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multiple_sclerosis_related_trigeminal_neuralgia

Trigeminal neuralgia secondary to multiple sclerosis (MS-TN) is a facial neuropathic pain syndrome similar to classic trigeminal neuralgia (TN). While TN is caused by neurovascular compression of the fifth cranial nerve (CN V), how MS-related demyelination correlates with pain in MS-TN is not understood.

Trigeminal neuralgia (TN) is relatively frequent in multiple sclerosis (MS) patients and can be extremely disabling.

Diagnosis

3T MR diffusion weighted, T1, T2 and FLAIR sequences were acquired for MS-TN, TN, and controls. Multi-tensor tractography was used to delineate CN V across cisternal, root entry zone (REZ), pontine and peri-lesional segments. Diffusion metrics including fractional anisotropy (FA), and radial (RD), axial (AD), and mean diffusivities (MD) were measured from each segment.

CN V segments showed distinctive diffusivity patterns. The TN group showed higher FA in the cisternal segment ipsilateral to the side of pain, and lower FA in the ipsilateral REZ segment. The MS-TN group showed lower FA in the ipsilateral peri-lesional segments, suggesting differential microstructural changes along CN V in these conditions 1).

Treatment

Surgical interventions are less effective for the treatment of MS-related TN compared with classic TN, and higher recurrence rates are observed and is more difficult to manage pharmacologically.

Treatment failure occurs in most of the MS-related TN patients independently of the type of treatment.

Gamma Knife surgery

Between July 1992 and November 2010, 43 cases with more than 1 year of follow-up were operated with GKS for TN related to MS and prospectively evaluated in the Timone University Hospital, Marseille, France. Radiosurgery using the Gamma Knife (model B or C or Perfexion) was performed. A single 4-mm isocenter was positioned at a median distance of 8 mm (range 5.7-14.7) anterior to the emergence of the nerve. A median maximum dose of 85 Gy (range 75-90) was delivered. Results: The median follow-up period was 53.8 months (12-157.1). Thirty-nine patients (90.7%) were initially pain free. Their actuarial probability of remaining pain free without medication at 6 months, 1, 3, 5 and 10 years was 87.2, 71.8, 43.1, 38.3 and 20.5%, respectively, and remained stable till 12 years. The hypoesthesia actuarial rate at 6 months, 1 and 2 years was 11.5, 11.5 and 16%, and remained stable till 12 years. GKS proved safe and effective in this special group of patients 2).

Balloon compression

Balloon compression had the highest rate of initial pain-free response (IPFR) and duration of pain-free intervals (PFIs), compared with other modalities in the initial treatment of MS-related TN 3).

1)
Chen DQ, DeSouza DD, Hayes DJ, Davis KD, O'Connor P, Hodaie M. Diffusivity signatures characterize trigeminal neuralgia associated with multiple sclerosis. Mult Scler. 2015 Apr 28. pii: 1352458515579440. [Epub ahead of print] PubMed PMID: 25921052.
2)
Tuleasca C, Carron R, Resseguier N, Donnet A, Roussel P, Gaudart J, Levivier M, Régis J. Multiple Sclerosis-Related Trigeminal Neuralgia: A Prospective Series of 43 Patients Treated with Gamma Knife Surgery with More than One Year of Follow-Up. Stereotact Funct Neurosurg. 2014 Jul 8;92(4):203-210. [Epub ahead of print] PubMed PMID: 25011487.
3)
Mohammad-Mohammadi A, Recinos PF, Lee JH, Elson P, Barnett GH. Surgical outcomes of trigeminal neuralgia in patients with multiple sclerosis. Neurosurgery. 2013 Dec;73(6):941-50; discussion 950. doi: 10.1227/NEU.0000000000000128. PubMed PMID: 23921703.
multiple_sclerosis_related_trigeminal_neuralgia.txt · Last modified: 2015/05/24 16:18 (external edit)