Efficacy and clinical outcomes of percutaneous treatments for trigeminal neuralgia secondary to multiple sclerosis.

BACKGROUND

People with Multiple Sclerosis (MS) have a 20-fold higher risk of developing trigeminal neuralgia compared to the general population. Treating trigeminal neuralgia in these patients is particularly challenging due to reduced tolerance and increased side effects from medications. When no neurovascular conflict exist, percutaneous treatments are usually the first option after drug therapy. According to the literature, treatment outcomes for MS-associated trigeminal neuralgia show higher relapse rates and lower rates of sustained pain relief compared to primary trigeminal neuralgia, often necessitating multiple procedures.

METHODS

We conducted a retrospective cohort study of patients who underwent percutaneous procedures for trigeminal neuralgia between 2010 and 2021 at Rouen University Hospital. The patients were divided into two groups based on the presence or absence of multiple sclerosis. The primary endpoint was the postoperative Barrow Neurological Institute (BNI) pain score, categorized as favourable (I-III) or unfavourable (IV-V) at 3 months postoperatively and at the last date of follow-up.

RESULTS

Patients with multiple sclerosis were younger, had fewer comorbidities, and experienced more bilateral trigeminal pain compared to those without multiple sclerosis. BNI score evaluations at 3 months and at the last follow-up did not differ significantly between the two groups, with 81 % and 77 % of patients, showing favourable outcomes. However, the recurrence of pain after percutaneous procedures was significantly higher in patients with multiple sclerosis (p < 0.05).

CONCLUSION

Percutaneous rhizotomies achieve satisfactory clinical outcomes in patients with MS, despite a higher incidence of recurrences and subsequent percutaneous procedures compared to the general population.