Trigeminal Neuralgia – A Prospective Systematic Study of Clinical Characteristics in 158 Patients

Abstract

Objective.-To prospectively describe the clinical characteristics of classical trigeminal neuralgia (TN) in a standardized manner.Background.-TN is a rare disease and most clinicians only see a few patients. There is a lack of prospective systematic studies of the clinical characteristics of TN. We hypothesized that contrary to current thinking, some TN patients suffer from sensory abnormalities at neurological examination.Methods.-Clinical characteristics such as demographics, pain characteristics, and comorbidities were systematically and prospectively collected from consecutive TN patients in a tertiary referral center in a cross-sectional study.Results.-A total of 158 patients were included. Average age of onset was 52.9 years. TN was more prevalent in women (95; 60%) than in men (63; 40%), P = .011, and more often located on the right (89; 56%) than on the left side (64; 41%), P = .043. It affected solely the second and/or third trigeminal branch in 109 (69%) while the first branch alone was affected in only 7 (4%). Notably, 78 (49%) had concomitant persistent pain in addition to paroxysmal stabbing pain. Autonomic symptoms were present in 48 (31%). Patients who had not undergone surgery for TN had sensory abnormalities in 35 (29%).Conclusions.-This, the first study in a series of papers focusing on the clinical, radiological, and etiological aspects of TN, revealed that the symptomatology of TN includes a high percentage of concomitant persistent pain, autonomic symptoms, and sensory abnormalities. These findings offer new insights to the prevailing clinical impression of the clinical characteristics in TN.

Association between neurovascular contact and clinical characteristics in classical trigeminal neuralgia: A prospective clinical study using 3.0 Tesla MRI

“…The remaining 135 patients constitute the study population ( Figure 3). The clinical characteristics of the total patient population were described in previous papers (19,23), and the prevalence of NVC and its associated characteristics on the symptomatic and asymptomatic side was reported in a recently published paper (5). The evaluation of the NVC was uncertain on the symptomatic side in three cases and in five cases on the asymptomatic side.…”

“…Exclusion criteria were bilateral TN, communication barriers, prior MVD or rhizotomia, symptomatic trigeminal neuralgia and contraindications to MRI. The method of the data collection, the MRI protocol and evaluation were previously reported in detail (5,19,23,24). It was determined by the Danish National Committee on Health Research Ethics (ID number H-1-2012-093) that the project did not need ethics approval or patients' informed consent, as it is observational and based on routine clinical and laboratory workup.…”

Quantitative sensory testing in classical trigeminal neuralgia—a blinded study in patients with and without concomitant persistent pain

“…1,14 In the current study, TN patients with sensory abnormalities were excluded, but there was a high frequency of subclinical sensory abnormalities at QST. It is possible that TN patients with clinically evident sensory abnormalities have even higher frequencies of QST abnormalities or more abnormal z scores.…”

Advances in diagnosis and treatment of trigeminal neuralgia

“…TN appears to be slightly more common among women and has both classical and symptomatic (~15% of cases) subtypes with the former most often associated with a neurovascular conflict of the trigeminal nerve in the prepontine cistern 5. The right side is more frequently involved 6. When TN occurs in young age or presents with bilateral symptoms, lack of triggered pain, absence of a refractory period, or an abnormal neurologic examination, secondary causes such as multiple sclerosis (MS) should be suspected 5.…”