Abnormal brain white matter in patients with right trigeminal neuralgia: a diffusion tensor imaging study

Abstract

BackgroundIdiopathic or classical trigeminal neuralgia (TN) is a chronic painful condition characterized by intermittent pain attacks. Enough evidence demonstrates classical TN is related to neurovascular compression (NVC) at the trigeminal root entry zone (REZ), but white matter change secondary to TN are not totally known.MethodsVisual Analogue Scale (VAS) and diffusion tensor imaging were performed on 29 patients with right TN and 35 healthy individuals. Voxel-wise analyses were performed with TBSS using multiple diffusion metrics, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). Group differences in these parameters were compared between right TN patients and controls using TBSS and correlations between the white matter change and disease duration and VAS in right TN patients were assessed. Multiple comparison correction were applied to test significant correlations.ResultsThe right TN patients showed significantly lower FA and higher RD in most left white matter (P < 0.05, FWE corrected). Moreover, negative correlations were observed between disease duration and the FA values of left corona radiata, genu of corpus callosum, left external capsule and left cerebral peduncle, and between VAS and the FA values of left corona radiata, left external capsule and left cerebral peduncle (P < 0.05). Positive correlations were observed for disease duration and the RD values of left corona radiata, right external capsule, left fornix cerebri and left cerebral peduncle, and for VAS and the RD values of left corona radiata and left external capsule (P < 0.05). However, once Bonferroni corrections were applied, these correlations were not statistically significant.ConclusionThese findings suggest that TN selectively impairs widespread white matter, especially contralateral hemisphere, which may be the hallmark of disease severity in TN patients.Electronic supplementary materialThe online version of this article (10.1186/s10194-018-0871-1) contains supplementary material, which is available to authorized users.

Patients with chronic migraine without history of medication overuse are characterized by a peculiar white matter fiber bundle profile

“…Nonetheless, the abnormalities in the microstructure of WM fiber bundles in patients with CM provide neuroanatomical evidence to support the hypothesis that dysfunctional central pain modulatory circuits contribute to migraine chronification. Of note, the presently observed neuroradiological findings are similar to those found in relation to other types of cephalic and extra-cephalic chronic pain, such as trigeminal neuralgia [38], fibromyalgia [39], chronic musculoskeletal pain [40], and irritable bowel syndrome [41]. This consistency further supports the hypothesis that WM fiber bundles mediate pain perception and control, and that chronic pain of any type may account for the widespread disruption of WM integrity in the brain.…”

Patients With Chronic Migraine Without History of Medication Overuse Are Characterized by a Peculiar White Matter Fiber Bundle Profile

“…Of note, the presently observed neuroradiological ndings are similar to those found in relation to other types of cephalic and extra-cephalic chronic pain, such as trigeminal neuralgia [38], chronic musculoskeletal pain [39], irritable bowel syndrome [40]. This consistency further supports the hypothesis that WM ber bundles mediate pain perception and control, and that chronic pain of any type may account for the widespread disruption of WM integrity in the brain.…”

“…The headache severity was also related to the DTI metrics in the present study; the subjective perception of headache intensity was negatively correlated with FA and positively correlated with MD in the overlapping WM tracts of the right PCR in patients with CM and MO, respectively. Since the PCR forms part of the central pain modulatory circuit, and because a similar correlation was previously found in other chronic pain disorders [38,40], it is possible that an abnormal microstructural integrity of the PCR compromises the perception of pain severity. However, since this was not a longitudinal study, we cannot exclude the possibility that, conversely, the intensity of the pain itself caused the microstructural integrity anomalies.…”

Patients with chronic migraine without history of medication overuse are characterized by a peculiar white matter fiber bundle profile

“…Of note, the presently observed neuroradiological ndings are similar to those found in relation to other types of cephalic and extra-cephalic chronic pain, such as trigeminal neuralgia [38], bromyalgia [39], chronic musculoskeletal pain [40], and irritable bowel syndrome [41]. This consistency further supports the hypothesis that WM ber bundles mediate pain perception and control, and that chronic pain of any type may account for the widespread disruption of WM integrity in the brain.…”