Multiple Sclerosis Research Repository

1. “The efficacy and safety of gabapentin vs. carbamazepine in patients with primary trigeminal neuralgia: A systematic review and meta-analysis”: Xin Zhao and Shuyu Ge

-”Carbamazepine is the first choice for the treatment of primary trigeminal neuralgia”

-”The results revealed that for patients with PTN, the gabapentin group resulted in a significant improvement in the effective rate compared with the carbamazepine group with an OR of 2.02 and a significant decrease in adverse event rate with an OR of 0.28.”

2. “Current and Innovative Pharmacological Options to Treat Typical and Atypical Trigeminal Neuralgia”: G Di Stefano, A Truini, G Cruccu

-”In patients with atypical TN, both gabapentin and antidepressants are expected to be efficacious and should be tried as an add-on to oxcarbazepine or carbamazepine”

-”Although carbamazepine and oxcarbazepine are effective in virtually the totality of patients, they are responsible for side effects causing withdrawal from treatment in an important percentage of cases”

-”…secondary, due to an identifiable underlying neurologic disease…”

-”13.1.1.2 Secondary TN (TN attributed to MS…”

-”Drugs in Secondary Trigeminal Neuralgia: No randomised controlled trials were found in patients with secondary TN”

-”The existing studies based on CBZ, OXC, eslicarbazepine, lamotrigine, gabapentin, pregabalin, topiramate and misoprostol have an open label design and include small sample of patients with multiple sclerosis (MS)”

–

3. “Worsening of symptoms of multiple sclerosis associated with carbamazepine”: Ramsaransing G et al

-”Carbamazepine is widely used to treat paroxysmal neurological symptoms and pain. We report on five patients with multiple sclerosis in whom disability was seriously enhanced by treatment with carbamazepine at comparatively low dosages. It is possible to misinterpret worsening of symptoms as an exacerbation of multiple sclerosis.”

4. “Trigeminal neuralgia and pain related to multiple sclerosis”: G Cruccu et al

–Abstract: Although many patients with multiple sclerosis (MS) complain of trigeminal neuralgia (TN), its cause and mechanisms are still debatable. In a multicentre controlled study, we collected 130 patients with MS: 50 patients with TN, 30 patients with trigeminal sensory disturbances other than TN (ongoing pain, dysaesthesia, or hypoesthesia), and 50 control patients. All patients underwent pain assessment, trigeminal reflex testing, and dedicated MRI scans. The MRI scans were imported and normalised into a voxel-based, 3D brainstem model that allows spatial statistical analysis. The onset ages of MS and trigeminal symptoms were significantly older in the TN group. The frequency histogram of onset age for the TN group showed that many patients fell in the age range of classic TN. Most patients in TN and non-TN groups had abnormal trigeminal reflexes. In the TN group, 3D brainstem analysis showed an area of strong probability of lesion (P<0.0001) centred on the intrapontine trigeminal primary afferents. In the non-TN group, brainstem lesions were more scattered, with the highest probability for lesions (P<0.001) in a region involving the subnucleus oralis of the spinal trigeminal complex. We conclude that the most likely cause of MS-related TN is a pontine plaque damaging the primary afferents. Nevertheless, in some patients a neurovascular contact may act as a concurring mechanism. The other sensory disturbances, including ongoing pain and dysaesthesia, may arise from damage to the second-order neurons in the spinal trigeminal complex.

5. “A dual concurrent mechanism explains trigeminal neuralgia in patients with multiple sclerosis”: Truini A et al

–Results: MRI scans in most patients showed a demyelinating plaque in the pontine trigeminal root entry zone on the affected side. The frequency of the neurovascular compression and its association with the pontine demyelinating plaque were higher on the affected than on the unaffected side (54% vs 0%; p = 0.0001).

Conclusions: Our observation that in many patients with MS-related TN a pontine demyelinating plaque and neurovascular compression coexist should prompt neurologists to seek possible neurovascular compression in patients with MS-related TN.

6. “Diffusivity signatures characterize trigeminal neuralgia associated with multiple sclerosis”: Chen DQ et al

-Results: 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.

Conclusions:The study demonstrates objective differences in CN V microstrucuture in TN and MS-TN using non-invasive neuroimaging. This represents a significant improvement in the methods currently available to study pain in MS.

7. “Operative findings and outcomes of microvascular decompression for trigeminal neuralgia in 35 patients affected by multiple sclerosis”: Broggi G et al

—Results: Magnetic resonance imaging revealed the presence of demyelinating lesions affecting the brainstem trigeminal pathways of the painful side in 26 (74%) of 35 patients. During surgery, severe neurovascular compression at the trigeminal root entry zone was found in 16 (46%) of 35 patients. The long-term outcome was excellent in 39%, good in 14%, fair in 8%, and poor in 39% of patients. No statistically significant prognostic factor predicting good outcome could be found. There was no mortality, with a 2.5% long-term morbidity rate (facial nerve palsy in one patient).

–Conclusion: Results of MVD in trigeminal neuralgia MS patients are much less satisfactory than in the idiopathic group, indicating that central mechanisms play a major role in pain genesis.

8. “Abnormal impulse generation in focally demyelinated trigeminal roots”: Burchiel KJ et al

-In 12 cats and two Macaca mulatta monkeys, areas of chronic focal injury were induced in the trigeminal root by implantation of a chromic suture in the nerve near its entry into the brain stem. Experimental lesions were examined histologically and electrophysiologically at 1 week, 3 weeks, and 6 weeks after surgery. At 3 weeks following implantation, lesioned nerves showed areas of focal inflammation surrounding implanted sutures with prominent demyelination of adjacent axons. A total of 497 trigeminal units were studied, 304 of which had associated demyelination of the root. In these 304 cells, two types of abnormal impulse generation from areas of focal demyelination were recorded. Reflected orthodromic action potentials and prolonged high-frequency after-discharges following short priming trains of orthodromic stimuli were observed in 23% and 4% of cells, respectively. Ectopic spike initiation from areas of focal demyelination was not dependent upon anatomical continuity of the nerve with the brain stem, was augmented by hyperventilation, and could be eliminated by the intravenous administration of diphenylhydantoin sodium. The relevance of these findings to the pathophysiological mechanisms of pain syndromes involving peripheral nerves in general and the trigeminal system in particular is discussed.

9. “Impaired trigeminal nociceptive processing in patients with trigeminal neuralgia”: Obermann M et al

–Results: We found prolonged PREP and nBR latencies and reduced amplitudes comparing symptomatic and nonsymptomatic sides in all patients with TN. In patients with chronic facial pain, however, PREP amplitudes were larger and latencies shorter compared to patients with TN without facial pain, while nBR results were similar across groups.

Conclusion: The data suggest an impairment of the trigeminal nociceptive system due to demyelination and/or axonal dysfunction on the symptomatic side and locate this defect close to the root entry zone in the brainstem. Moreover, central facilitation of trigeminal nociceptive processing was observed in patients with trigeminal neuralgia with concomitant chronic facial pain indicating overactivation of central sensory transmission. This may represent a possible adaptive mechanism for the development of chronic pain.

10. “MRI characteristics of trigeminal nerve involvement in patients with multiple sclerosis”: Swinnen C et al

–Results and conclusion: A linear plaque involving the intrapontine fascicular part of the trigeminal nerve and lesions of the spinal trigeminal nucleus and tract seem to be distinctive MRI findings in patients with RRMS or CIS.

11. “Worsening of symptoms of multiple sclerosis associated with carbamazepine”: Ramsaransing G et al

-Carbamazepine is widely used to treat paroxysmal neurological symptoms and pain. We report on five patients with multiple sclerosis in whom disability was seriously enhanced by treatment with carbamazepine at comparatively low dosages. It is possible to misinterpret worsening of symptoms as an exacerbation of multiple sclerosis.

12. “Lamotrigine in trigeminal neuralgia secondary to multiple sclerosis”: Leandri M et al

-no abstract available

13. “An open-label trial of gabapentin treatment of paroxysmal symptoms in multiple sclerosis”: Solaro C et al

–

14. “Pregabalin for treating paroxysmal painful symptoms in multiple sclerosis: a pilot study”: Solaro C et al

-could not find abstract

15. “Topiramate modulation of R3 nociceptive reflex in multiple sclerosis patients suffering paroxysmal symptoms”: D’Aleo G et al

-doesn’t appear to be on PubMed

16. “Low-dose gabapentin combined with either lamotrigine or carbamazepine can be useful therapies for trigeminal neuralgia in multiple sclerosis”: Solaro C et al

-CBZ or LMT were reduced to a level which no longer produced adverse effects, although resulting in a lack of efficacy in relieving pain. Pain control was obtained in all patients but 1, with no side effects.

-*How was “pain control” defined? 

17. “Gabapentin relieves trigeminal neuralgia in multiple sclerosis patients”: Khan OA

-Gabapentin relieved pain completely in six and significantly in the seventh patient.

18. “Topiramate relives refractory trigeminal neuralgia in MS patients”: Zvartau-Hind M et al

-no abstract available

19. “Refractory trigeminal neuralgia successfully treated by combination therapy”: Solaro CM et al

-could not find abstract

20. “Surgical outcomes of trigeminal neuralgia in patients with multiple sclerosis”: Mohammad-Mohammadi A et al

–Methods: A total of 96 MS patients underwent 277 procedures (range, 1-11 procedures per patient) to treat TN at our institution from 1995 to 2011. Of these, 89 percutaneous retrogasserian glycerol rhizotomies, 82 balloon compressions, 52 stereotactic radiosurgeries, 28 peripheral neurectomies, 15 percutaneous radiofrequency rhizotomies, and 10 microvascular decompressions were performed as upfront or repeat treatments.

Results: Bilateral pain was observed in 10% of patients during the course of disease. During the follow-up period (median, 5.7 years), recurrence of symptoms was seen in 66% of patients, and 181 procedures were performed for symptom recurrence. As an initial procedure, balloon compression had the highest IPFR (95%; P = .006) and median PFI (28 months; P = .05), followed by percutaneous retrogasserian glycerol rhizotomy (IPFR, 74%, P = .04; median PFI, 9 months; P = .05). In general, repeat procedures had lower effectiveness compared with initial procedures, with no statistically significant difference seen across the various treatment modalities.

21. “A systematic review of the management of trigeminal neuralgia in patients with multiple sclerosis”: “Zakrzewska JM et

–Results: All studies were of low quality using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. For medical management, 10 studies were included, of which one was a randomized controlled trial. Two studies were on the use of misopropol, unique to patients with MS. For surgical therapy, 26 studies with at least 10 patients and a minimum of 2 years follow-up were included. All types of surgical procedures are reported and the results are poorer for TN with MS, with 50% having a recurrence by 2 years. The main complication was sensory loss. Many patients had to undergo further procedures to become pain free and there were no agreed prognostic factors.

Conclusions: There was insufficient evidence to support any 1 medical therapy and so earlier surgery may be preferable. A patient with TN and MS has therefore to make a decision based on low-level evidence, beginning with standard drug therapy and then choosing a surgical procedure.

22. “Percutaneous retrogasserian glycerol rhizotomy in the treatment of tic douloureux associated with multiple sclerosis”: Pickett GE et al

-need to look again for this one

23. “Percutaneous glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis: a long-term retrospective cohort study: Michael D. Staudt, MD, MsC

-RESULTS

The initial pain-free response rate was similar between groups (p = 0.726): MS-TN initial GR 89.6%; MS-TN repeat GR 91.9%; ITN initial GR 89.6%; ITN repeat GR 87.0%. The median time to recurrence after initial GR was similar between MS-TN (2.7 ± 1.3 years) and ITN (2.1 ± 0.6 years) patients (p = 0.87). However, there was a statistically significant difference in the time to recurrence after repeat GR between MS-TN (2.3 ± 0.5 years) and ITN patients (1.2 ± 0.2 years; p < 0.05). The presence of periprocedural hypesthesia was highly predictive of pain-free survival (p < 0.01).

24. “Outcomes after percutaneous surgery for patients with multiple sclerosis-related trigeminal neuralgia”: Mallory GW et al

-RESULTS:: Ninety-five patients initially had excellent (n = 45, 33%) or good (n = 50, 37%) outcomes. Pain relief was maintained in 58% of patients at 3 months and 28% at 2 years. There was no difference in excellent/good outcomes between the surgical groups (hazard ratio = 0.73; P = .14). No correlation was noted between pain relief and new or increased facial numbness (hazard ratio = 0.78; P = .19). Forty-four BMC patients (64%) had additional surgery compared with 36 PRGR patients (54%; P = .19). Complications were more frequent after BMC (17.4% vs 3.0%; P < .01). CONCLUSION:: Percutaneous surgery for patients with MS-TN is less likely to provide pain relief than similar operations performed for patients with idiopathic TN. New trigeminal deficits did not correlate with better facial pain outcomes, supporting the concept that many patients with MS-TN have centrally mediated pain.

25. “Long-term follow up of multimodality treatment for multiple sclerosis-related trigeminal neuralgia”: Krishnan S et al

-couldn’t find abstract

26. “The treatment of trigeminal neuralgia in patients with multiple sclerosis using percutaneous radiofrequency rhizotomy”: Berk C et al

–Results: There were thirteen patients with MS and medically refractory TN treated with percutaneous radiofrequency rhizotomy. The average age at diagnosis for MS was 41 with TN beginning an average of eight years later. Following rhizotomy, complete pain relief without the need for any medication was achieved in 81% of the patients. The addition of medications resulted in pain control in the remaining patients. During a mean follow-up period of 52 months, there was a 50% recurrence rate. There were no complications related to the procedure and the associated facial numbness was well-tolerated.

27. “Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis”: Rogers CL et al

-could not find abstract

28. “Role of microvascular decompression in trigeminal neuralgia and multiple sclerosis”: Broggi G et al

-need to look again for this one

29. “Therapy of trigeminal neuralgia secondary to multiple sclerosis”: Leandri M 

30. “What is the best treatment of drug-resistant trigeminal neuralgia in patients affected by multiple sclerosis?  A literature analysis of surgical procedures”: Montano N et al

–METHODS: We reviewed the literature about the studies reporting on surgical treatment of drug-resistant TN in MS patients. Case reports and case series less than 4 patients were excluded from the analysis. Nineteen studies were selected for the statistical analysis. To reduce the variability of the data, the selected studies were evaluated for the following outcome parameters: acute pain relief rate (APR), rate of recurrence (RR), pain free at follow-up rate (PF at FU) and complication rate (CR). For the statistical analysis, chi-square statistic, using the Fisher’s exact test was utilized.

RESULTS: There was no procedure statistically superior in terms of APR rate in MS patients following the surgical treatment of TN. The highest RR was observed for percutaneous balloon compression (PBC) (60.2±14.4%). This result was statistically significant when compared to gamma knife surgery (GKS) (p=0.0129) and microvascular decompression (MVD) (p=0.0281). MVD together with percutaneous radiofrequency rhizothomy (PRR) was associated with a statistically better PF at FU rate (56.5±16.8% and 73.5±14.2%, respectively). However PBC and MVD showed statistical significant minor CR compared to other techniques (no complications and 18.7±17.4%, respectively).

31. “Comparative study of gamma knife surgery and percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis”: Mathieu D et al

-Results

The median duration of follow-up was 39 months (range 13–69 months) in the GKS group and 38 months (range 2–75 months) in the PRGR group. Reasonable pain control (BNI Pain Scale Scores I–IIIb) was noted in 22 patients (81.5%) who underwent GKS and in 18 patients (100%) who underwent PRGR. For patients who underwent GKS, the median time to pain relief was 6 months; for those who underwent PRGR, pain relief was immediate. In the GKS group12 patients required subsequent procedures (3 patients for absence of response and 9 patients for pain recurrence), whereas in the PRGR group 6 patients required subsequent procedures (all for pain recurrence). As of the last follow-up, complete or reasonable pain control was finally achieved in 23 patients (85.2%) in the GKS group and in 16 patients (88.9%) in the PRGR group. The morbidity rate was 22.2% in the GKS group (all due to sensory loss and paresthesia) and 66.7% in the PRGR group (mostly hypalgesia, with 2 patients having corneal reflex loss and 1 patient suffering from meningitis).

32. “Retrogasserian glycerol injection of percutaneous stimulation in the treatment of typical and atypical trigeminal pain”: Dieckmann G et al

-21 patients suffered from symptomatic trigeminal neuralgia due to multiple sclerosis or of traumatic or infectious origin. Of these, only 38% became free of pain.

33. “Long-term results after glycerol rhizotomy for multiple-sclerosis-related trigeminal neuralgia”: Kondziolka D et al

-Percutaneous retrogasserian glycerol rhizotomy (PRGR) was used during an 11-year interval in 53 patients with typical trigeminal neuralgia associated with multiple sclerosis. All patients had failed extensive medical trials prior to PRGR. Long-term (median follow-up, 36 months) complete pain relief (no further medication) was achieved in 29 (59%) of 49 evaluable patients. Eight patients (16%) had satisfactory pain control but required occasional medication. Twelve patients (25%) had initial unsatisfactory results with inadequate pain relief; nine underwent alternative surgical procedures. Sixteen patients (30%) subsequently required repeat glycerol rhizotomies to reachieve pain control. Twenty-seven patients (60% of 45 patients evaluated for this finding) retained normal trigeminal sensation after injection. Major trigeminal sensory loss developed in a single patient who had four glycerol rhizotomies over a 25-month interval. No patient developed deafferentation pain. We believe that PRGR is a low-morbidity, effective, and repeatable surgical procedure for the management of trigeminal neuralgia in the setting of multiple sclerosis. 

34. “Percutaneous balloon compression for the treatment of trigeminal neuralgia in patients with multiple sclerosis.  Analysis of the potentially prognostic factors”: Montano N et al

-An excellent (BNI I-II)-good (BNI III) outcome was obtained in all patients with a single or repeated procedure. The presence of a single affected trigeminal division (p = 0.042), the absence of previous operations (p = 0.048), the compression time ≤5 min (p = 0.0067) and the pear-like shape of the balloon at the operation (p < 0.05) were associated to higher pain-free survival.

35. “The effectiveness of percutaneous balloon compression in the treatment of trigeminal neuralgia in patients with multiple sclerosis”: Martin S et al

-RESULTS

The mean age at first operation was significantly younger in the MS group compared with the non-MS group (59 years vs 72 years, respectively, p < 0.0001). After a mean follow-up of 43 months (MS group) and 25 months (non-MS group), the symptom recurrence rate following the first operation was higher in the MS group compared with that in the non-MS group (86% vs 47%, respectively, p < 0.01). During long-term follow-up, more than 70% of MS patients required multiple procedures compared with only 44% of non-MS patients. Excellent or satisfactory outcomes were not significantly different between the MS and non-MS cohorts, respectively, at 1 day postoperatively (82% vs 91%, p = 0.35), 3 months postoperatively (65% vs 81%, p = 0.16), and at last follow-up (65% vs 76%, p = 0.34). A similar incidence of postoperative complications was observed in the 2 groups.

36. “Percutaneous controlled radiofrequency rhizotomy in the management of patients with trigeminal neuralgia due to multiple sclerosis”: Kanpolat Y et al

-In the latter group, TN was found to be caused by multiple sclerosis (MS) in 17 cases (23.6%), one of whom had bilateral TN. All patients having TN with MS (17 cases) underwent percutaneous controlled radiofrequency rhizotomy (25 procedures) as the procedure of choice. The MS patients were followed for an average of 60 months (range: 6-141 months). Complete pain relief was achieved with a single procedure in 12 of the 17 MS cases (70.6%). Early (less than 2 weeks) pain recurrence was seen in two patients (11.8%), while the overall recurrence rate was 29.4%. A second procedure was required to control TN in three cases (17.6%), a third in one (5.9%), and twice for each side for the case with bilateral TN (5.9%). Pain was completely relieved in 14 cases (82.4%) with single or multiple RF rhizotomies. In three cases (17.6%), partial pain control was achieved with RF rhizotomy, and the patients continued to receive adjunctive medical therapy. No complications were observed. All 17 patients (100%) were classified to have done well with RF rhizotomy. Satisfactory results and good long-term pain control were obtained in patients having TN due to MS with percutaneous controlled RF rhizotomy. The authors propose that RF rhizotomy may be a safe and effective procedure in the neurosurgical armamentarium for the treatment of patients having TN due to MS.

37. “Experience in the use of high-frequency selective percutaneous rhizotomy in trigeminal neuralgia associated with multiple sclerosis”: Tyurnikov VM et al

-could not find abstract

38. “Gamma knife radiosurgery for treatment of trigeminal neuralgia in multiple sclerosis patients”: Huang E et al

–Methods: Seven patients with multiple-sclerosis-associated trigeminal neuralgia were identified from 50 consecutive patients treated for trigeminal neuralgia at the Memorial-Hermann Gamma Knife Radiosurgery Center. A Leksell gamma knife was used to deliver 80 or 90 Gy to a single 4-mm isocenter targeting the fifth nerve root entry zone into the pons. The patients were followed for a median period of 28 months and graded on a scale of 1 to 5, adopted from the Barrow Neurological Institute.

Results: All 7 patients showed excellent responses to radiosurgery with complete resolution of their pain and cessation of pain medications. The time to maximal response varied from 1 day to 8 months after treatment. The only complication was persistent facial numbness over the distribution of V2 and V3 which occurred in 4 patients. One patient experienced a recurrence of pain (grade 3) 24 months after radiation treatment, and she is currently being treated with carbamazepine.

39. “Single-institution retrospective series of gamma knife radiosurgery in the treatment of multiple sclerosis-related trigeminal neuralgia: factors that predict efficacy”: Weller M et al

– Methods: Between 2002 and 2010, 35 patients with MS-related trigeminal neuralgia were treated with GKRS. The median maximum dose was 90 Gy. Data were analyzed to determine the response to GKRS and factors that may predict for efficacy. Results: Of the 35 patients, 88% experienced a Barrow Neurological Institute (BNI) pain score of I-III at 3 months after GKRS. Kaplan-Meier estimates of 1-, 2- and 5-year freedom from BNI IV-V pain relapse were 57, 57 and 52%, respectively. Numbness was experienced by 39% of patients after GKRS, though no patients reported bothersome numbness. Several differences were noted between how the MS-related variant responded to GKRS and what has previously been reported for idiopathic trigeminal neuralgia. These include the observations that development of post-GKRS numbness did not predict for treatment response (p = 0.62) and that dorsal root entry zone dose did not predict for freedom from pain relapse (odds ratio 1.01, p = 0.1). Active smoking predicted for freedom from pain relapse (odds ratio 67.4, p = 0.04)

40. “Gamma knife radiosurgery for multiple sclerosis-related trigeminal neuralgia”: Zorro O et al

–Results: Eventual complete pain relief (BNI grade I) after GKRS and reasonable pain control (BNI grade I-IIIb) after GKRS were noted in 23 patients (62.1%) and 36 patients (97.3%) at some point in their course. Reasonable pain control (BNI grade I-IIIb) after GKRS was maintained in 82.6%, 73.9%, and 54.0% of patients after 1, 3, and 5 years. Fourteen patients (37.8%) underwent a second or a subsequent procedure for residual or recurrent pain. Eight patients underwent a second GKRS, 5 underwent percutaneous glycerol rhizotomy, and 1 underwent balloon microcompression. The complication rate after GKRS was 5.4% (new onset of nondisabling paresthesias). No patient developed dysesthesias.

41. “Frameless stereotactic radiosurgery for treatment of multiple sclerosis-related trigeminal neuralgia”: Conti A et al

–Results: Median follow-up was 37 (18-72) months. Barrow Neurological Institute pain scale score I-III was achieved in 23/27 patients (85%) within 45 days. Prescription isodose line (80%) accounting for a dose of 58 Gy incorporated an average of 4.85 mm (4-6 mm) of the nerve and mean nerve volume of 26.4 mm3 (range 20-38 mm3). Seven out of 27 patients (26%) had mild, not bothersome, facial numbness (Barrow Neurological Institute numbness score II). The rate of pain control decreased progressively after the first year, and only 44% of patients retained pain control 4 years later.

42. “Multiple sclerosis-related trigeminal neuralgia: a prospective series of 43 patients treated with gamma knife surgery with more than one of year of follow-up”: Tuleasca C et al

–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.

43. “Radiosurgery for multiple sclerosis-related trigeminal neuralgia: retrospective review of long-term outcomes”: Przybylowski CJ et al

–Results: Of the 50 living patients who underwent GKRS, 42 responded to surveys (31 women [74%], median age 59 years, range 32-76 years). During the initial GKRS, the trigeminal nerve root entry zone was targeted with a single isocenter, using a 4-mm collimator with the 90% isodose line completely covering the trigeminal nerve and the 50% isodose line abutting the surface of the brainstem. The median maximum radiation dose was 85 Gy (range 50-85 Gy). The median follow-up period was 78 months (range 36-226 months). The rate of pain control after the index GKRS (n = 42) was 62%, 29%, 22%, and 13% at 1, 3, 5, and 7 years, respectively. Twenty-eight patients (67%) underwent salvage treatment, including 25 (60%) whose first salvage treatment was GKRS. The rate of pain control after the first salvage GKRS (n = 25) was 84%, 50%, 44%, and 17% at 1, 3, 5, and 7 years, respectively. The rate of pain control after the index GKRS with or without 1 salvage GKRS (n = 33) was 92%, 72%, 52%, 46%, and 17% at 1, 3, 5, 7, and 10 years, respectively. At last follow-up, 9 (21%) of the 42 patients had BNI grade I facial pain, 35 (83%) had achieved pain control, and 4 (10%) had BNI grade IV facial numbness (very bothersome in daily life).

44. “Comparison of percutaneous Retrograsserian balloon compression and gamma knife radiosurgery for the treatment of trigeminal neuralgia in multiple sclerosis”: Alvarez-Pinzon AM et al

–Results: Immediate pain relief occurred in 87% of patients treated with PBC and in 23% of patients treated with GKRS. Kaplan-Meier plots for the 2 treatment modalities were similar. The 50% recurrence rate was at 12 months for the PBC group and 18 months for the GKRS group. Complication (excluding numbness) rates were 3% for GKRS and 21% for PBC. The difference was statistically significant (χ2 test, P = 0.03).

45. “Stereotactic radio surgery and radio frequency rhizotomy for trigeminal neuralgia in multiple sclerosis: a single institution experience”: Holland MT et al

–Results: The median age of patients at first operation in each group was 58.5±10.9 and 63.5±7.5 for SRS and RFR respectively. There were no significant differences in basic demographics. Overall, 71% of these patients had an excellent or good initial pain outcome. Over time, 60% of RFR and 29% of SRS patients required additional procedures to obtain satisfactory pain relief. The patients who underwent RFR as their index procedure required a significantly higher number of procedures to achieve adequate pain relief (RFR=2.7 vs SRS=2.0 [p=0.04]). The average index procedure costs in US dollars were significantly different (SRS=53,300±5257 vs RFR=12,315±3387). The average subsequent costs (costs incurred following the initial intervention) (SRS=8320±17,842, RFR=36,002±46,767) and total costs (SRS=61,620±16,087, RFR=48,317±48,475) were not statistically significantly different.

46. “Some patients with multiple sclerosis have neurovascular compression causing their trigeminal neuralgia and can be treated effectively with MVD: report of five cases”: Athanasiou TC et al

-need to look for this again

47. “Microvascular decompression for trigeminal neuralgia in patients with multiple sclerosis”: Eldridge PR et al

–RESULTS 

Of the 19 MS patients, 15 were available for follow-up. The median observation period was 55 months (range, 17–99 months). At follow-up, 7 of 15 patients (47%) were completely free of their episodic pain, and an additional 4 (27%) had significant relief of episodic pain (ie, worst pain marked as 0 to 3 cm on a 10-cm visual analog scale). Among the subgroup of 8 patients with a constant pain component, all were free of their constant pain, and 4 (50%) were free of their episodic pain.

48. “The effect of microvascular decompression in patients with multiple sclerosis and trigeminal neuralgia”: Sandell T et al

-need to look again for this one

49. “Outcomes after microvascular decompression for patients with trigeminal neuralgia and suspected multiple sclerosis”: Ariai MS et al
    -need to look again for this one

50. “Tapentadol helps in trigeminal neuralgia: a case report”: Mirosław Kiedrowski

51. “Trigeminal Pontine Sign: From Imaging to Diseases Beyond Trigeminal Neuralgia”: Marialuisa Zedde et al

–