-
The Journal of Headache and Pain Oct 2023BMP7 has been shown to have neuroprotective effects and to alleviate demyelination. However, its role in trigeminal neuralgia (TN) has not been well investigated. The...
BACKGROUND
BMP7 has been shown to have neuroprotective effects and to alleviate demyelination. However, its role in trigeminal neuralgia (TN) has not been well investigated. The current study aims to determine whether BMP7 plays a role in demyelination, its effects on pain behaviors and mechanism of action in rats with TN.
METHODS
We used an infraorbital-nerve chronic-constriction injury (ION-CCI) to establish a rat model of TN. Adeno-associated viruses (AAVs) were injected into the rats to upregulate or downregulate BMP7. The mechanical withdrawal thresholds (MWT) of the injured rats were detected using Von Frey filaments. The changes in expression levels of BMP7 and oligodendrocyte (OL) markers were examined by western blotting, quantitative real-time PCR, immunofluorescence, and transmission electron microscopy.
RESULTS
The ION-CCI induced mechanical allodynia, demyelination, and loss of OLs with a reduction of BMP7. Short-hairpin RNA (shRNA)-BMP7 that inhibited BMP7 expression also caused mechanical allodynia, demyelination, and loss of OLs, and its mechanism may be OL apoptosis. Overexpressing BMP7 in the trigeminal spinal subnucleus caudalis(VC) with AAV-BMP7 relieved all three phenotypes induced by the CCI, and its mechanism may be alleviating OLs apoptosis. Two signal pathways associated with apoptosis, STAT3 and p65, were significantly downregulated in the VC after CCI and rescued by BMP7 overexpression.
CONCLUSION
BMP7 can alleviate TN by reducing OLs apoptosis and subsequent demyelination. The mechanism behind this protection could be BMP7-mediated activation of the STAT3 and NF-κB/p65 signaling pathway and subsequent decrease in OL apoptosis. Importantly, our study presents clear evidence in support of BMP7 as a possible therapeutic target for the treatment of TN.
Topics: Rats; Animals; Trigeminal Neuralgia; Hyperalgesia; Rats, Sprague-Dawley; Apoptosis; Oligodendroglia; Demyelinating Diseases
PubMed: 37875834
DOI: 10.1186/s10194-023-01681-3 -
The Journal of International Medical... Oct 2022To evaluate the effect of trigeminal nerve block (TNB) on patients' quality of life (QOL) 15 days after the procedure in patients with refractory TN. (Review)
Review
OBJECTIVE
To evaluate the effect of trigeminal nerve block (TNB) on patients' quality of life (QOL) 15 days after the procedure in patients with refractory TN.
METHODS
This retrospective observational cohort study involved patients receiving TNB (levobupivacaine, clonidine, corticosteroid) between 2014 and 2018 at a postoperative pain clinic in France. Change in QOL from Day 0 (before block) to Day 15 was assessed according to SF-12.
RESULTS
21 patients (62 ± 14 y) were included in the study. Most patients (71%) were referred following surgery or dentistry. Of the 9 patients (43%) who exhibited >10% increase in SF-12 scores and so were deemed responders, SF12-physical and SF12-mental were increased by mean differences of 17 and 9 points, respectively. The mean duration of block lasted 15 ± 59 days (range 1 to 90 days) and no severe adverse effects were observed.
CONCLUSION
Improved QOL was observed in approximately 50% of patients with trigeminal neuralgia (TN) two weeks after specific nerve block. The technique was easy to administer and well accepted by the patients.
Topics: Humans; Trigeminal Neuralgia; Quality of Life; Retrospective Studies; Levobupivacaine; Clonidine; Treatment Outcome; Trigeminal Nerve; Observational Studies as Topic
PubMed: 36281027
DOI: 10.1177/03000605221132027 -
Scientific Reports Aug 2021Neuroimaging studies have documented brain structural alterations induced by chronic pain, particularly in gray matter volume. However, the effects of trigeminal...
Neuroimaging studies have documented brain structural alterations induced by chronic pain, particularly in gray matter volume. However, the effects of trigeminal neuralgia (TN), a severe paroxysmal pain disorder, on cortical morphology are not yet known. In this study, we recruited 30 TN patients and 30 age-, and gender-matched healthy controls (HCs). Using Computational Anatomy Toolbox (CAT12), we calculated and compared group differences in cortical thickness, gyrification, and sulcal depth with two-sample t tests (p < 0.05, multiple comparison corrected). Relationships between altered cortical characteristics and pain intensity were investigated with correlation analysis. Compared to HCs, TN patients exhibited significantly decreased cortical thickness in the left inferior frontal, and left medial orbitofrontal cortex; decreased gyrification in the left superior frontal cortex; and decreased sulcal depth in the bilateral superior frontal (extending to anterior cingulate) cortex. In addition, we found significantly negative correlations between the mean cortical thickness in left medial orbitofrontal cortex and pain intensity, and between the mean gyrification in left superior frontal cortex and pain intensity. Chronic pain may be associated with abnormal cortical thickness, gyrification and sulcal depth in trigeminal neuralgia. These morphological changes might contribute to understand the underlying neurobiological mechanism of trigeminal neuralgia.
Topics: Cerebral Cortex; Chronic Pain; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Trigeminal Neuralgia
PubMed: 34381144
DOI: 10.1038/s41598-021-95811-z -
Current Pain and Headache Reports Apr 2024Trigeminal postherpetic neuralgia (TG-PHN) is a neuropathic pain condition complicating herpes zoster (HZ) attributed to the trigeminal nerve. It poses significant... (Review)
Review
PURPOSE OF REVIEW
Trigeminal postherpetic neuralgia (TG-PHN) is a neuropathic pain condition complicating herpes zoster (HZ) attributed to the trigeminal nerve. It poses significant challenges due to its persistent and debilitating nature. This review explores the clinical characteristics of TG-PHN, analyzes its pathophysiological underpinnings, and addresses existent and potential therapies.
RECENT FINDINGS
TG-PHN is one of the most common and complex PHN locations. It has distinguishing clinical and pathophysiological characteristics, starting with viral triggered injuries to the trigeminal ganglion (TG) and peripheral tissue and involving the ascending and descending brain modulation pathways. Current therapies include vaccines, oral and topical medications, and interventional approaches, like nerve blocks and neurostimulation. This review covers TG-PHN's clinical and physiological components, treatment options, and potential future targets for improved management. By exploring the complexities of this condition, we aim to contribute to developing more effective and targeted therapies for patients suffering from trigeminal PHN.
Topics: Humans; Neuralgia, Postherpetic; Neuralgia; Herpes Zoster; Trigeminal Neuralgia; Nerve Block
PubMed: 38261232
DOI: 10.1007/s11916-023-01209-z -
Ideggyogyaszati Szemle Nov 2022Trigeminal neuralgia is a severe neuropathic disorder, affecting the distribution area of the trigeminal nerve and often impairs the quality of life of patients. More... (Review)
Review
Trigeminal neuralgia is a severe neuropathic disorder, affecting the distribution area of the trigeminal nerve and often impairs the quality of life of patients. More and more scholars agree that one of the pathogenesis of trigeminal neuralgia is due to the demyelinating lesion caused by vascular compression or arachnoid bundle wrapping on the root exit zone of trigeminal nerve. In this regard, the most effective method is microvascular decompression, which can relieve the compression of the offending vessels and the thickened arachnoid on the trigeminal nerve. However, it still has some disadvantages, such as the possibility of fatal complications. In recent years, with the advancement of neurosurgical treatment technology, new progress has been made in microvascular decompression. This article mainly introduces the surgical techniques and new methods of the microvascular decompression.
Topics: Humans; Microvascular Decompression Surgery; Trigeminal Neuralgia; Quality of Life; Trigeminal Nerve; Neurosurgical Procedures; Decompression, Surgical
PubMed: 36541149
DOI: 10.18071/isz.75.0369 -
Medicina (Kaunas, Lithuania) Mar 2022: Managing people with trigeminal neuralgia (TN) and osteoporosis is challenging due to their debilitating conditions. Currently, the exact association between TN and...
: Managing people with trigeminal neuralgia (TN) and osteoporosis is challenging due to their debilitating conditions. Currently, the exact association between TN and osteoporosis in patients remains unknown, although there is potential overlapping of pathophysiological mechanisms. In response, we calculated TN risk in patients who have osteoporosis. : 45,393 patients aged over 50 years diagnosed with osteoporosis were matched with 45,393 non-osteoporosis patients aged over 50 years (1:1 ratio) who were used as the control group, using data from 1996 to 2010 from Taiwan's National Health Insurance Research Database. The cumulative incidences of subsequent TN and the hazard ratio were estimated using Cox proportional hazards modeling and the Kaplan-Meier method, respectively. : Among the total sample, 333 patients were diagnosed with TN during the follow-up period: 205 in the osteoporosis cohort and 128 in the control cohort. Through covariate adjustment, the overall TN incidence showed a 1.80-fold increase in the osteoporosis cohort in comparison with the control cohort (0.60 vs. 0.18 per 1000 person-years, respectively). The High Charlson Comorbidity Index, hypertension, and migraines were risk factors of TN. : Osteoporosis patients had a higher TN risk than that of the control cohort. Therefore, early recognition of pain and symptoms in osteoporotic people may help to identify possible TN patients who need prompt therapy.
Topics: Aged; Cohort Studies; Humans; Incidence; Osteoporosis; Retrospective Studies; Trigeminal Neuralgia
PubMed: 35334622
DOI: 10.3390/medicina58030447 -
Journal of the Neurological Sciences Mar 2022Trigeminal neuralgia (TN) is a severe facial pain disease with unknown pathogenesis. It has been thought that the familial form of TN is rare with a prevalence of about...
Trigeminal neuralgia (TN) is a severe facial pain disease with unknown pathogenesis. It has been thought that the familial form of TN is rare with a prevalence of about 1-2% among affected individuals, but emerging evidence suggests a role of genetic factors. This study examined the occurrence of familial TN among patients with classical or idiopathic TN. Patients with TN recruited from a hospital registry received an informed consent form with a questionnaire, and individuals reporting other family members with TN underwent a structured phone-interview. For affected family members, type of TN, available clinical, imaging, management results and available hospital patient records were studied. Pedigrees for all affected families were established. This study included 268 patients with either classical or idiopathic TN. The familial form of TN was present in 41/268 (15.3%) patients, that is, 37/244 (15.2%) patients with classical TN and in 4/24 (16.7%) with idiopathic TN. Total 38 families were identified, with two affected members in 32/38 families (84.2%), three affected family members in 5/38 (13.2%) and four family members in 1/38 (2.6%) families. Comparing the 41 familial TN cases with the 227 sporadic TN patients showed significantly earlier onset of TN and a significantly higher occurrence of right-sided pain in familial cases, while there was no difference in gender distribution, occurrence of arterial hypertension or trigeminal branch involved. Among patients with classical or idiopathic TN, the occurrence of the familial form of the disease is more frequent than traditionally assumed.
Topics: Facial Pain; Humans; Pedigree; Prevalence; Trigeminal Neuralgia
PubMed: 34954619
DOI: 10.1016/j.jns.2021.120101 -
Journal of Clinical Neuroscience :... Nov 2023To compare the efficacy and safety of full endoscopic or endoscope-assisted microvascular decompression (E-MVD) and microscopic microvascular decompression (M-MVD) for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To compare the efficacy and safety of full endoscopic or endoscope-assisted microvascular decompression (E-MVD) and microscopic microvascular decompression (M-MVD) for primary trigeminal neuralgia (TN).
METHODS
We systematically searched the online database, including PubMed, Embase and Cochrane Library. The search terms used included, but were not limited to, "Trigeminal Neuralgia", "Microvascular Decompression Surgery" and "Endoscope". Postoperative facial pain relief and postoperative complications were considered for meta-analysis. All the outcomes were calculated as odds ratios (ORs) with 95% confidence intervals using R language.
RESULTS
A total of three studies involving 442 (E-MVD [218] versus M-MVD [224]) patients were included for analysis in our study. Postoperative facial pain relief (very much improved or much improved) was no difference between the two groups (OR, 0.95;95% CI, 0.57-1.58; I = 0%; p = 0.83). In addition, the occurrence of some postoperative complications was not statistically different between the two groups, including CSFleak (OR, 1.35;95% CI, 0.16-11.13; I = 0%; p = 0.94), facial paralysis (OR, 0.26;95% CI, 0.03-2.54; I = 0%; p = 0.67), hearing loss (OR, 0.87;95% CI, 0.30-2.55; I = 32%; p = 0.22), facial numbness (OR, 1.03;95% CI, 0.56-1.87; I = 62%; p = 0.10).
CONCLUSIONS
Both endoscopic microvascular decompression and microscopic microvascular decompression for trigeminal neuralgia appear to provide patients with equivalent facial pain relief outcomes. Complication rates were also similar between the groups.
Topics: Humans; Trigeminal Neuralgia; Microvascular Decompression Surgery; Facial Pain; Endoscopy; Face; Postoperative Complications; Treatment Outcome; Retrospective Studies
PubMed: 37776679
DOI: 10.1016/j.jocn.2023.09.009 -
Pain Physician Dec 2022Conventional radiofrequency (CRF), pulsed radiofrequency (PRF), and pulsed com-bined conventional radiofrequency (PCRF) are widely used in the clinical treatment of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Conventional radiofrequency (CRF), pulsed radiofrequency (PRF), and pulsed com-bined conventional radiofrequency (PCRF) are widely used in the clinical treatment of trigeminal neuralgia (TN), collective evidence comparing the efficacy and safety of these radiofrequency therapies is still controversial.
OBJECTIVES
To provide additional evidence for the efficacy and safety of different radiofrequency therapies in the management of TN to update this section of the systematic review of Wu et al 2019.
STUDY DESIGN
A secondary systematic review and meta-analysis was conducted.
METHODS
Systematic database research about double-blind, randomized controlled trials (RCTs) was conducted based on PubMed, Embase, and Web of Science. Literature on TN in adults under different radiofrequency therapies was collected to evaluate pain scores, excellent pain relief, and occurrence of adverse effects after corresponding therapies.
RESULTS
A total of 11 studies, including 570 patients, were involved in our systematic review. Two studies from the same research team and one study with a completely different pain assessment tool were excluded from the meta-analysis. Ultimately, 8 studies, including 412 samples, were included in the quantitative synthesis. In secondary analyses, as with the report of Wu and colleagues, we also observed a safer outcome in PRF than CRF when regarding the occurrence of adverse effects. Nevertheless, unlike the last meta-analysis, despite no statistical difference in pain scores between CRF and PRF one week after surgery, a positive impact was observed in the CRF group one month and 3 months after surgery. A meta-analysis of 6 studies comparing PCRF and CRF was conducted and revealed no evidence to prove excellent pain relief of PCRF and CRF groups at 6 months, one year, and 2 years after surgery. However, a positive influence in reducing pain scores was observed in the PCRF group. Subgroup analysis further exhibited that PCRF positively affected TN when the temperature was lower than 70°C.
LIMITATIONS
(1) A small overall sample of included trials; (2) the diversity of tools used for pain assessment across trials, such as VAS, BNI, and NRS, limits the evaluation of outcomes; (3) a high risk exists for most studies in the meta-analysis for at least one domain, which may affect the reliability of results; (4) the short follow-up period of a few studies in the meta-analysis while the long-term efficacy of different radiofrequency treatments may require longer follow-up data to enhance the accuracy of the assessment.
CONCLUSIONS
PCRF provides better long-term efficacy and fewer adverse effects for treating TN. Yet, it is hard to draw definitive conclusions about excellent pain relief comparisons due to the moderate quality of evidence, high heterogeneity, and scarcity of available data.
Topics: Adult; Humans; Trigeminal Neuralgia; Pulsed Radiofrequency Treatment; Radiofrequency Therapy; Pain Management; Pain; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 36608005
DOI: No ID Found -
BMC Neurology Oct 2022Neurovascular compression (NVC) produces morphological changes on the trigeminal nerve root is considered the cause of trigeminal neuralgia (TN), but there were some...
OBJECTIVES
Neurovascular compression (NVC) produces morphological changes on the trigeminal nerve root is considered the cause of trigeminal neuralgia (TN), but there were some patients with TN found no NVC, and also NVC was found in asymptomatic individuals. Many studies found tight relationships of TN and morphological structures of trigeminal nerve. We designed this study to explore the correlation between multiplanar reconstruction (MPR) trigeminal nerve angulation (TNA) and TN.
METHODS
Patients with classical symptoms of TN were recruited as observation group (OG) in this study, 50 healthy controls were enrolled as control group (CG), the OG was further subtyped into young patients (YP), middle-aged patients (MP) and old patients (OP) based to the onset age of symptoms, and also divided into patients with or without trigger maneuvers (TM) based on the presence of TM or not. All the participants underwent magnetic resonance (MR) examinations in same device, bilateral TNA measurements were carried out in OG and CG, then TNA was compared between different groups or subgroups. All images were interpreted by two radiologists who were blinded to the study, diagnosis of TN was made by two senior neurosurgery professors.
RESULT
Ultimately, 95 patients with primary TN were recruited in OG, aged from 25 to 84 (61.15 ± 12.70) years with a course of 0.5 to 30 (5.03 ± 5.41) years, their onset age ranged from 24 to 82 (56.13 ± 11.98) years. There were 34 males and 61 females in OG, and 58 cases involved right side. The CG aged from 22 to 85 (61.86 ± 13.03) years. No statistical difference was found between the age of OG and CG(p = 0.76), and also the bilateral TNA of CG (154.92 ± 16.90° vs 155.55 ± 17.03°, p > 0.05), while TNA of OG was significantly smaller than CG (150.78 ± 11.29° vs 155.24 ± 16.88°, p = 0.019). In OG, TNA on the affected side was significantly smaller than the unaffected side (149.29 ± 12.44° vs 152.27 ± 9.85°, p = 0.014). TNA showed a positive correlation with onset age of patients with TN, as TNA on the affected side of YP was significantly smaller than MP and OP (139.00 ± 11.64° vs 148.86 ± 11.54°, 139.00 ± 11.64° vs 152.18 ± 12.61°, p = 0.004 and 0.026). Furthermore, patients with TM showed smaller TNA than those without TM (147.05 ± 11.30° vs 164.75 ± 8.39°, p < 0.001).
CONCLUSIONS
This study suggested that TNA might play a role in TN, small TNA could be a risk factor of TN. Furthermore, patients with small TNA are more likely to combine with TM, but more studies are needed to explore the exact role of TNA in TN.
Topics: Adult; Aged; Aged, 80 and over; Correlation of Data; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgical Procedures; Trigeminal Nerve; Trigeminal Neuralgia; Young Adult
PubMed: 36224533
DOI: 10.1186/s12883-022-02906-9