Characteristics and treatment of Multiple Sclerosis-related trigeminal neuralgia: An Italian multi-centre study.

Adult Aged Analgesics, Non-Narcotic / therapeutic use Female Follow-Up Studies Humans Italy Male Microvascular Decompression Surgery / statistics & numerical data Middle Aged Multiple Sclerosis / complications Neurosurgical Procedures / statistics & numerical data Outcome Assessment, Health Care / statistics & numerical data Radiosurgery / statistics & numerical data Retrospective Studies Severity of Illness Index Sex Factors Time Factors Trigeminal Neuralgia / epidemiology

Disability Multiple Sclerosis Pain Trigeminal neuralgia

Journal

Multiple sclerosis and related disorders

ISSN: 2211-0356

Titre abrégé: Mult Scler Relat Disord

Pays: Netherlands

ID NLM: 101580247

Informations de publication

Date de publication:
Jan 2020

Historique:

received: 05 07 2019

revised: 07 10 2019

accepted: 18 10 2019

pubmed: 5 11 2019

medline: 20 11 2020

entrez: 4 11 2019

Statut: ppublish

Résumé

The prevalence of trigeminal neuralgia (TN) in Multiple Sclerosis (MS) patients is higher than in the general population and its management can be particularly challenging. Our aim is to describe the characteristics, treatment and prognostic factors of MS-related TN in a retrospective multicentre study. Neurologists members of the RIREMS group (Rising Researchers in MS) enrolled MS patients with a TN diagnosis and filled out a spreadsheet comprising their clinical data. Population consisted of 298 patients. First-choice preventive treatments were carbamazepine and oxcarbazepine. A surgical procedure was performed in 81 (30%) patients, most commonly gamma knife stereotactic radiosurgery (37%), followed by microvascular decompression (22%) and radiofrequency thermocoagulation (21%); one third of patients underwent at least two procedures. Surgery was associated with higher disability, male sex and longer interval between MS and TN onset. Patients (77%) who stayed on at least one preventive medication at most recent follow-up, after a mean period of 8 years, had a higher disability compared to the untreated group. Furthermore, patients with higher disability at TN onset were less likely to discontinue their first preventive medication due to pain remission, had bilateral TN more frequently and underwent surgical interventions earlier. MS patients with a higher disability at TN onset and with a longer interval between MS and TN onset had differing clinical features and outcomes: pain was more frequently bilateral, surgery was more frequent and anticipated, and preventive medication discontinuation due to pain remission was less common.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

Neurologists members of the RIREMS group (Rising Researchers in MS) enrolled MS patients with a TN diagnosis and filled out a spreadsheet comprising their clinical data.

RESULTS RESULTS

Population consisted of 298 patients. First-choice preventive treatments were carbamazepine and oxcarbazepine. A surgical procedure was performed in 81 (30%) patients, most commonly gamma knife stereotactic radiosurgery (37%), followed by microvascular decompression (22%) and radiofrequency thermocoagulation (21%); one third of patients underwent at least two procedures. Surgery was associated with higher disability, male sex and longer interval between MS and TN onset. Patients (77%) who stayed on at least one preventive medication at most recent follow-up, after a mean period of 8 years, had a higher disability compared to the untreated group. Furthermore, patients with higher disability at TN onset were less likely to discontinue their first preventive medication due to pain remission, had bilateral TN more frequently and underwent surgical interventions earlier.

CONCLUSION CONCLUSIONS

MS patients with a higher disability at TN onset and with a longer interval between MS and TN onset had differing clinical features and outcomes: pain was more frequently bilateral, surgery was more frequent and anticipated, and preventive medication discontinuation due to pain remission was less common.

Identifiants

DOI: 10.1016/j.msard.2019.101461 PMID: 31678859

pubmed: 31678859

pii: S2211-0348(19)30450-X

doi: 10.1016/j.msard.2019.101461

pii:

doi:

Substances chimiques

Analgesics, Non-Narcotic 0

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

101461

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of Competing Interest Authors report no conflicts of interest in relation to the study.