Summary
Trigeminal neuralgia (TN) in patients with multiple sclerosis (MS) is thought to be caused by demyelinating plaques within the nerve root entry zone, the trigeminal nucleus, or the trigeminal tracts. Authors review their experience of microvascular decompression (MVD) in patients with MS and symptomatic TN. Sandell T, Eide PK., Neurosurgery. 2010 Jul 21. [Epub ahead of print]
Details
All first-time MVDs for symptomatic trigeminal neuralgia in
patients with MS performed by the senior author during an 8-year
period (1999-2007) in this department were reviewed. The
preoperative pain components were differentiated as being 100%
episodic pain, > 50% episodic pain, or > 50% constant pain.
At follow-up, pain relief was assessed with a standard mail
questionnaire; those still having residual pain were further
examined in the outpatient clinic or interviewed by phone.
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.
CONCLUSION: In an 8-year experience of doing MVD in MS patients
with TN, authors found complete and significant relief of
episodic TN in a large proportion of patients. Even those with a
constant pain component before MVD were completely relieved of
their constant pain. Thus, in patients with TN (with or without a
constant pain component), the presence of MS should not prevent
patients from being offered MVD.