Brain white matter plasticity and functional reorganization underlying the central pathogenesis of trigeminal neuralgia

Abstract

Peripheral nerve damage does not fully explain the pathogenesis of trigeminal neuralgia (TN). Central nervous system changes can follow trigeminal nerve dysfunction. We hypothesized that brain white matter and functional connectivity changes in TN patients were involved in pain perception, modulation, the cognitive-affective system, and motor function; moreover, changes in functional reorganization were correlated with white matter alterations. Twenty left TN patients and twenty-two healthy controls were studied. Diffusion kurtosis imaging was analyzed to extract diffusion and kurtosis parameters, and functional connectivity density (FCD) mapping was used to explore the functional reorganization in the brain. In the patient group, we found lower axial kurtosis and higher axial diffusivity in tracts participated in sensory, cognitive-affective, and modulatory aspects of pain, such as the corticospinal tract, superior longitudinal fasciculus, anterior thalamic radiation, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, cingulated gyrus, forceps major and uncinate fasciculus. Patients exhibited complex FCD reorganization of hippocampus, striatum, thalamus, precentral gyrus, precuneus, prefrontal cortex and inferior parietal lobule in multiple modulatory networks that played crucial roles in pain perception, modulation, cognitive-affective system, and motor function. Further, the correlated structural-functional changes may be responsible for the persistence of long-term recurrent pain and sensory-related dysfunction in TN.

Altered Primary Motor Cortex Structure, Organization, and Function in Chronic Pain: A Systematic Review and Meta-Analysis

“…Two studies investigated functional as well as structural MRI changes. 95,101 In total, the included studies involved 1,248 chronic pain (20 different pain conditions) and 1,042 healthy participants. CRPS (n = 16 studies) and LBP (n = 16 studies) were the most frequently investigated conditions.…”

Acupuncture affects different ways for migraineurs of long- and short- courses on the efficiency of structural brain network

“…In the results, the left corticospinal tract, left posterior limb of the internal capsule, left superior longitudinal fasciculus and right tapetum were significantly decreased after acupuncture, while the left fornix and right medial lemniscus were increased significantly (Table 2, Figure 3). Previous studies [49,50] considered that the corticospinal tract, internal capsule and superior longitudinal fasciculus were all involved with sensory-motor, affective, cognitive and pain processing functions.…”

Combination of trigeminal neuralgia and cerebellopontine angle tumors. Modern approaches to diagnosis and treatment: literature review

“…В настоящее время существуют многочисленные теории, объясняющие патогенез классической НТН [3,[27][28][29][30][31][32]. Выделяют 2 основные гипотезы, первая -"периферическая", которую поддерживают боль-шинство исследователей, ее же считают основной причиной формирования классической НТН (в 75-90% наблюдений).…”

“…Именно к этому "слабому месту" ТН чаще всего прилежит петля ВМА, обусловливающая НВК [28,29]. Вторая гипотеза "центральная" рассматривает НТН как подобие фо-кальной эпилепсии, связанной с раздражением ядер ТН [30]. Есть и третье мнение, которое объединяет оба взгляда.…”