Neurovascular contact plays no role in trigeminal neuralgia secondary to multiple sclerosis

Abstract

Introduction A demyelinating plaque and neurovascular contact with morphological changes have both been suggested to contribute to the etiology of trigeminal neuralgia secondary to multiple sclerosis (TN-MS). The aim of this study was to confirm or refute whether neurovascular contact with morphological changes is involved in the etiology of TN-MS. Methods We prospectively enrolled consecutive TN-MS patients from the Danish Headache Center. Clinical characteristics were collected systematically. MRI scans were done using a 3.0 Tesla imager and were evaluated by the same experienced blinded neuroradiologist. Results Sixty-three patients were included. Fifty-four patients were included in the MRI analysis. There was a low prevalence of neurovascular contact with morphological changes on both the symptomatic side (6 (14%)) and the asymptomatic side (4 (9%)), p = 0.157. Demyelinating brainstem plaques along the trigeminal afferents were more prevalent on the symptomatic side compared to the asymptomatic side (31 (58%) vs. 12 (22%), p < 0.001). A demyelinating plaque was highly associated with the symptomatic side (odds ratio = 10.6, p = 0.002). Conclusion The primary cause of TN-MS is demyelination along the intrapontine trigeminal afferents. As opposed to classical trigeminal neuralgia, neurovascular contact does not play a role in the etiology of TN-MS. Microvascular decompression should generally not be offered to patients with TN-MS. The study was registered at ClinicalTrials.gov (number NCT04371575)

Headache and immunological/autoimmune disorders: a comprehensive review of available epidemiological evidence with insights on potential underlying mechanisms

“…Indeed, in TN-MS the primary cause seems to be demyelination along the intra-pontine trigeminal afferents. Therefore, the authors concluded that microvascular decompression should generally not be offered to TN-MS patients [ 88 ].…”

Clinical Effect of Partial Sensory Root Rhizotomy on Recurrence of Multiple Sclerosing Trigeminal Neuralgia After Percutaneous Balloon Compression

“…Truini [16] believes that a dual concurrent mechanism explains trigeminal neuralgia in patients with multiple sclerosis. But Noory [17] has different opinion on it, he believes that neurovascular contact plays no role in trigeminal neuralgia secondary to MS. Paulo [18] reported 33 cases of MVD in the treatment of TN-MS, and a follow-up of 53.5 months after surgery indicated that the pain relief rate was 67%. They believed that although MVD is not as effective as classic TN in the treatment of TN-MS, it can still be recommended Choose, and the more severe the preoperative pain, the worse the surgical effect.…”

The role of neurovascular conflict in patients with multiple sclerosis and trigeminal neuralgia

“…al. (1) about the role of neurovascular conflict (NVC) in patients with trigeminal neuralgia (TN) and multiple sclerosis (MS). They included 54 patients for a MRI analysis and found no significant difference between symptomatic and asymptomatic TN side concerning the prevalence of a NVC, while a brainstem demyelinating plaque (BDP) was more frequent on the symptomatic TN side compared to the asymptomatic one.…”