Trigeminal neuralgia and pain related to multiple sclerosis

@article{Cruccu2009TrigeminalNA,
  title={Trigeminal neuralgia and pain related to multiple sclerosis},
  author={Giorgio Cruccu and Antonella Biasiotta and Simone Di Rezze and Marco Fiorelli and Francesca Galeotti and P. Innocenti and Sergio Mameli and Enrico Millefiorini and Andrea Truini},
  journal={PAIN{\textregistered}},
  year={2009},
  volume={143},
  pages={186-191}
}
A dual concurrent mechanism explains trigeminal neuralgia in patients with multiple sclerosis
TLDR
It is observed that in many patients with MS-related TN a pontine demyelinating plaque and neurovascular compression coexist, and this observation should prompt neurologists to seek possible neurov vascular compression in patients withMS- related TN.
The Molecular Basis and Pathophysiology of Trigeminal Neuralgia
TLDR
The current article aims to review the latest findings on the pathophysiology of TN and cross-examining them with the current surgical and pharmacologic management for TN patients, to help scientists and clinicians to identify novel targets and improve treatments for this complex, debilitating disease.
Surgical outcomes of trigeminal neuralgia in patients with multiple sclerosis.
BACKGROUND Trigeminal neuralgia (TN) is relatively frequent in multiple sclerosis (MS) patients and can be extremely disabling. Surgical interventions are less effective for the treatment of
Neurovascular contact plays no role in trigeminal neuralgia secondary to multiple sclerosis
TLDR
The primary cause of TN-MS is demyelination along the intrapontine trigeminal afferents, and neurovascular contact does not play a role in the etiology ofTN-MS.
Minimally invasive surgical treatment of intractable trigeminal neuralgia in multiple sclerosis
TLDR
Retrograssean balloon compression by neuro-navigation could be a successfully rescue technique in acute complex trigeminal neuralgia in MS patient.
Diffusion tensor imaging of the trigeminal nerve in patients with trigeminal neuralgia due to multiple sclerosis
TLDR
In patients with MS-related TN, DTI reveals microstructural changes within the trigeminal nerve not only on the affected side but also on the clinically non-affected side.
Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options
TLDR
The relatively poor tolerability of the centrally-acting drugs carbamazepine and oxcarbazepine highlights the need to develop new selective and better-tolerated sodium-channel blockers.
Trigeminal neuralgia
TLDR
A classification of trigeminal neuralgia is developed that aligns with the nosology of other neurologic disorders and neuropathic pain and is proposed 3 diagnostic categories.
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References

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Association of trigeminal neuralgia with multiple sclerosis: Clinical and pathological features
TLDR
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.
Impaired trigeminal nociceptive processing in patients with trigeminal neuralgia
TLDR
The data suggest an impairment of the trigeminal nociceptive system due to demyelination and/or axonal dysfunction on the symptomatic side and locate this defect close to the root entry zone in the brainstem.
The Treatment of Trigeminal Neuralgia in Patients with Multiple Sclerosis using Percutaneous Radiofrequency Rhizotomy
TLDR
Percutaneous radiofrequency rhizotomy is a safe and effective method for the treatment of TN in patients with MS and the unique susceptibility of this cohort to the side effects of antineuralgic medications may require early consideration ofrhizotomy.
Some patients with multiple sclerosis have neurovascular compression causing their trigeminal neuralgia and can be treated effectively with MVD: Report of five cases
TLDR
Five patients with MS and TGN who had failed to respond to medical treatment or percutaneous procedures are presented, demonstrating that neurovascular compression can occasionally be the responsible mechanism and that MVD can be the treatment of choice.
Idiopathic trigeminal neuralgia: sensory features and pain mechanisms
Operative Findings and Outcomes of Microvascular Decompression for Trigeminal Neuralgia in 35 Patients Affected by Multiple Sclerosis
TLDR
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.
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.
Practice Parameter: The diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review)
TLDR
Routine head imaging identifies structural causes in up to 15% of patients and may be considered useful in distinguishing STN from classic trigeminal neuralgia and the role of surgery vs pharmacotherapy in the management of TN in patients with MS remains uncertain.
From paroxysmal to chronic pain in trigeminal neuralgia
TLDR
An electrophysiologic analysis of trigeminal nociceptive pathways in patients with typical TN and those with persisting chronic pain in between paroxysms, using a novel, concentric stimulating electrode which has previously been shown to preferentially depolarize superficial nocICEptive A-delta fibers.
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