Stereotactic radio surgery and radio frequency rhizotomy for trigeminal neuralgia in multiple sclerosis: A single institution experience

Holland, Marshall T.; Teferi, Nahom; Noeller, Jennifer; Swenson, Andrea; Smith, Mark C.; Buatti, John M.; Hitchon, Patrick W.

doi:10.1016/j.clineuro.2017.09.004

Cited by 16 publications

(13 citation statements)

References 33 publications

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“…The results of our study appear consistent with other studies evaluating SRS and RFA for MS-TN, with initial pain relief (BNI I–IIIb) response rates ranging between 50 and 100% and between 75 and 100%, respectively, and recurrence rates of 30–60% for both modalities [10, 13-25]. In terms of onset of pain freedom, SRS patients in our series experienced pain freedom with a median of 15 and 10 weeks following the initial and final procedures, respectively, which is within the lower range of reported response times in the literature (4–64 weeks) [10, 16, 17, 19].…”

Section: Discussionsupporting

confidence: 91%

“…Our current study is one of the few that directly compared the outcomes of SRS and RFA for MS-TN within a single institution [13]. Because of the episodic nature and high recurrence rate of surgically refractory MS-TN, we report BNI outcomes following initial and final treatments.…”

Section: Discussionmentioning

confidence: 99%

“…Since vascular compression is not typically present in MS-TN, current treatments aim to selectively lesion the trigeminal nerve and include glycerol rhizotomy, balloon compression, radiofrequency ablation (RFA), and stereotactic radiosurgery (SRS) [10]. There is, however, no consensus regarding the preferred treatment modality for TN-MS [11, 12], and limited data exist comparing the outcomes of SRS and RFA [13]. In this study, we performed a retrospective cohort study to examine the effectiveness of SRS and RFA in the treatment of MS-TN patients.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Stereotactic Radiosurgery and Radiofrequency Ablation for Trigeminal Neuralgia in Multiple Sclerosis Patients

Lee

Raygor

Elefant

et al. 2020

Stereotact Funct Neurosurg

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Background: The optimal treatment for medically refractory trigeminal neuralgia in multiple sclerosis (MS-TN) patients is unknown. Objective: To compare treatment outcomes between stereotactic radiosurgery (SRS) and radiofrequency ablation (RFA). Methods: We performed a retrospective study of MS-TN patients treated with SRS or RFA between 2002 and 2019. Outcomes included degree of pain relief, pain recurrence, and sensory changes, segregated based on initial treatment, final treatment following retreatment with the same modality, and crossover patients. Results: Sixty surgical cases for 42 MS-TN patients were reviewed. Initial pain freedom outcomes and rates of retreatment were similar (SRS: 30%; RFA: 42%). RFA resulted in faster onset of pain freedom (RFA: < 1 week; SRS: 15 weeks; p < 0.001). SRS patients with pain relief had longer intervals to pain recurrence at 2 years (p = 0.044). Final treatment outcomes favored RFA for pain freedom/off-medication outcomes (RFA: 44%; SRS: 11%; p = 0.031), though RFA resulted in more paresthesia (RFA: 81%; SRS: 39%; p = 0.012). Both provided at least 80% of adequate pain relief. Crossover patients did not have improved pain relief. Conclusions: SRS and RFA are both valid surgical options for MS-TN. Discussion with providers will need to balance patient preference with their unique treatment characteristics.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of Stereotactic Radiosurgery and Radiofrequency Ablation for Trigeminal Neuralgia in Multiple Sclerosis Patients

Lee

Raygor

Elefant

et al. 2020

Stereotact Funct Neurosurg

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“…In a recent study involving a small sample of patients radiofrequency thermocoagulation and stereotactic radiosurgery provide initial pain relief in 71% of patients. Over time, 60% of radiofrequency thermocoagulation and 29% of stereotactic radiosurgery patients required additional procedures to obtain satisfactory pain relief [87].…”

Section: Resultsmentioning

confidence: 99%

Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options

2019

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BackgroundTrigeminal neuralgia is one of the most characteristic and difficult to treat neuropathic pain conditions in patients with multiple sclerosis. The present narrative review addresses the current evidence on diagnostic tests and treatment of trigeminal neuralgia secondary to multiple sclerosis.MethodsWe searched for relevant papers within PubMed, EMBASE and the Cochrane Database of Systematic Reviews, taking into account publications up to December 2018.ResultsTrigeminal neuralgia secondary to multiple sclerosis manifests with facial paroxysmal pain triggered by typical manoeuvres; neurophysiological investigations and MRI support the diagnosis, providing the definite evidence of trigeminal pathway damage. A dedicated MRI is required to identify pontine demyelinating plaques. In many patients with multiple sclerosis, neuroimaging and surgical evidence suggests that neurovascular compression might act in concert with the pontine plaque through a double-crush mechanism. Although no placebo-controlled trials have been conducted in these patients, according to expert opinion the first-line therapy for trigeminal neuralgia secondary to multiple sclerosis relies on sodium-channel blockers, i.e. carbamazepine and oxcarbazepine. The sedative and motor side effects of these drugs frequently warrant an early consideration for neurosurgery. Surgical procedures include Gasserian ganglion percutaneous techniques, gamma knife radiosurgery and microvascular decompression in the posterior fossa.ConclusionsThe relatively poor tolerability of the centrally-acting drugs carbamazepine and oxcarbazepine highlights the need to develop new selective and better-tolerated sodium-channel blockers. Prospective studies based on more advanced neuroimaging techniques should focus on how trigeminal anatomical abnormalities may be able to predict the efficacy of microvascular decompression.

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“…Some TN patients may end up needing surgery, particularly if pharmacotherapy is ineffective or they become resistant to the drugs. Surgical treatments include microvascular decompression, gamma knife radio surgery treatment (GKRS), stereotactic radio surgery, and other invasive approaches [6][7][8] . Unfortunately, invasive treatments for TN can cause severe, diverse, and unpredictable side effects.…”

mentioning

confidence: 99%

Effects of palmatine on BDNF/TrkB-mediated trigeminal neuralgia

Liu

Yin

et al. 2020

Sci Rep

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Trigeminal neuralgia (TN), a sudden, needle-like pain in the distribution area of the trigeminal nerve, can seriously affect the physical and mental health of patients. In chronic pain conditions including TN, increased levels of brain-derived neurotrophic factor (BDNF) may enhance pain transmission. This study compares the effect of palmatine administration on the expression of BDNF and its receptor TrkB (tropomyosin receptor kinase B) in trigeminal ganglion cells of Sprague-Dawley rats in a shamversus TN model group. Within 14 days of surgery, the mechanical allodynia threshold of the TN group was significantly lower than that of the sham group, while the TN + palmatine group had a higher mechanical pain sensitivity threshold than the TN group (p < 0.05). Real-time quantitative PCR, immunohistochemistry, and immunofluorescence showed that BDNF and TrkB expression in the TN group was higher than that in the sham group, while palmatine treatment could reverse these changes. Western blotting showed that palmatine treatment could reduce the elevated phosphorylation of extracellular signal-regulated kinases 1/2 (ERK1/2) in TN rats. Thus, the BDNF/TrkB pathway may be involved in the pain transmission process of TN, and palmatine treatment may reduce pain transmission by inhibiting the BDNF/TrkB pathway and suppressing ERK1/2 phosphorylation.

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Stereotactic radio surgery and radio frequency rhizotomy for trigeminal neuralgia in multiple sclerosis: A single institution experience

Cited by 16 publications

References 33 publications

Comparison of Stereotactic Radiosurgery and Radiofrequency Ablation for Trigeminal Neuralgia in Multiple Sclerosis Patients

Comparison of Stereotactic Radiosurgery and Radiofrequency Ablation for Trigeminal Neuralgia in Multiple Sclerosis Patients

Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options

Effects of palmatine on BDNF/TrkB-mediated trigeminal neuralgia

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