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Neurovascular contact plays no role in trigeminal neuralgia secondary to multiple sclerosis

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@article{b05a45fa9ee041449bd2ac41585214ef,
title = "Neurovascular contact plays no role in trigeminal neuralgia secondary to multiple sclerosis",
abstract = "INTRODUCTION: A demyelinating plaque and neurovascular contact with morphological changes have both been suggested to contribute to the etiology of trigeminal neuralgia secondary to multiple sclerosis (TN-MS). The aim of this study was to confirm or refute whether neurovascular contact with morphological changes is involved in the etiology of TN-MS.METHODS: We prospectively enrolled consecutive TN-MS patients from the Danish Headache Center. Clinical characteristics were collected systematically. MRI scans were done using a 3.0 Tesla imager and were evaluated by the same experienced blinded neuroradiologist.RESULTS: Sixty-three patients were included. Fifty-four patients were included in the MRI analysis. There was a low prevalence of neurovascular contact with morphological changes on both the symptomatic side (6 (14%)) and the asymptomatic side (4 (9%)), p = 0.157. Demyelinating brainstem plaques along the trigeminal afferents were more prevalent on the symptomatic side compared to the asymptomatic side (31 (58%) vs. 12 (22%), p < 0.001). A demyelinating plaque was highly associated with the symptomatic side (odds ratio = 10.6, p = 0.002).CONCLUSION: The primary cause of TN-MS is demyelination along the intrapontine trigeminal afferents. As opposed to classical trigeminal neuralgia, neurovascular contact does not play a role in the etiology of TN-MS. Microvascular decompression should generally not be offered to patients with TN-MS.The study was registered at ClinicalTrials.gov (number NCT04371575).",
keywords = "demyelinating plaque, microvascular decompression, multiple sclerosis, neurovascular contact, Trigeminal neuralgia",
author = "Navid Noory and Smilkov, {Emil Andonov} and Frederiksen, {Jette Lautrup} and Heinskou, {Tone Bruvik} and Andersen, {Anne Sofie Schott} and Lars Bendtsen and Stine Maarbjerg",
year = "2021",
month = apr,
doi = "10.1177/0333102420974356",
language = "English",
volume = "41",
pages = "593--603",
journal = "Cephalalgia",
issn = "0333-1024",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "5",

}

RIS

TY - JOUR

T1 - Neurovascular contact plays no role in trigeminal neuralgia secondary to multiple sclerosis

AU - Noory, Navid

AU - Smilkov, Emil Andonov

AU - Frederiksen, Jette Lautrup

AU - Heinskou, Tone Bruvik

AU - Andersen, Anne Sofie Schott

AU - Bendtsen, Lars

AU - Maarbjerg, Stine

PY - 2021/4

Y1 - 2021/4

N2 - INTRODUCTION: A demyelinating plaque and neurovascular contact with morphological changes have both been suggested to contribute to the etiology of trigeminal neuralgia secondary to multiple sclerosis (TN-MS). The aim of this study was to confirm or refute whether neurovascular contact with morphological changes is involved in the etiology of TN-MS.METHODS: We prospectively enrolled consecutive TN-MS patients from the Danish Headache Center. Clinical characteristics were collected systematically. MRI scans were done using a 3.0 Tesla imager and were evaluated by the same experienced blinded neuroradiologist.RESULTS: Sixty-three patients were included. Fifty-four patients were included in the MRI analysis. There was a low prevalence of neurovascular contact with morphological changes on both the symptomatic side (6 (14%)) and the asymptomatic side (4 (9%)), p = 0.157. Demyelinating brainstem plaques along the trigeminal afferents were more prevalent on the symptomatic side compared to the asymptomatic side (31 (58%) vs. 12 (22%), p < 0.001). A demyelinating plaque was highly associated with the symptomatic side (odds ratio = 10.6, p = 0.002).CONCLUSION: The primary cause of TN-MS is demyelination along the intrapontine trigeminal afferents. As opposed to classical trigeminal neuralgia, neurovascular contact does not play a role in the etiology of TN-MS. Microvascular decompression should generally not be offered to patients with TN-MS.The study was registered at ClinicalTrials.gov (number NCT04371575).

AB - INTRODUCTION: A demyelinating plaque and neurovascular contact with morphological changes have both been suggested to contribute to the etiology of trigeminal neuralgia secondary to multiple sclerosis (TN-MS). The aim of this study was to confirm or refute whether neurovascular contact with morphological changes is involved in the etiology of TN-MS.METHODS: We prospectively enrolled consecutive TN-MS patients from the Danish Headache Center. Clinical characteristics were collected systematically. MRI scans were done using a 3.0 Tesla imager and were evaluated by the same experienced blinded neuroradiologist.RESULTS: Sixty-three patients were included. Fifty-four patients were included in the MRI analysis. There was a low prevalence of neurovascular contact with morphological changes on both the symptomatic side (6 (14%)) and the asymptomatic side (4 (9%)), p = 0.157. Demyelinating brainstem plaques along the trigeminal afferents were more prevalent on the symptomatic side compared to the asymptomatic side (31 (58%) vs. 12 (22%), p < 0.001). A demyelinating plaque was highly associated with the symptomatic side (odds ratio = 10.6, p = 0.002).CONCLUSION: The primary cause of TN-MS is demyelination along the intrapontine trigeminal afferents. As opposed to classical trigeminal neuralgia, neurovascular contact does not play a role in the etiology of TN-MS. Microvascular decompression should generally not be offered to patients with TN-MS.The study was registered at ClinicalTrials.gov (number NCT04371575).

KW - demyelinating plaque

KW - microvascular decompression

KW - multiple sclerosis

KW - neurovascular contact

KW - Trigeminal neuralgia

U2 - 10.1177/0333102420974356

DO - 10.1177/0333102420974356

M3 - Journal article

C2 - 33249870

VL - 41

SP - 593

EP - 603

JO - Cephalalgia

JF - Cephalalgia

SN - 0333-1024

IS - 5

ER -

ID: 61820974