Highlights
- •Demyelination phase in MS is required for development of trigeminal neuralgia.
- •Trigeminal neuralgia in MS primarily occurs in RRMS and SPMS subtypes.
- •Trigeminal neuralgia is more refractory in SPMS than RRMS.
- •MS progression is associated with worse trigeminal neuralgia pain outcome.
- •Demyelinating lesion in trigeminal sensory pathways leads to worse trigeminal pain.
Abstract
Background
Trigeminal neuralgia (TN) is a well-recognized symptom of multiple sclerosis (MS),
yet its clinical characteristics related to MS subtype is poorly studied. Our aim
was to evaluate whether development and clinical outcome of TN are influenced by MS
phenotype.
Methods
In this retrospective cohort study, our database from 2007 to 2022 was reviewed to
identify patients who had both the diagnosis of MS and TN, whether TN was an initial
symptom of MS or developed later in diagnosis. A detailed medical history and treatment
outcome was obtained. Pain status was assessed retrospectively using the Barrow Neurological
Institute Pain Scale (BNI-PS), with BNI-PS I-III considered as good pain control and
BNI-PS IV-V as poor pain control.
Results
58 patients had MS-related TN. 44 patients had relapsing remitting multiple sclerosis
(RRMS) at the time of TN diagnosis, 11 had secondary progressive multiple sclerosis
(SPMS) at the time of TN diagnosis, and type of MS was not clear in 3 patients at
the time of TN diagnosis (either RRMS or SPMS). Over a mean follow up of 18.8 (SD=10.9)
years, 30 transitioned to SPMS. TN was refractory to medical management in 9 RRMS
and 22 SPMS patients (p = 0.001). TN patients with RRMS required lower median number of pain medications
compared to SPMS (p = 0.014). Brain MRI was available in 41 of the entire cohort. Of these, 27 patients
had demyelinating lesions in the trigeminal sensory pathway and 14 did not. Patients
with existing lesions had a higher chance of failure of medical management (74% versus
36%, p = 0.017) and required surgical intervention (55% versus 7%, p = 0.003).
Discussion
TN was not seen in primary progressive multiple sclerosis (PPMS). In patients who
transitioned to SPMS, TN was more likely to be refractory to medical management. TN
was more refractory in the presence of demyelinating plaque involving trigeminal sensory
pathway.
Keywords
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Article info
Publication history
Published online: April 17, 2023
Accepted:
April 16,
2023
Received in revised form:
March 18,
2023
Received:
February 8,
2023
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
