The prevalence of trigeminal neuralgia in multiple sclerosis (MS) patients is higher than in the general population. Patients whose pain is insufficiently relieved by medication requires invasive treatment, although studies on outcomes of surgically treated MS-related trigeminal neuralgia patients suggest higher recurrence rates and lower pain-free responses compared to idiopathic trigeminal neuralgia.
Researchers launched a retrospective, multicentre study to gather information on the characteristics of MS patients with trigeminal neuralgia on medical and surgical treatments.
This Italian study consisted of 298 patients (179 female and 119 male) with a mean age of 48 at the onset of trigeminal neuralgia. The mean Expanded Disability Status Scale score at onset was four. Pain was most frequently located in the territory of the third trigeminal branch and was bilateral in only 4% of cases.
Carbamazepine was the most frequent preventative treatment, prescribed as a first choice in 52% of cases, followed by oxcarbazepine (20%), gabapentin (14%) and pregabalin (10%).
The first choice treatment was mostly discontinued due to inefficacy (48%) or adverse events and tolerability issues (40%), with only 12% of patients discontinuing it due to pain remission.
A second, third or fourth preventive treatment was prescribed, either in combination or sequentially, in 43, 12 and 4% of patients, respectively. First-choice symptomatic treatments were intravenous steroids (44%), nonsteroidal anti-inflammatory drugs (20%) and opioids (17%).
Surgery was performed in 81 (30%) patients, most commonly gamma knife stereotactic radiosurgery (37%), followed by microvascular decompression (22%) and radiofrequency thermocoagulation (21%). A second surgical procedure was carried out in 32% of these, and a third procedure in 10%. The majority of patients (77%) are currently being treated for trigeminal neuralgia; of these, 19% require a combination of at least two medications.
Researchers concluded that long-lasting pain remission in MS-related trigeminal neuralgia was uncommon in its study population, with over one third of surgically treated patients undergoing a repeat surgical procedure and with 77% of all patients requiring at least one preventive medication after a mean period ofnine years from trigeminal neuralgia onset.
This study was published on the ECTRIMS 2018 online library.
Source MS-UK 11/10/2018