Demyelinating plaques: a explanation for trigeminal neuralgia after MS

Demyelinating plaques play a primary role in the etiology of trigeminal neuralgia due to multiple sclerosis (TN-MS), while neurovascular contact does not play a role in cephalalgia, according to study results. Similarly, microvascular decompression may not be a suitable treatment strategy for patients with TN-MS.

In this study, a Danish research team wanted to find out whether neurovascular contact with morphological changes influences the etiology of TN-MS. They prospectively enrolled consecutive patients with TN-MS from the Danish Headache Center. The study investigators systematically collected clinical features and neuroanatomical abnormalities from these patients. A blinded neuroradiologist performed magnetic resonance imaging (MRI) to examine the trigeminal nerve.

A total of 63 patients were enrolled in the study, 54 of whom were included in the MRI analysis. Overall, the mean age of the patients at the beginning of the TN was 49.3 years (95% CI, 46.5–52.0). The mean age of the patient population at the start of the study was 56.5 years (95% CI, 53.6–59.5).

The study researchers observed a low prevalence of neurovascular contact with morphological changes on the symptomatic side (14%) and the asymptomatic side (9%), with no significant difference between the two sides (P = 0.157).

However, the results showed a significantly higher prevalence of demyelinating brainstem plaques along the trigeminal afferents on the symptomatic side compared to the asymptomatic side (58% versus 22%; P <0.001). In addition, the presence of demyelinating plaque was significantly associated with the symptomatic side (odds ratio 10.6; 95% Cl 2.5-44.8; P = 0.002).

Regarding the limitations of the study, the investigators found that the MRI sequence did not include the medulla spinalis or medulla oblongata, nor did it examine plaque in higher brain structures.

While the study’s researchers concluded that microvascular decompression should be reserved for patients with classic TN, they suggest that “the final decision on treatment strategy should be based on an individual judgment, as this study does not provide a definitive conclusion about what is possible Benefits of Microvascular Decompression may drag on patients with TN-MS. ”


Noory N., Smilkov EA, Frederiksen JL, et al. Neurovascular contact does not play a role in trigeminal neuralgia due to multiple sclerosis. Published online November 28, 2020. Cephalalgia. doi: 10.1177 / 0333102420974356

This article originally appeared on Clinical Pain Advisor

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