Misoprostol as a Therapeutic Option for Trigeminal Neuralgia in Patients with Multiple Sclerosis

Pfau, Giselher; Brinkers, Michael; Treuheit, Tim; Kretzschmar, Moritz; Şentürk, Mert; Hachenberg, Thomas

doi:10.1111/j.1526-4637.2012.01472.x

Cited by 17 publications

(6 citation statements)

References 6 publications

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“…Five out of six patients treated with topiramate (50–300 mg/day) reported complete pain relief [36]. Three studies reported efficacy of misoprostol (a prostaglandin-E1-analogue) in a total of 28 patients with TN secondary to MS [37, 44, 45]. Reder and Arnason reported that misoprostol (300–800 μg) relieved pain in six of seven patients who had failed to respond to conventional pharmacologic therapy, without serious side effects [37].…”

Section: Resultsmentioning

confidence: 99%

Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options

2019

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BackgroundTrigeminal neuralgia is one of the most characteristic and difficult to treat neuropathic pain conditions in patients with multiple sclerosis. The present narrative review addresses the current evidence on diagnostic tests and treatment of trigeminal neuralgia secondary to multiple sclerosis.MethodsWe searched for relevant papers within PubMed, EMBASE and the Cochrane Database of Systematic Reviews, taking into account publications up to December 2018.ResultsTrigeminal neuralgia secondary to multiple sclerosis manifests with facial paroxysmal pain triggered by typical manoeuvres; neurophysiological investigations and MRI support the diagnosis, providing the definite evidence of trigeminal pathway damage. A dedicated MRI is required to identify pontine demyelinating plaques. In many patients with multiple sclerosis, neuroimaging and surgical evidence suggests that neurovascular compression might act in concert with the pontine plaque through a double-crush mechanism. Although no placebo-controlled trials have been conducted in these patients, according to expert opinion the first-line therapy for trigeminal neuralgia secondary to multiple sclerosis relies on sodium-channel blockers, i.e. carbamazepine and oxcarbazepine. The sedative and motor side effects of these drugs frequently warrant an early consideration for neurosurgery. Surgical procedures include Gasserian ganglion percutaneous techniques, gamma knife radiosurgery and microvascular decompression in the posterior fossa.ConclusionsThe relatively poor tolerability of the centrally-acting drugs carbamazepine and oxcarbazepine highlights the need to develop new selective and better-tolerated sodium-channel blockers. Prospective studies based on more advanced neuroimaging techniques should focus on how trigeminal anatomical abnormalities may be able to predict the efficacy of microvascular decompression.

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Section: Resultsmentioning

confidence: 99%

Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options

2019

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“…In selected cases, baclofen and misoprostol can be used to relieve neuralgia. The last drug can help in nerve stabilization by decreasing the inflammatory activity in the plaques [57]. Tramadol and opioid analgesics can be used as second-line therapies, for limited periods [58].…”

Section: Management Of Pain In Ms Patientsmentioning

confidence: 99%

Headache and Other Pain Syndromes in Multiple Sclerosis: A Narrative Review

Sîrbu,

Rotaru,

Antochi

et al. 2024

Life

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Multiple sclerosis is a chronic and progressive neurological disease, with an important socio-economic burden. Over time, an increased incidence of headaches like migraines and tension headaches has been observed among these patients. Headaches have not been considered as multiple sclerosis-related symptoms, even representing a red flag for multiple sclerosis diagnosis. It is uncertain whether the headache–multiple sclerosis association could be explained by the presence of common triggers or a common physiopathological mechanism (involvement of tertiary B-cell follicles). An important differential diagnosis is between multiple sclerosis attacks and migraines with aura, which can also be associated with neurological deficits. Another important aspect is the occurrence or exacerbation of the cephalalgic syndrome after the initiation of therapy for multiple sclerosis (DMTs), or the improvement of headache after the initiation of certain DMT drugs. In addition to headaches, individuals diagnosed with multiple sclerosis often report experiencing diverse pain syndromes, contributing to an additional decline in their overall quality of life. These syndromes are frequently neglected, the focus being on slowing down the progression of neurological deficits. This review aims to evaluate the characteristics of multiple-sclerosis-related headaches (frequency, possible correlation with attacks, and disease-modifying therapies) and the key distinctions in imaging characteristics between demyelinating lesions in multiple sclerosis and those observed in cases of primary headaches.

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“…Few studies reported the efficacy of misoprostol in a total of 27 patients with TN secondary to multiple sclerosis. 31 However, there is insufficient evidence to support or refute the use of this drug in TN.…”

Section: Calcium Channel Blockers (Ccbs): Usually In Patientsmentioning

confidence: 99%

Recent Advances in Trigeminal Neuralgia and Its Management: A Narrative Review

Burman

Khandelwal

Chaturvedi

2021

J Neuroanaesth Crit Care

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Trigeminal neuralgia (TN) is a chronic facial pain condition that affects one or more divisions of the trigeminal nerve (5th cranial nerve). It can be idiopathic, primary, or secondary. The cornerstone of the therapy has been antiepileptic medications, peripheral nerve blocks with various neurolytic agents, and surgical procedures. With the advent of newer technologies, minimally invasive neurolytic techniques like low-level laser therapy and ozone injection have revolutionized the management of TN. Novel drugs like vixotrigine and eslicarbazepine have been promising in reducing the frequency and severity of attacks. Inhaled carbon dioxide too has shown promising results in initial trials. Neuromodulation has given robust data in controlling neuralgic pain especially refractory to medical management. Pulsed radiofrequency has been used with increasing success and the side effects like dysesthesia and paresthesia are less. Cryotherapy, neural prolotherapy, and fiber knife techniques have helped us believe that TN can be controlled and cured. The need of the hour is to develop and explore newer modalities for trigeminal neuralgia treatment with minimum side effects. In this narrative review, we have tried to shed light into the newer modalities of treatment of TN along with new clinical classification for better disease recognition and management.

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Misoprostol as a Therapeutic Option for Trigeminal Neuralgia in Patients with Multiple Sclerosis

Cited by 17 publications

References 6 publications

Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options

Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options

Headache and Other Pain Syndromes in Multiple Sclerosis: A Narrative Review

Recent Advances in Trigeminal Neuralgia and Its Management: A Narrative Review

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