity to any sound and vibration, and balance issues. I was even unable to be in a car or train because the vibrations and bumps of the road caused so much pain. I was in constant unremitting pain and unable to do basic everyday tasks. It really left me at my wits end… I could go on, but I am sure you get the idea that my immune system had mounted a full-fledged attack on my cranial nerves.
Now, back to the autoimmune aspect of it, which I hope may help some other patients. All of the nerve/pain issues described occurred before any of the more twenty doctors that I saw during this time diagnosed me with autoimmune disease. If anything, the pain threw them off. I was told I had a pain syndrome and doctors put me on pain meds. All they did was make me slow-witted and, while they masked the pain at times, they did not make it go away and I kept getting worse. The doctor's response? You must have a "bad pain syndrome. Take more drugs." This was from some of the most prominent medical centers in the country.
I know that I am probably not alone in the autoimmune disease community of having had something like this happen. What I have learned since then is that many doctors, even rheumatologists, are not aware of the possible neurological complications of Sjogren's Syndrome. And the big and important question of course is why is this the case? So that is what I’ll try to tackle in a bit more detail in an upcoming post. Stay tuned.