Introduction: Multiple sclerosis (MS) is a demyelinating neurologic disorder that can sometimes manifest as trigeminal neuralgia (TN). While some MS patients with TN develop their facial pain from demyelinating plaques on the trigeminal nerve, some have neurovascular compression and could benefit from microvascular decompression (MVD).
Methods: We retrospectively studied 17 MS patients with TN who underwent MVD at one institution between December 2011-September 2016. Recorded variables included patient demographics, baseline symptoms, radiologic data, and surgical and pain follow-up outcomes.
Results: The average age of our cohort was 52.9 ± 10.5 years, with a female predominance of 82.4%. The average duration of MS from time of diagnosis was 448.3 ± 241.9 months, while the average duration of TN symptoms was 95.1 ± 82.3 months. 11 patients (64.7%) had prior procedures, including rhizotomy or radiosurgery. Trigeminal nerve compression was seen on pre-operative MRI for thirteen patients (76.5%), and, of note, enhancement of the trigeminal nerve was observed in seven cases (41.2%). Within the first three months following MVD, no patients had worsening pain or lack of pain relief. In fact, thirteen patients (76.5%) had complete pain relief with discontinuation of discharge medications for TN. The average time of follow-up was 21.3 ± 17.6 months. In that time, six patients (35.3%) had specifically recurrence of sharp, shooting pain. No risk factors were found to be significantly associated with residual TN pain following MVD or recurrence. The cohort was further stratified into patients who were using disease-modifying drugs for MS, which included natalizumab, glatiramer, teriflunomide, and fingolimod. 10 patients (58.8%) were on disease-modifying therapy; however, the use of disease-modifying medications was not a significant risk factor for poorer MVD outcomes or recurrence of TN pain.
Conclusions: MS patients can suffer from a variety of neurologic symptoms, including TN pain. Patients with both conditions can benefit from MVD.
Patient Care: There are few case series on treating patients with trigeminal neuralgia pain in the setting of multiple sclerosis, and even fewer on the outcomes of microvascular decompression surgery.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe characteristics of patients presenting with both MS and trigeminal neuralgia, 2) understand the efficacy of MVD for TN in the setting of MS