Results of percutaneous rhizotomy for trigeminal neuralgia in patients with multiple sclerosis

Abstract

Introduction. Neuropathic pain in trigeminal neuralgia (TN) is one of the most common and debilitating symptoms in patients with multiple sclerosis (MS). This condition in MS is due to the demyelination of pontine afferent fibers in the sensory root of the trigeminal nerve. The area of demyelination is usually located in the ventrolateral pons between the exit of the trigeminal nerve root and the trigeminal nucleus, which is confirmed on MRI. In some cases, neurovascular compression also plays a role in afferent fiber injury, leading to the so-called double crush effect. Conservative therapy for TN in patients with MS is often insufficiently effective, thus increasing the pertinence of surgical treatment.

Materials and methods. The article reviews current pharmacological and surgical approaches to treating TN, findings from the literature, and our data on the safety and efficacy of percutaneous radiofrequency rhizotomy (PRR) for TN, based on the surgical treatment of 52 patients with MS at the Research Center of Neurology.

Results. PRR works by interrupting the connection between peripheral receptor zones and the hyperactive trigeminal structures in the brainstem. All patients were discharged from the hospital on day 2–3 after surgery, with complete pain resolution. There were early and late relapses in some instances, which required a repeated PRR.

Conclusion. PRR is a symptomatic surgical method that is safe, repeatable, and effective for treating TN in patients with MS, in whom pharmacological therapy has been ineffective or who could not tolerate it.

About the authors

Vladimir M. Tyurnikov

Research Center of Neurology

Email: lolaaskarova@mail.ru
Russian Federation, Moscow

Lola Sh. Askarova

Research Center of Neurology

Author for correspondence.
Email: lolaaskarova@mail.ru
Russian Federation, Moscow

Olga V. Trifonova

Research Center of Neurology

Email: lolaaskarova@mail.ru
Russian Federation, Moscow

Maria N. Zakharova

Research Center of Neurology

Email: lolaaskarova@mail.ru
Russian Federation, Moscow

Artem O. Gushcha

Research Center of Neurology

Email: lolaaskarova@mail.ru
Russian Federation, Moscow

References

  1. Katusic S., Williams D.B., Beard M., et al. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945-1984. Neuroepidemiology. 1991; 10(5–6):276–281. doi: 10.1159/000110284. PMID: 1798430.
  2. Di Stefano G., Maarbjerg S., Truini A. Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options. J Headache Pain. 2019; 20(1): 20. doi: 10.1186/s10194-019-0969-0. PMID: 30782116
  3. Hooge J.P., Redekop W. Trigeminal neuralgia in multiple sclerosis. Neurology. 1995; 45(7): 1294–1296. doi: 10.1212/wnl.45.7.1294. PMID: 7617185.
  4. Tyurnikov V.M., Peresedova A.V., Gushcha A.O., Zavalishin I.A. Percutaneous high-frequency selective rhizotomy in the trigeminal neuralgia therapy in multiple sclerosis. Neuromuscular Diseases. 2012(1):19–24. doi: 10.17650/2222-8721-2012-0-1-19-24.
  5. Truini A., Prosperini L., Calistri V., et al. A dual concurrent mechanism explains trigeminal neuralgia in patients with multiple sclerosis. Neurology. 2016; 86(22): 2094–2099. doi: 10.1212/WNL.0000000000002720. PMID: 27164695.
  6. Broggi G., Ferroli P., Franzini A., et al. Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatr. 2000; 68(1): 59–64. doi: 10.1136/jnnp.68.1.59. PMID: 10601403.
  7. Tyurnikov V.M., Peresedova A.V., Gushcha A.O., Koval K.V. Experience in the use of high-frequency selective percutaneous rhizotomy in trigeminal neuralgia associated with multiple sclerosis. Zh Vopr Neirokhir Im N N Burdenko. 2015; 79(5): 34–42. doi: 10.17116/neiro201579534-42. PMID: 26528611.
  8. Berk C., Constantoyannis C., Honey C.R. The treatment of trigeminal neuralgia in patients with multiple sclerosis using percutaneous radiofrequency rhizotomy. Can J Neurol Sci. 2003; 30(3): 220–223. doi: 10.1017/s0317167100002626. PMID: 12945945.
  9. Leandri M., Lunardi G., Inglese M., et al. Lamotrigine in trigeminal neuralgia secondary to multiple sclerosis. J Neurol. 2000; 247(7): 556–558. doi: 10.1007/s004150070157. PMID: 10993501.
  10. Solaro C., Boehmker M., Tanganelli P. Pregabalin for treating paroxysmal painful symptoms in multiple sclerosis: a pilot study. J Neurol. 2009; 256(10): 1773–1774. doi: 10.1007/s00415-009-5203-6. PMID: 19579001.
  11. Solaro C.M., Ferriero G. Refactory trigeminal neuralgia successfully treated by combination therapy (Pregabalin plus lamotrigine). Mult Scler Relat Disord. 2018; 25: 165–166. doi: 10.1016/j.msard.2018.07.027. PMID: 30081317.
  12. Pfau G., Brinkers M., Treuheit T., et al. Misoprostol as a therapeutic option for trigeminal neuralgia in patients with multiple sclerosis. Pain Med. 2012; 13(10): 1377–1378. doi: 10.1111/j.1526-4637.2012.01472.x. PMID: 22925476.
  13. Zakrzewska J.M., Palmer J., Morisset V., et al. Safety and efficacy of a Nav1. 7 selective sodium channel blocker in patients with trigeminal neuralgia: a double-blind, placebo-controlled, randomised withdrawal phase 2a trial. Lancet Neurol. 2017; 16(4): 291–300. doi: 10.1016/S1474-4422(17)30005-4. PMID: 28216232.
  14. Texakalidis P., Xenos D., Karras C.L., Rosenow J.M. Percutaneous surgical approaches in multiple sclerosis-related trigeminal neuralgia: a systematic review and meta-analysis. World Neurosurg. 2020. S1878-8750(20)32381-0. doi: 10.1016/j.wneu.2020.11.006. PMID: 33171325.
  15. Krishnan S., Bigder M., Kaufmann A.M. Long-term follow-up of multimodality treatment for multiple sclerosis-related trigeminal neuralgia. Acta Neurochir (Wien). 2018; 160(1): 135–144. doi: 10.1007/s00701-017-3383-x. PMID: 29167978.
  16. Patwardhan R.V., Minagar A., Kelley R.E., Nanda A. Neurosurgical treatment of multiple sclerosis. Neurol Res. 2006; 28(3): 320–325. doi: 10.1179/016164106X98224. PMID: 16687060.
  17. Sandell T., Eide P.K. The effect of microvascular decompression in patients with multiple sclerosis and trigeminal neuralgia. Neurosurgery. 2010; 67(3): 749–754. doi: 10.1227/01.NEU.0000375491.81803.5D. PMID: 20651626.
  18. Mohammad-Mohammadi A., Recinos P.F., Lee J.H. et al. Surgical outcomes of trigeminal neuralgia in patients with multiple sclerosis. Neurosurgery. 2013; 73(6): 941–950. doi: 10.1227/NEU.0000000000000128. PMID: 23921703.
  19. Cruccu G., Biasiotta A., Di Rezze S., et al. Trigeminal neuralgia and pain related to multiple sclerosis. Pain. 2009; 143(3): 186–191. doi: 10.1016/j.pain.2008.12.026. PMID: 19171430.

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Copyright (c) 2021 Tyurnikov V.M., Askarova L.S., Trifonova O.V., Zakharova M.N., Gushcha A.O.

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