Symptomatic cranial neuralgias in multiple sclerosis: Clinical features and treatment

@article{Santi2012SymptomaticCN,
  title={Symptomatic cranial neuralgias in multiple sclerosis: Clinical features and treatment},
  author={Lorenzo De Santi and Pasquale Annunziata},
  journal={Clinical Neurology and Neurosurgery},
  year={2012},
  volume={114},
  pages={101-107}
}
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Cranial Neuralgias
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In patients presenting with a cranial neuralgia, unless the etiology is apparent (eg, herpes zoster), cranial imaging studies should be undertaken to look for structural abnormalities such as neoplasm, granulomatous disease, demyelinating disease, or vascular malformations.
The Neuralgias
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Patients who present with neuralgias should have imaging studies to investigate for structural abnormalities unless the etiology is apparent, and management of both common and rare neuralgia can be challenging and is best guided by the most recent available evidence.
Occipital neuralgia associates with high cervical spinal cord lesions in idiopathic inflammatory demyelinating disease
TLDR
In patients with multiple sclerosis, clinical features in occipital neuralgia that were predictive of the presence of a C2-3 lesion were unilateral episodic symptoms, sensory loss, later onset of occipitals, and progressive multiple sclerosis phenotype.
Occipital Neuralgia and Its Treatment
Occipital neuralgia: What NPs need to know.
TLDR
It is paramount that NPs appreciate the clinical features and diagnostic criteria of this condition and consider ON in the differential diagnosis in order for it to be appropriately treated.
Trigeminal neuralgia.
TLDR
This systematic review presents information relating to the effectiveness and safety of the following interventions: baclofen; carbamazepine; gabapentin; lamotrigine; oxcarbazepine%; microvascular decompression; and destructive neurosurgical techniques (radiofrequency thermocoagulation, glycerol rhizolysis, balloon compression, and stereotactic radiosurgery).
A Systematic Review of the Management of Trigeminal Neuralgia in Patients with Multiple Sclerosis.
Headache and Its Management in Patients With Multiple Sclerosis
TLDR
H/As can be a cause for significant comorbidity in patients with MS and should be addressed in the same fashion as in the non-MS population, which is a combination of pharmacological and non-pharmacological methods.
Central Neuropathic Pain: Multiple Sclerosis-Related Headaches
TLDR
A 32-year-old man presents to his neurologist with a history of new-onset right-sided occipital head and neck pain and receives a course of IV Solu-Medrol with resolution of his symptoms.
[Surgical treatment of trigeminal neuralgia in patients with multiple sclerosis].
TLDR
At the follow up of 3-5 years, no relapses of trigeminal pain syndrome were observed after the successful surgery and indications to this treatment should be made on the basis of MRI.
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References

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TLDR
If the aetiology of trigeminal neuralgia (TN) and other typical neuralgias must be brought back to the peripheral injury, their pathogenesis could involve central allodynic mechanisms, which, in patients with inter-critical pain, also engage the nociceptive neurons at the thalamic-cortical level.
The Effect of Microvascular Decompression in Patients With Multiple Sclerosis and Trigeminal Neuralgia
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In the 8-year experience of doing MVD in MS patients with TN, complete and significant relief of episodic TN is found in a large proportion of patients, and the presence of MS should not prevent patients from being offered MVD.
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Radiosurgery proved to be an effective procedure and resulted in fewer retreatments and longer pain-free intervals compared with MVD or radiofrequency ablation.
Trigeminal neuralgia and pain related to multiple sclerosis
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While sclerotic plaques in the central nervous system probably are of etiological significance for development of TN neither clinical nor neuropathological findings suggest that this is due to affection of trigeminal nuclei complex in the brain‐stem.
Operative Findings and Outcomes of Microvascular Decompression for Trigeminal Neuralgia in 35 Patients Affected by Multiple Sclerosis
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Results of MVD in trigeminal neuralgia MS patients are much less satisfactory than in the idiopathic group, indicating that central mechanisms play a major role in pain genesis.
8. Occipital Neuralgia
Occipital neuralgia is defined as a paroxysmal shooting or stabbing pain in the dermatomes of the nervus occipitalis major and/or nervus occipitalis minor. The pain originates in the suboccipital…
Trigeminal neuralgia due to multiple sclerosis: ultrastructural findings in trigeminal rhizotomy specimens
TLDR
Experimental studies indicate that this arrangement of demyelinated axons is conducive to both spontaneous impulse activity and ephaptic spread of excitation, and may account for key aspects of the pathogenesis of trigeminal neuralgia.
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The findings support the view of a common pathogenetic mechanism underlying TN in the two groups, possibly related to demyelination of the trigeminal entry root in the pons, and typical TN in MS patients should be considered as “symptomatic trigeminals neuralgia”.
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