Trigeminal Neuralgia
Ronald Brisman, M.D.

Trigeminal Neuralgia And Multiple Sclerosis

 

 

 What is multiple sclerosis (MS)?

Multiple sclerosis is a disease of the brain, spinal cord and optic (vision) nerves. There are multiple areas of involvement that usually occur at different periods of time. The fatty material (myelin) that surrounds nerves is often damaged (causing a scar or plaque) and nerve impulses are impaired. The body’s own defenses attack the myelin (autoimmune disease). Many kinds of symptom are present including abnormal sensations, muscle weakness, impaired coordination and balance, visual impairment and trigeminal neuralgia. Women are affected more than men and the disease usually starts in young adults.

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 How often do patients with trigeminal neuralgia (TN) have multiple sclerosis (MS)?

Approximately 5 percent of patients with TN have MS and about 2 percent of patients with MS will develop TN. Most patients with multiple sclerosis and trigeminal neuralgia (about 85 percent) will first develop other symptoms of MS before the TN and the diagnosis of multiple sclerosis is usually established before they develop trigeminal neuralgia.

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 How does trigeminal neuralgia differ between those with or without multiple sclerosis?

Patients with multiple sclerosis (MS) are much more likely (about 20 times) to develop trigeminal neuralgia (TN) than patients without MS. Patients with TN and MS are more likely to be younger than those without MS. Patients with trigeminal neuralgia and multiple sclerosis are more likely to develop it on both sides of the face (approximately 20 percent of patients) than those without multiple sclerosis (approximately 5 percent of patients), but it is rare for anyone to have it on both sides of the face at the same time. Although compression of the trigeminal nerve is a common cause of trigeminal neuralgia in those without multiple sclerosis, it is unlikely to be the cause in those who have multiple sclerosis where the cause is a demyelinating scar or plaque.

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 How can the Magnetic Resonance Imaging (MRI) be helpful in patients with trigeminal neuralgia and multiple sclerosis?

If a high resolution MRI is done with appropriate sequences in patients with multiple sclerosis, lesions are usually seen some place in the brain and are often seen in the area that carries messages from the trigeminal system, especially in patients with trigeminal neuralgia and multiple sclerosis. Special MRI sequences such as T2 FLAIR (fluid attenuated inversion recovery) are particularly effective in showing multiple sclerosis lesions. It is a good idea to do these imaging sequences in patients with trigeminal neuralgia whether or not they have been diagnosed with multiple sclerosis. 

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 What is the medical treatment for patients with trigeminal neuralgia and multiple sclerosis?

Patients with trigeminal neuralgia (TN) and multiple sclerosis (MS) respond very well to the medicines that are used to treat TN. Carbamazepine and oxcarbazepine are the two most effective medicines. However, patients with MS are more likely to develop unpleasant side effects such as worsening of their MS symptoms with added weakness and fatigue from these and other medicines used to treat trigeminal neuralgia.

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 What is the neurosurgical treatment for patients with trigeminal neuralgia and multiple sclerosis?

Since trigeminal neuralgia in patients with multiple sclerosis is caused by a demyelinating plaque and not vascular compression, the surgical treatments recommended are those which cause direct nerve alteration and partial damage. These can be accomplished by minimally invasive, out-patient procedures such as needle rhizotomy (especially Radiofrequency Electrocoagulation and/or glycerol) or Gamma Knife radiosurgery.

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 What are the results of treatment of patients with trigeminal neuralgia?

Almost all patients with trigeminal neuralgia (TN) including those with multiple sclerosis can get relief from face pain. The minimally invasive procedures (Gamma Knife radiosurgery and needle rhizotomy) are very effective and are especially attractive for patients with multiple sclerosis as these procedures are well tolerated. Further benefit can occur from improvement in other multiple sclerosis symptoms, which often results from the lowering or eliminating the medicines needed to control TN. However, it is not unusual for there to be a need for more than one procedure during the patient’s lifetime as trigeminal neuralgia sometimes returns. Multiple sclerosis patients are more prone to recurrence because they may occasionally develop face pain on the other side and often poorly tolerate medicines used to treat trigeminal neuralgia.

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 What is a reference for trigeminal neuralgia and multiple sclerosis?

Brisman, Ronald: trigeminal neuralgia and multiple sclerosis, Arch Neurol 1987;44-379-381

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