Trigeminal Neuralgia and Multiple Sclerosis

Brisman, Ronald

doi:10.1001/archneur.1987.00520160021008

Cited by 108 publications

(37 citation statements)

References 16 publications

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“…In this paper, an important number of patients with MS-related TN (11 patients, 29.7%) had bilateral pain. As underlined before, this fact had also been stated by other studies [25,26]. …”

Section: Discussionsupporting

confidence: 85%

Multiple Sclerosis-Related Trigeminal Neuralgia: A Prospective Series of 43 Patients Treated with Gamma Knife Surgery with More than One Year of Follow-Up

Tuleasca

Carron

Resseguier

et al. 2014

Stereotact Funct Neurosurg

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Background: Trigeminal neuralgia (TN) related to multiple sclerosis (MS) is more difficult to manage pharmacologically and surgically. Objective: This article aims to evaluate the safety and efficacy of Gamma Knife surgery (GKS) in this special group of patients. Methods: Between July 1992 and November 2010, 43 cases with more than 1 year of follow-up were operated with GKS for TN related to MS and prospectively evaluated in the Timone University Hospital, Marseille, France. Radiosurgery using the Gamma Knife (model B or C or Perfexion) was performed. A single 4-mm isocenter was positioned at a median distance of 8 mm (range 5.7-14.7) anterior to the emergence of the nerve. A median maximum dose of 85 Gy (range 75-90) was delivered. Results: The median follow-up period was 53.8 months (12-157.1). Thirty-nine patients (90.7%) were initially pain free. Their actuarial probability of remaining pain free without medication at 6 months, 1, 3, 5 and 10 years was 87.2, 71.8, 43.1, 38.3 and 20.5%, respectively, and remained stable till 12 years. The hypoesthesia actuarial rate at 6 months, 1 and 2 years was 11.5, 11.5 and 16%, and remained stable till 12 years. Conclusions: GKS proved safe and effective in this special group of patients.

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“…In this paper, an important number of patients with MS-related TN (11 patients, 29.7%) had bilateral pain. As underlined before, this fact had also been stated by other studies [25,26]. …”

Section: Discussionsupporting

confidence: 85%

Multiple Sclerosis-Related Trigeminal Neuralgia: A Prospective Series of 43 Patients Treated with Gamma Knife Surgery with More than One Year of Follow-Up

Tuleasca

Carron

Resseguier

et al. 2014

Stereotact Funct Neurosurg

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“…Bilaterality was slightly more (16%) than in the literature (12%) and MS was more frequent (5.5%) than in the literature (2%) likely related to overrepresentation of women in the sample. Women are more likely to have MS and MS is the most common (18%) known cause of bilateral trigeminal neuralgia [13,14]. Aside from this, the demographics and clinical features of our patients are in line with the literature indicating that even though they were not consecutive patients-impossible to obtain the low cost and novel method employed-they truly represent most TN patients.…”

Section: Discussionsupporting

confidence: 80%

Low saturated fat diet is effective in trigeminal neuralgia

Verma¹,

Sherwood²

2013

OJPM

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Objective: To determine the effectiveness of low saturated fat diet (LSFD) in patients with trigeminal neuralgia (TN). Design: 1) Internet forum where patients could request a 10 page LSFD plan, and 2) Follow-up assessment done by a retrospective 20-item questionnaire. Duration of treatment-2 months to 13 years. Pain rated on a Visual Analogue Scale and reported as typical, atypical, or both, defining typical TN as intermittent quick jolts/stabbing pain and atypical TN as continuous never ending discomfort. Setting: General community. Patients: 55 unselected patients, most with unilateral, severe and daily symptoms in V2 and V3 distribution for a mean duration of 8 years and on medications. 84% had pain level 9 -10 before treatment, 89% had daily attacks and 31% had undergone surgical procedures. Intervention: LSFD for 2 months-13 years (mean 20 months). Main outcome measure: VAS score and medication use before and after LSFD treatment. Results: Reported SF content was 3 -25 gm. With treatment 96% typical TN (p < 0.0001) and 71% atypical TN (p < 0.002) improved to level 0% -2. 9% improved in less than a week, 47% in 1 -2 weeks and 44% in 3 -4 weeks. 66% rated their compliance with diet as excellent and 27% as good. There were no side effects except weight loss. 72% of those on medications reduced or discontinued them. All patients with post-surgical residual severe typical TN also improved (p < 0.0001). Conclusions: LSFD is effective in TN with high compliance, few adverse effects and may result in reduction/ elimination of medications even in most severe cases.

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“…[714] Certainly, the present lack documentation of the safety/efficacy of BMP-2 “off-label” in the anterior cervical spine should make it an investigational drug/device. [1413]…”

Section: Questions Raised About Bmp-2: Dosage Indications Containmementioning

confidence: 99%

“…Rather, there had to be some reason to believe that the agent was both safe and effective for its intended use. [1413]…”

Section: Major Initial Error: Failure To Understand Limitations Of “Omentioning

confidence: 99%

Complications due to the use of BMP/INFUSE in spine surgery: The evidence continues to mount

2013

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Increasingly, adverse events (AE) attributed to utilizing BMP/INFUSE (Bone Morphogenetic Protein, Medtronic, Memphis, TN, USA) “off-label” in spine surgery are being reported. In 2008, the Food and Drug Administration (FDA) issued a warning that in anterior cervical spine surgery, the “off-label” use of BMP/INFUSE contributed to marked dysphagia, hematoma, seroma, swelling, and/or the need for intubation/tracheostomy. Subsequent studies have cited the following AE; heterotopic ossification (HO), osteolysis, infection, arachnoiditis, increased neurological deficits, retrograde ejaculation, and cancer. Furthermore, in 2011, Carragee et al. noted that 13 of the original industry-sponsored BMP/INFUSE spinal surgery studies failed to acknowledge multiple AE. Additionally, in 2012, Comer et al. observed that the frequency of retrograde ejaculation reported for BMP/INFUSE used “on-label” to perform Anterior Lumbar Interbody Fusion/Lumbar Tapered Fusion-Cage Device (ALIF/LT-Cage) was also largely “under-reported.” To summarize, there is mounting evidence in the spinal literature that utilizing BMP/INFUSE in spinal fusions contributes to major perioperative and postoperative morbidity.

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Trigeminal Neuralgia and Multiple Sclerosis

Cited by 108 publications

References 16 publications

Multiple Sclerosis-Related Trigeminal Neuralgia: A Prospective Series of 43 Patients Treated with Gamma Knife Surgery with More than One Year of Follow-Up

Multiple Sclerosis-Related Trigeminal Neuralgia: A Prospective Series of 43 Patients Treated with Gamma Knife Surgery with More than One Year of Follow-Up

Low saturated fat diet is effective in trigeminal neuralgia

Complications due to the use of BMP/INFUSE in spine surgery: The evidence continues to mount

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