Diana Ferraro1, Pietro Annovazzi2, Marcello Moccia3, Roberta Lanzillo3, Giovanna De Luca4, Viviana Nociti5, Roberta Fantozzi6, Damiano Paolicelli7, Paolo Ragonese8, Alberto Gajofatto9, Laura Boffa10, Paola Cavalla11, Salvatore Lo Fermo12, Maria Chiara Buscarinu13, Lorena Lorefice14, Cinzia Cordioli15, Massimiliano Calabrese9, Antonio Gallo16, Federica Pinardi17, Carla Tortorella18, Massimiliano Di Filippo19, Valentina Camera20, Giorgia Teresa Maniscalco21, Marta Radaelli22, Fabio Buttari6, Valentina Tomassini23, Eleonora Cocco14, Claudio Gasperini18, Claudio Solaro24. 1. Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, Modena 41126, Italy. Electronic address: diana.ferraro@unimore.it. 2. MS Centre, ASST Valle Olona, Gallarate Hospital, Varese, Italy. 3. MS Clinical Care and Research Centre, Department of Neuroscience, Federico II University of Naples, Naples, Italy. 4. Neurology Unit, Policlinico SS. Annunziata, Chieti, Italy. 5. Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy. 6. Neurology Unit, IRCCS Neuromed, Pozzilli, IS, Italy. 7. Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy. 8. Department of Biomedicine Neurosciences and advanced Diagnostic (BiND), University of Palermo, Palermo, Italy. 9. Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy. 10. Neurology Unit, Tor Vergata Hospital, Rome, Italy. 11. MS Center, Department of Neurosciences and Mental Health, AOU City of Health & Science University Hospital, Turin, Italy. 12. MS Centre, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy. 13. Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Rome, Italy. 14. Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy. 15. Multiple Sclerosis Center, ASST Spedali Civili di Brescia, Brescia, Italy. 16. Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy. 17. UOSI Multiple Sclerosis Rehabilitation, IRCCS, Bologna, Italy. 18. Department of Neurosciences, Ospedale San Camillo Forlanini, Rome, Italy. 19. Neurology Unit, Medicine Department, University of Perugia, Perugia, Italy. 20. Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, Modena 41126, Italy. 21. Neurology and Stroke Unit, A. Cardarelli Hospital, Naples, Italy. 22. Department of Neurology, San Raffaele Hospital, Milan, Italy. 23. Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK. 24. Rehabilitation Department, Mons. L. Novarese, Moncrivello, Vercelli, Italy.
Abstract
BACKGROUND: 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. 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: 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: 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.
BACKGROUND: 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. METHODS: Neurologists members of the RIREMS group (Rising Researchers in MS) enrolled MSpatients with a TN diagnosis and filled out a spreadsheet comprising their clinical data. 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:MSpatients 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.