Diffusion tensor imaging reveals distributed white matter abnormalities in primary trigeminal neuralgia: Tract-based spatial statistics study

For trigeminal neuralgia (TN), a major role of imaging is to identify the causes, but recent studies demonstrated structural and microstructural changes in the affected nerve. Moreover, an increasing number of studies have reported central nervous system involvement in TN. In this systematic review, recent quantitative magnetic resonance imaging (MRI) studies of the trigeminal nerve and the brain in patients with TN were compiled, organized, and discussed, particularly emphasizing the possible background mechanisms and the interpretation of the results. A systematic search of quantitative MRI studies of the trigeminal nerve and the brain in patients with TN was conducted using PubMed. We included the studies of the primary TN published during 2013 to 2023, conducted for the assessment of the structural and microstructural analysis of the trigeminal nerve, and the structural, diffusion, and functional MRI analysis of the brain. Quantitative MRI studies of the affected trigeminal nerves and the trigeminal pathway demonstrated structural/microstructural alterations and treatment-related changes, which differentiated responders from nonresponders. Quantitative analysis of the brain revealed changes in the brain areas associated with pain processing/modulation and emotional networks. Studies of the affected nerve demonstrated evidence of demyelination and axonal damage, compatible with pathological findings, and have shown its potential value as a tool to assess treatment outcomes. Quantitative MRI has also revealed the possibility of dynamic microstructural, structural, and functional neuronal plasticity of the brain. Further studies are needed to understand these complex mechanisms of neuronal plasticity and to achieve a consensus on the clinical use of quantitative MRI in TN.

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Thalamic nuclei in patients with chronic facial pain: gray matter volume patterns before and after surgery

Anton,

Elena,

Boris

et al. 2023

Preprint

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Trigeminal neuralgia is a prevalent chronic pain disorder characterized by recurring episodes of intense facial pain, which significantly impairs patients’ quality of life. MRI-based biomarkers have consistently demonstrated their ability to predict pain intensity and treatment outcomes. However, most studies have primarily focused on the trigeminal system, disregarding the extensive neural reorganization that occurs throughout the brain in response to chronic pain. In this study, we aimed to examine the thalamus, a key brain structure involved in information processing, and provide a detailed perspective on thalamic remodeling in response to chronic pain at the level of individual thalamic nuclei. We analyzed a sample of 61 patients with primary trigeminal neuralgia undergoing surgical treatment, along with 28 healthy participants. Our results revealed significant gray matter volume changes in thalamic nuclei among patients with trigeminal neuralgia. Notably, the intralaminar nuclei (centromedian/parafascicular) and nuclei associated with visual and auditory signal processing (lateral and medial geniculate bodies) exhibited significant alterations, contrasting with the ventral group nuclei involved in nociceptive processing. Additionally, we found no substantial volume increase in any of the studied nuclei following successful surgical intervention. The volumes of thalamic nuclei were negatively correlated with pain intensity and disease duration, while positively correlated with working memory scores. The findings obtained in this study, albeit preliminary, have promising clinical implications as they unveil previously unknown facets of chronic pain development and provide valuable guidance for clinical decision-making.

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Diffusion tensor imaging reveals distributed white matter abnormalities in primary trigeminal neuralgia: Tract-based spatial statistics study

Cited by 3 publications

References 29 publications

Structure alterations in left-sided trigeminal neuralgia: A voxel-based morphometry and diffusion tensor imaging study

Structure alterations in left-sided trigeminal neuralgia: A voxel-based morphometry and diffusion tensor imaging study

Advanced neuroimaging of the trigeminal nerve and the whole brain in trigeminal neuralgia: a systematic review

Thalamic nuclei in patients with chronic facial pain: gray matter volume patterns before and after surgery

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