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Current Pain and Headache Reports Feb 2007The paroxysmal facial pain of trigeminal neuralgia is notoriously severe. Recent advances in medical science are achieving significant strides toward alleviating this...
The paroxysmal facial pain of trigeminal neuralgia is notoriously severe. Recent advances in medical science are achieving significant strides toward alleviating this incapacitating condition. High-resolution neuroimaging techniques are rendering detailed views of underlying neurovascular relationships. Newer antiepileptic medications and novel therapies are proving helpful in treating pain resistant to carbamazepine. Further developments also in targeted neurosurgical and radiosurgical techniques are providing pain relief within increasingly wider margins of safety. Much has been accomplished, yet much remains to be done.
Topics: Anticonvulsants; Carbamazepine; Humans; Magnetic Resonance Imaging; Oxcarbazepine; Radiography; Radiosurgery; Trigeminal Neuralgia
PubMed: 17214925
DOI: 10.1007/s11916-007-0025-7 -
Neurologia Medico-chirurgica 2015Microvascular decompression (MVD) is a highly effective surgical treatment for trigeminal neuralgia (TN). Although there is little prospective clinical evidence,... (Review)
Review
Microvascular decompression (MVD) is a highly effective surgical treatment for trigeminal neuralgia (TN). Although there is little prospective clinical evidence, accumulated observational studies have demonstrated the benefits of MVD for refractory TN. In the current surgical practice of MVD for TN, there have been recognized patterns and variations in surgical anatomy and various decompression techniques. Here we provide a stepwise description of surgical procedures and relevant anatomical characteristics, as well as procedural options.
Topics: Humans; Microvascular Decompression Surgery; Patient Positioning; Preoperative Period; Treatment Outcome; Trigeminal Neuralgia
PubMed: 25925756
DOI: 10.2176/nmc.ra.2014-0393 -
BMJ (Clinical Research Ed.) Jan 2007
Review
Topics: Facial Pain; Humans; Patient Satisfaction; Prognosis; Referral and Consultation; Trigeminal Neuralgia
PubMed: 17255614
DOI: 10.1136/bmj.39085.614792.BE -
BMC Neurology Jul 2021Medically-refractory trigeminal neuralgia (TN) can be treated successfully with operative intervention, but a significant proportion of patients are non-responders...
BACKGROUND
Medically-refractory trigeminal neuralgia (TN) can be treated successfully with operative intervention, but a significant proportion of patients are non-responders despite undergoing technically successful surgery. The thalamus is a key component of the trigeminal sensory pathway involved in transmitting facial pain, but the role of the thalamus in TN, and its influence on durability of pain relief after TN surgery, are relatively understudied. We aimed to test the hypothesis that variations in thalamic structure and metabolism are related to surgical non-response in TN.
METHODS
We performed a longitudinal, peri-operative neuroimaging study of the thalamus in medically-refractory TN patients undergoing microvascular decompression or percutaneous balloon compression rhizotomy. Patients underwent structural MRI and MR spectroscopy scans pre-operatively and at 1-week following surgery, and were classified as responders or non-responders based on 1-year post-operative pain outcome. Thalamus volume, shape, and metabolite concentration (choline/creatine [Cho/Cr] and N-acetylaspartate/creatine [NAA/Cr]) were evaluated at baseline and 1-week, and compared between responders, non-responders, and healthy controls.
RESULTS
Twenty healthy controls and 23 patients with medically-refractory TN treated surgically (17 responders, 6 non-responders) were included. Pre-operatively, TN patients as a group showed significantly larger thalamus volume contralateral to the side of facial pain. However, vertex-wise shape analysis showed significant contralateral thalamus volume reduction in non-responders compared to responders in an axially-oriented band spanning the outer thalamic circumference (peak p = 0.019). Further, while pre-operative thalamic metabolite concentrations did not differ between responders and non-responders, as early as 1-week after surgery, long-term non-responders showed a distinct decrease in contralateral thalamic Cho/Cr and NAA/Cr, irrespective of surgery type, which was not observed in responders.
CONCLUSIONS
Atrophy of the contralateral thalamus is a consistent feature across patients with medically-refractory TN. Regional alterations in preoperative thalamic structure, and very early post-operative metabolic changes in the thalamus, both appear to influence the durability of pain relief after TN surgery.
Topics: Female; Humans; Magnetic Resonance Imaging; Male; Microvascular Decompression Surgery; Rhizotomy; Thalamus; Treatment Outcome; Trigeminal Neuralgia
PubMed: 34303364
DOI: 10.1186/s12883-021-02323-4 -
Multiple Sclerosis and Related Disorders Sep 2019The commonest secondary cause for trigeminal neuralgia (TN) is multiple sclerosis (MS) and little is known about this group of patients in terms of their presentation... (Comparative Study)
Comparative Study
OBJECTIVES
The commonest secondary cause for trigeminal neuralgia (TN) is multiple sclerosis (MS) and little is known about this group of patients in terms of their presentation and treatments. We compared patients with TN and MS (pwTNMS) with a cohort of patients with primary TN, who had been referred to the same specialist unit, both in terms of characteristics and impact on quality of life at the time of their first assessment.
METHODS
Using a prospective patient database we extracted key clinical data and results from psychometrically tested questionnaires of 26 pwTNMS and compared them to an age and gender-matched set of 68 patients with primary TN.
RESULTS
Our findings suggest that pwTNMS exhibit a more severe clinical phenotype than primary TN. Prior to referral, pwTNMS are more likely to have used more healthcare services and undergone more neurosurgical interventions. Strikingly, pwTNMS exhibit reduced lengths and duration of remission periods and fewer identifiable triggers. Furthermore, pwTNMS report significant impact on quality of life comparable to those in primary TN, scoring highly in measures of anxiety, depression, and catastrophizing, but also report greater sleep disturbance, and overall interference in activities of daily living.
CONCLUSIONS
pwTNMS have a more intractable TN, one which may necessitate a more complex approach to treatment, earlier referral to secondary care and an extensive assessment of mental health. Quality of life in pwTNMS is severely affected by both their MS and their TN, suggesting management should occur in specialist centres with access to a multidisciplinary team.
Topics: Case-Control Studies; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Prospective Studies; Trigeminal Neuralgia
PubMed: 31228715
DOI: 10.1016/j.msard.2019.06.015 -
The Journal of Headache and Pain Nov 2020Previous researches have reported gray and white matter microalterations in primary trigeminal neuralgia (TN) with neurovascular compression (NVC). The central mechanism...
PURPOSE
Previous researches have reported gray and white matter microalterations in primary trigeminal neuralgia (TN) with neurovascular compression (NVC). The central mechanism underlying TN without NVC are unknown but may include changes in specific brain regions or circuitries. This study aimed to investigate abnormalities in the gray matter (GM) and white matter (WM) of the whole brain and the possible pathogenetic mechanism underlying this disease.
METHODS
We analyzed brain morphologic images of TN patients, 23 with NVC (TN wNVC) and 22 without NVC (TN wNVC) compared with 45 healthy controls (HC). All subjects underwent 3T-magnetic resonance imaging and pain scale evaluation. Voxel-based morphometry (VBM) and surface-based morphometry (SBM) were used to investigate whole brain grey matter quantitatively; graph theory was applied to obtain network measures based on extracted DTI data based on DTI data of the whole brains. Sensory and affective pain rating indices were assessed using the visual analog scale (VAS) and short-form McGill Pain Questionnaire (SF-MPQ).
RESULTS
The VBM and SBM analyses revealed widespread decreases in GM volume and cortical thickness in TN wNVC compared to TN woNVC, and diffusion metrics measures and topology organization changes revealed DTI showed extensive WM integrity alterations. However, above structural changes differed between TN wNVC and TN woNVC, and were related to specific chronic pain modulation mechanism.
CONCLUSION
Abnormalities in characteristic regions of GM and WM structural network were found in TN woNVC compared with TN wNVC group, suggesting differences in pathophysiology of two types of TN.
Topics: Brain; Gray Matter; Humans; Magnetic Resonance Imaging; Trigeminal Neuralgia; White Matter
PubMed: 33238886
DOI: 10.1186/s10194-020-01205-3 -
Acta Clinica Croatica Sep 2022The purpose of the study was to find differences in the parameters of the response to the blink reflex (BR) between patients with idiopathic trigeminal neuralgia (TN)...
The purpose of the study was to find differences in the parameters of the response to the blink reflex (BR) between patients with idiopathic trigeminal neuralgia (TN) and health volunteers. A prospective cohort study was conducted over 2 years. The TN-subgroup included 15 patients (mean age / SD 62.3 ± 10.7 years). Pain-free and healthy volunteers as a HV-subgroup (mean age / SD: 30.8 ± 8.1 years) were recruited from asymptomatic students of dental medicine. Diagnostic parameters were determined by measuring latency to the onset of the BR components from electric stimulation. The following branches of the trigeminal nerve were affected: maxillary branch only (26.7%), mandibular branch only (20%), combined: ophthalmic branch with maxillary branch (6.7%), and ophthalmic branch with mandibular branch (6.7%) respectively, combined maxillary and mandibular branch (26.7%) and affected all three branches (13.4%). The latencies of the BR, left and right side together, between subgroups were significantly higher for values R1 (homolateral early response), R2 (homolateral late response), R2c latency (contralaterally expressed response) in the TN-subgroup (p < 0.05). On the basis of the presence of R1c and R3 latencies and upon considering the abnormal findings of the BR, no statistically significant differences were found between the examined subgroups (p > 0.05). Blink-reflex parameters (R1, R2 and R2c) were significantly abnormal comparing TN-patients with healthy volunteers. The R3 component of the BR was related to noxious stimuli, likewise by innocuous stimuli.
Topics: Humans; Young Adult; Adult; Trigeminal Neuralgia; Blinking; Prospective Studies; Healthy Volunteers; Trigeminal Nerve
PubMed: 36824643
DOI: 10.20471/acc.2022.61.s2.16 -
Korean Journal of Radiology Aug 2022To determine the anatomical characteristics of the petrous ridge and trigeminal nerve in trigeminal neuralgia (TN) without neurovascular compression (NVC).
OBJECTIVE
To determine the anatomical characteristics of the petrous ridge and trigeminal nerve in trigeminal neuralgia (TN) without neurovascular compression (NVC).
MATERIALS AND METHODS
From May 2017 to March 2021, 66 patients (49 female and 17 male; mean age ± standard deviation [SD], 56.8 ± 13.3 years) with TN without NVC and 57 controls (46 female and 11 male; 52.0 ± 15.6 years) were enrolled. The angle of the petrous ridge (APR) and angle of the trigeminal nerve (ATN) were measured using magnetic resonance imaging with a high-resolution three-dimensional T2 sequence. Data on the symptomatic side were compared with those on the asymptomatic side in patients and with the mean measurements of the bilateral sides in controls. Receiver operating characteristic (ROC) analysis was conducted to evaluate the performance of APR and ATN in distinguishing TN patients from controls.
RESULTS
In TN patients without NVC, the mean ± standard deviation (SD) of APR on the symptomatic side (98.40° ± 19.75°) was significantly smaller than that of the asymptomatic side (105.59° ± 22.45°, = 0.019) and controls (108.44° ± 15.98°, = 0.003). The mean ATN ± SD on the symptomatic side (144.41° ± 8.92°) was significantly smaller than that of the asymptomatic side (149.67° ± 8.09°, = 0.003) and controls (150.45° ± 8.48°, = 0.001). The area under the ROC curve for distinguishing TN patients from controls was 0.673 (95% confidence interval [CI]: 0.579-0.758) for APR and 0.700 (CI: 0.607-0.782) for ATN. The sensitivity and specificity using the diagnostic cutoff yielding the highest Youden index were 81.8% (54/66) and 49.1% (28/57), respectively, for APR (with a cutoff score of 94.30°) and 65.2% (43/66) and 66.7% (38/57), respectively, for ATN (cutoff score, 148.25°).
CONCLUSION
In patients with TN without NVC, APR and ATN were smaller than those in controls, which may explain the potential cause of TN and provide additional information for diagnosis.
Topics: Female; Humans; Magnetic Resonance Imaging; Male; Trigeminal Nerve; Trigeminal Neuralgia
PubMed: 35695314
DOI: 10.3348/kjr.2021.0771 -
World Neurosurgery Mar 2018Patients with trigeminal neuralgia (TN) and multiple sclerosis (MS) are often treated with medications or a surgical procedure. However, there is little evidence that... (Review)
Review
BACKGROUND AND OBJECTIVE
Patients with trigeminal neuralgia (TN) and multiple sclerosis (MS) are often treated with medications or a surgical procedure. However, there is little evidence that such treatments result in 50% pain reduction and improvement in quality of life. The aim of this systematic review is to evaluate the clinical effectiveness of treatments in patients with MS and trigeminal neuralgia.
METHODS
We searched Medline, EMBASE, and the Cochrane Collaboration database from inception until October 2016. Two authors independently selected studies for inclusions, data extraction, and bias assessment.
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.
Topics: Disease Management; Humans; Multiple Sclerosis; Trigeminal Neuralgia
PubMed: 29294398
DOI: 10.1016/j.wneu.2017.12.147 -
Clinical Evidence Jun 2006
Review
Topics: Analgesics, Non-Narcotic; Carbamazepine; Humans; Trigeminal Neuralgia
PubMed: 16973066
DOI: No ID Found