Introduction: Trigeminal neuralgia (TN) is relatively frequent in Multiple Sclerosis (MS) patients and procedural treatments are less effective than when used for classical TN. Outcomes from direct comparisons between different procedures for MS-related TN is lacking. In this study, initial pain-free rates (IPFR), duration of pain-free intervals (PFI) and associated prognostic factors were evaluated.
Methods: This was a retrospective IRB-approved analysis performed on 96 MS-related TN patients who underwent 277 procedures(1-11/patient) in our institution (1996-2011). Patient, disease and treatments characteristics, as well as outcomes were statistically evaluated.
Results: Most patients were female (60%). Median age at diagnosis of MS and TN were 39 and 50 years, respectively. 44 patients (47%) had brainstem plaques on MRI. At treatment, most of the patients had secondary-progressive (33%) or relapsing-remitting (31%) MS and 50% were receiving MS treatment. Overall, 89 patients (32%) underwent Glycerol Injection (GI), 82 (30%) Balloon Compression (BC), 54 (19%) Stereotactic Radiosurgery (SRS) and 52 (19%) other procedures. As upfront treatments GI (41%) and SRS (24%) were most common. IPFR was 72%, BC had the best (77%) and SRS the worst (56%) results. Overall failure-rate after 277 procedures was 77% with no significant difference between treatment modalities. Median PFI was 9 months. BC had the best (12 months) and SRS the worst (5 month) median PFI. Complications occurred after 94 procedures (34%), 77 of them (28%) were temporary or minor. SRS had the lowest complication rate (10%). In multivariable analysis, treatment type had significant effect on IPFR with better results for BC and GI.
Conclusions: The results of treatment in MS-related TNs are suboptimal. In our large series, treatment failure occurred frequently (77%) independent of procedure type. The best IPFRs were achieved after BC and GI. SRS had the lowest complication rate (10%) but also the lowest IPFR (56%) and the shortest PFI (5 months).
Patient Care: It could be used as a guidline for procedural treatment of patients with MS related trigeminal neuralgia
Learning Objectives: One of the largest series of different procedural approaches to the trigeminal neuralgia in multiple sclerosis patients