Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-05-06T17:40:03.268Z Has data issue: false hasContentIssue false
  • English
  • Français

The Treatment of Trigeminal Neuralgia in Patients with Multiple Sclerosis using Percutaneous Radiofrequency Rhizotomy

Published online by Cambridge University Press:  02 December 2014

Caglar Berk ,
Constantine Constantoyannis  and
Christopher R. Honey
Caglar Berk
Affiliation:
Surgical Centre for Movement Disorders, Stereotactic and Functional Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
Constantine Constantoyannis
Affiliation:
Surgical Centre for Movement Disorders, Stereotactic and Functional Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
Christopher R. Honey
Affiliation:
Surgical Centre for Movement Disorders, Stereotactic and Functional Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Trigeminal neuralgia (TN) has a higher incidence among patients with multiple sclerosis (MS) than in the general population. This cohort of MS patients with TN presents a series of management challenges including poor tolerance of antineuralgic medications and occasional bilateral presentation. We analyzed our surgical series of MS patients presenting with TN who were treated with percutaneous radiofrequency rhizotomy to estimate the success, failure and recurrence rate of this procedure for those patients.

Methods:

Surgical reports were retrospectively reviewed between the years 1996-2000. Patients with MS and TN who received a percutaneous rhizotomy during that time were included in the study and followed until the end of 2002. Data regarding age, sex, duration of MS and pain, response to medical treatment, pain distribution and surgical outcome were evaluated.

Results:

There were thirteen patients with MS and medically refractory TN treated with percutaneous radiofrequency rhizotomy. The average age at diagnosis for MS was 41 with TN beginning an average of eight years later. Following rhizotomy, complete pain relief without the need for any medication was achieved in 81% of the patients. The addition of medications resulted in pain control in the remaining patients. During a mean follow-up period of 52 months, there was a 50% recurrence rate. There were no complications related to the procedure and the associated facial numbness was well-tolerated.

Conclusions:

Percutaneous radiofrequency rhizotomy is a safe and effective method for the treatment of TN in patients with MS. The unique susceptibility of this cohort to the side effects of antineuralgic medications may require early consideration of rhizotomy.

Résumé:

RÉSUMÉ:Introduction:

L’incidence de la névralgie du trijumeau (NT) est plus élevée chez les patients atteints de sclérose en plaques (SEP) que dans la population générale. Les patients atteints de SEP qui présentent une NT sont difficile à traiter, entre autres parce qu’ils tolèrent mal les médicaments antinévralgiques et que, chez certains, la symptomatologie est bilatérale. Nous avons analysé notre série de cas chirurgicaux de patients atteints de SEP et présentant une NT qui ont été traités par rhizotomie percutanée par courants de radiofréquence afin d’évaluer le taux de succès, d’échec et de récidive chez ces patients.

Méthodes:

Les dossiers chirurgicaux de 1996 à 2000 ont été révisés rétrospectivement. Les patients atteints de SEP et de NT qui ont subi une rhizotomie percutanée par courants de radiofréquence pendant cette période ont été inclus dans l’étude et suivis jusqu’à la fin de 2002. Les données sur l’âge, le sexe, la durée de la SEP et de la douleur, la réponse au traitement médical, la distribution de la douleur et le résultat chirurgical ont été évalués.

Résultats:

Treize patients atteints de SEP et de névralgie du trijumeau réfractaire au traitement médical ont subi une rhizotomie percutanée par courants de radiofréquence. L’âge moyen au moment du diagnostic de SEP était de 41 ans et en moyenne la névralgie du trijumeau était apparue huit ans après le diagnostic. Suite à la rhizotomie, 81% des patients étaient complètement soulagés et n’avaient pas besoin de médicaments. L’ajout d’une médication a contrôlé la douleur chez les autres patients. On a observé un taux de récidive de 50% pendant le suivi d’une durée moyenne de 52 mois. Il n’y a eu aucune complication reliée à l’intervention et l’engourdissement facial résultant de la chirurgie était bien toléré.

Conclusions:

La rhizotomie percutanée par courants de radiofréquence est une méthode sûre et efficace pour traiter la NT chez les patients atteints de SEP. Il faut envisager la rhizotomie tôt dans la prise en charge de ces patients à cause de leur sensibilité particulière aux effets secondaires des antinévralgiques.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 3 , August 2003 , pp. 220 - 223
Copyright
Copyright © The Canadian Journal of Neurological 2003

References

1. Maxwell, RE. Clinical diagnosis of trigeminal neuralgia anddifferential diagnosis of facial pain. In: Rovit, RL, Murali, R, Janetta, PJ, (Eds). Trigeminal Neuralgia. Baltimore:Williams & Wilkins, 1990, 53–77.Google Scholar
2. Brisman R. Trigeminal neuralgia and multiple sclerosis. ArchNeurol 1987; 44: 379-381.Google Scholar
3. Hooge, JP, Redekop, WK. Trigeminal neuralgia with multiplesclerosis. Neurology 1995;45:1294–1296.CrossRefGoogle Scholar
4. Jensen, TS, Rasmussen, P, Reske-Nielsen, E. Association oftrigeminal neuralgia with multiple sclerosis: clinical and pathological features. Acta Neurol Scand 1982;65:182–189.CrossRefGoogle Scholar
5. Kanpolat, Y, Berk, C, Savas, A, Bekar, A. Percutaneous controlledradiofrequency rhizotomy in the management of patients with trigeminal neuralgia due to multiple sclerosis. Acta Neurochir (Wien) 2000;142:685–690.CrossRefGoogle ScholarPubMed
6. Kanpolat, Y, Jho, HD, Tew, JM, et al. Trigeminal neuralgia: clinicalcontroversy. Surg Neurol 1996;45:406–408.CrossRefGoogle Scholar
7. Berk, C, Honey , CR. Microvascular decompression for trigeminalneuralgia in patients over 65 years of age. Br J Neurosurg 2001;15:76.Google Scholar
8. Poser, CM, Paty, DW, Scheinberg, L. New diagnosis criteria formultiple sclerosis: guidelines for research protocols. In: Poser, CM, Paty, DW, Scheinberg, L, et al (Eds). The Diagnosis ofMultiple Sclerosis. New York:Thieme Stratton, 1984, 225–229.Google Scholar
9. Sweet, WH, Wepsic, JG. Controlled thermocoagulation of trigeminalganglion and rootlets for differential destruction of pain fibers: Part 1. Trigeminal neuralgia. J Neurosurg 1974;39:143–156.CrossRefGoogle Scholar
10. Ebers, GC, Yee, IML, Sadovnick, AD, et al. Conjugal multiplesclerosis: population-based prevalence and recurrence risks inoffspring. Ann Neurol 2000;48:927–931.3.0.CO;2-F>CrossRefGoogle Scholar
11. Victor, M, Ropper, AH. Principles of Neurology. New York:McGrawHill, 2001, 954–982.Google Scholar
12. Fromm, GH, Terrence, CF, Maroon, JC. Trigeminal neuralgia: currentconcepts regarding etiology and pathogenesis. Arch Neurol 1984;41:1204–1207.CrossRefGoogle ScholarPubMed
13. Iraqui, VJ, Wiederholt, WC, Romine, JS. Evoked potentials intrigeminal neuralgia associated with multiple sclerosis. ArchNeurol 1986;43:444–446.Google Scholar
14. Kerr, FW. Pathology of trigeminal neuralgia: light and electronmicroscopic observations. J Neurosurg 1967;26:132–137.CrossRefGoogle Scholar
15. Sweet, WH. The pathophysiology of trigeminal neuralgia. In: Gilden-berg, PL, Tasker, RR, (Eds). Textbook of Stereotactic and Functional Neurosurgery. New York:McGraw Hill, 1998, 1667–1686.Google Scholar
16. Sweet, WH. The treatment of trigeminal neuralgia. N Engl J Med 1986;315:174–177.CrossRefGoogle ScholarPubMed
17. Berk, C. Bilateral trigeminal neuralgia: a therapeutic dilemma. Br JNeurosurg 2001;15:198.Google ScholarPubMed
18. Brisman, R. Bilateral trigeminal neuralgia. J Neurosurg 1987;67:44–48.CrossRefGoogle ScholarPubMed
19. Broggi, G,Franzini, A, Servello, D, et al. Microvasculardecompression: is it a rational surgical operation for trigeminal neuralgia in MS patients? Acta Neurochir (Wien) 1998;140:853.Google Scholar
20. Crooks, DA, Miles, JB. Trigeminal neuralgia due to vascularcompression in multiple sclerosis: postmortem findings. Br JNeurosurg 1996;10:85–88.CrossRefGoogle Scholar
21. Taha, JM, Tew, JM Jr. Comparison of surgical treatments oftrigeminal neuralgia. Percutaneous techniques and posterior fossa exploration (abstr.). J Neurosurg 1994;80:383.Google Scholar
22. Kanpolat, Y, Savas, A, Bekar, A, Berk, C. Percutaneous controlledradiofrequency rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1600 patients. Neurosurgery 2001;48:524–534.CrossRefGoogle Scholar
23. Tekkok, IH, Brown, JA. The neurosurgical management of trigeminalneuralgia. Neurosurg Quart 1996;6:89–107.CrossRefGoogle Scholar