Management of medically refractory trigeminal neuralgia in patients with multiple sclerosis

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Trigeminal neuralgia (TN) is a painful disorder that frequently causes lancinating, electrical shock–like pain in the trigeminal distribution. Common surgical treatments include microvascular decompression (MVD), radio-surgery, and radiofrequency ablation, and complete pain relief is generally achieved with a single treatment in 70 to 85% of cases for all modalities. In a subset of patients with multiple sclerosis (MS), however, the rates of surgical treatment failure and the need for additional procedures are significantly increased compared with those in patients without MS. In this study the authors report their experience with a cohort of 11 patients with TN who also had MS, and assess the efficacy of MVD, gamma knife surgery (GKS), and radiofrequency ablation in achieving complete or partial long-term pain relief.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Eleven patients with TN and MS who were treated by the senior author (N.B.) at the University of California, San Francisco were included in this study. All patients underwent GKS and/or radiofrequency ablation, and four received MVD. A detailed clinical history and intraoperative findings were recorded for each patient and frequent follow-up evaluations were performed, with a mean follow-up duration of 40.6 months (range 1–96 months). Pain was assessed for each patient by using the Barrow Neurological Institute scale (Scores I–V).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Achieving complete pain relief in patients with TN and MS required significantly more treatments compared with all other patients with TN who did not have MS (p = 0.004). Even when compared with a group of 32 patients who had highly refractory TN, the cohort with MS required significantly more treatments (p = 0.05). Radiosurgery proved to be an effective procedure and resulted in fewer retreatments and longer pain-free intervals compared with MVD or radiofrequency ablation.</jats:p></jats:sec>

Treatment options in trigeminal neuralgia

“…Nevertheless, the possibility of additional nervevessel conflict in MS patients should be kept in mind. Microvascular decompression is associated with a favourable response in approximately 50% of patients [Monstad, 2007;Patwardhan et al 2006;Cheng et al 2005]. The major problem with microvascular decompression in this patient population is the observation that TN often occurs bilaterally and bilateral posterior fossa craniotomies entail a greater risk [Berk, 2001].…”

Классическая Невралгия Тройничного Нерва

“…В тех случаях, ко-гда клиника классической НТН сопровождается чувствительным дефицитом, используют термин чувствительная тригеминальная нейропатия [331,423]. У больных рассеянным склерозом также наблюдается НТН, которую многие авторы относят ко вторичной НТН [63,74,154,158,169,170,184,340,354,365,366,378].…”

Clinical, Anatomo-Radiological and Dosimetric Features Influencing Pain Outcome After Gamma Knife Treatment of Trigeminal Neuralgia

“…If the analysis is done in those series that compare classic trigeminal neuralgia and neuralgia associated to multiple sclerosis, some authors reported worse results in cases of multiple sclerosis (Brisman 2000a;Cheng, 2005;Morbidini-gaffney, 2006;Verheul, 2010;Young, 1998). Other manuscripts did not report significant differences in pain control between classic trigeminal neuralgia and neuralgia secondary to multiple sclerosis (Cheuk, 2004;Petit, 2003;Regís, 2009;Riesenburger, 2010;;Rogers, 2000).…”