Journal
CEPHALALGIA
Volume 41, Issue 5, Pages 593-603Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/0333102420974356
Keywords
Trigeminal neuralgia; multiple sclerosis; neurovascular contact; demyelinating plaque; microvascular decompression
Categories
Ask authors/readers for more resources
The primary cause of trigeminal neuralgia secondary to multiple sclerosis is demyelination along the intrapontine trigeminal afferents. In contrast to classical trigeminal neuralgia, neurovascular contact does not play a role in the etiology of trigeminal neuralgia secondary to multiple sclerosis. Microvascular decompression should generally not be offered to patients with this condition.
Introduction A demyelinating plaque and neurovascular contact with morphological changes have both been suggested to contribute to the etiology of trigeminal neuralgia secondary to multiple sclerosis (TN-MS). The aim of this study was to confirm or refute whether neurovascular contact with morphological changes is involved in the etiology of TN-MS. Methods We prospectively enrolled consecutive TN-MS patients from the Danish Headache Center. Clinical characteristics were collected systematically. MRI scans were done using a 3.0 Tesla imager and were evaluated by the same experienced blinded neuroradiologist. Results Sixty-three patients were included. Fifty-four patients were included in the MRI analysis. There was a low prevalence of neurovascular contact with morphological changes on both the symptomatic side (6 (14%)) and the asymptomatic side (4 (9%)), p = 0.157. Demyelinating brainstem plaques along the trigeminal afferents were more prevalent on the symptomatic side compared to the asymptomatic side (31 (58%) vs. 12 (22%), p < 0.001). A demyelinating plaque was highly associated with the symptomatic side (odds ratio = 10.6, p = 0.002). Conclusion The primary cause of TN-MS is demyelination along the intrapontine trigeminal afferents. As opposed to classical trigeminal neuralgia, neurovascular contact does not play a role in the etiology of TN-MS. Microvascular decompression should generally not be offered to patients with TN-MS. The study was registered at ClinicalTrials.gov (number NCT04371575)
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available