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Pickles KJ, Marlin DJ, Williams JM, Roberts VLH. Use of a poll-mounted accelerometer for quantification and characterisation of equine trigeminal-mediated headshaking. Equine Vet J 2025; 57:645-653. [PMID: 39020521 PMCID: PMC11982430 DOI: 10.1111/evj.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 06/05/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Equine trigeminal-mediated (TGM) headshaking (HS) is a neuropathic facial pain syndrome characterised by varying intensity and frequencies of head movements and signs of nasal irritation. An accurate method for quantification and/or characterisation of HS severity is lacking. OBJECTIVES To develop and validate an objective measure of TGMHS. STUDY DESIGN Prospective case control study. METHODS Horses presenting for investigation of HS were recruited alongside those presenting for forelimb lameness (LAME) and pre-purchase examination as well as healthy controls (CONTROL). Head movement data were collected for 5 min whilst trotting on the lunge using a tri-axial accelerometer, with a range of ±16 g and sampling rate of 800 Hz, attached to the bridle headpiece. Recordings were exported for processing. Peak detection was performed using minimum and maximum thresholds of -1 g and +1 g (corrected for gravity) and a minimum peak width of 10 samples. RESULTS Fifty-six horses were included in the study; 18 TGMHS, 10 non-TGMHS, 12 LAME and 16 CONTROL. Characteristics and frequency of vertical (Z axis) head movements of TGMHS horses differed significantly from other horses. TGMHS horses had peaks with greater mean and maximum positive g-force (P < 0.005) and lower mean and minimum negative g-force (P < 0.001), greater frequency of peaks/min (P < 0.001) and over 12 times greater percentage of peaks >+2 g compared with other horses (P < 0.001). Receiver operator curve characteristics of percentage of peaks >+2 g (CI 0.72-0.95), percentage of peaks <-2 g (CI 0.66-0.92) and percentage of peaks <-2 g and >+2 g (CI 0.72-0.96) showed excellent discrimination of TGMHS horses from LAME, CONTROL and non-TGMHS horses. MAIN LIMITATIONS Referral population of horses, small sample size and control horses were not evaluated for orthopaedic disease. CONCLUSIONS Accelerometer data from trotting exercise on the lunge provides an objective measure of HS and can differentiate between TGMHS, non-TGMHS, normal head movements and those associated with forelimb lameness. Accelerometer use may aid HS diagnosis and monitoring of management strategies.
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Affiliation(s)
- Kirstie Jane Pickles
- School of Veterinary Medicine and ScienceUniversity of NottinghamSutton BoningtonUK
- Present address:
KP ConsultingDuffieldUK
- Present address:
Harper Keele Veterinary SchoolKeeleStaffordshireUK
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Alomari AA, Boccacci F, Scavo CG, Cedrone G, Roperto R, Zomorodi A, Mastronardi L. A case report with a literature review of trigeminal neuralgia secondary to a large posterior communicating artery aneurysm. BRAIN & SPINE 2025; 5:104215. [PMID: 40223822 PMCID: PMC11986251 DOI: 10.1016/j.bas.2025.104215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 02/11/2025] [Accepted: 02/12/2025] [Indexed: 04/15/2025]
Abstract
This is a case report of a 66-year-old female who developed atypical trigeminal neuralgia over ophthalmic-V1 and maxillary-V2 divisions secondary to a posterior communicating artery aneurysm (1.5 cm). Literature review of similar cases, description of the pain, its distribution, the aneurysm features, the pathophysiology, and the patient's management and outcome are presented.
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Affiliation(s)
- Amer A. Alomari
- Division of Neurosurgery, Department of Special Surgery, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Fabio Boccacci
- Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy
| | | | - Guido Cedrone
- Department of Neurosurgery, Sapienza University, Rome, Italy
| | - Raffaelino Roperto
- Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy
| | - Ali Zomorodi
- Skull Base Surgery Center, Duke University Medical Center, Durham, NC, USA
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3
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Werner C, Harden J, Lawton J. Pathways to a diagnosis of trigeminal neuralgia: a qualitative study of patients' experiences. BMC PRIMARY CARE 2025; 26:65. [PMID: 40050720 PMCID: PMC11884208 DOI: 10.1186/s12875-025-02763-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 02/19/2025] [Indexed: 03/09/2025]
Abstract
BACKGROUND Trigeminal Neuralgia (TN) is a rare disorder which causes episodes of intense facial pain and has been described as the 'suicide disease'. Hence, prompt diagnosis and timely initiation of treatment is vital. However, delays to diagnosis and high rates of misdiagnosis are common, particularly within primary care. To date, most research has focused upon treatment options rather than improving diagnostic experiences. This study sought to explore patients' experiences of the events leading up to their TN diagnosis and their views about the care and support they received when they were diagnosed to provide recommendations for improving the TN diagnostic pathway. METHODS This was a qualitative, exploratory study using in-depth interviews. Interviews were conducted with (n = 25) UK-based people with TN recruited via online forums. Data were analysed thematically. RESULTS Following the onset of their TN pain, most participants described an arduous and uncertain journey to diagnosis, with many encountering significant delays, misdiagnoses and receiving inappropriate referrals and treatment. As a consequence, participants reported experiencing profound distress, anxiety, depression and, in extreme cases, suicidal ideation; some also described drug and alcohol misuse during this time. Most participants conveyed relief upon finally receiving a diagnosis. However, this was often by eclipsed by what they saw as poor and insensitive communication and inadequate information provisioning. CONCLUSIONS The present study highlights the importance of developing bespoke training for primary care and other professionals to facilitate timely recognition of TN symptomatology and ensure that they deliver a TN diagnosis in clear, sensitive and empathetic ways.
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Affiliation(s)
- Cameron Werner
- Department of Psychology, IU International University of Applied Sciences, Erfurt, Germany.
| | - Jeni Harden
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, UK
| | - Julia Lawton
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, UK
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Shil M, Jain NK, Sinha D, Kumar N. Precision and Relief: The Ginwala Technique in Trigeminal Neuralgia Treatment. Indian J Otolaryngol Head Neck Surg 2025; 77:1598-1602. [PMID: 40093481 PMCID: PMC11909387 DOI: 10.1007/s12070-024-05301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 12/25/2024] [Indexed: 03/19/2025] Open
Abstract
Trigeminal Neuralgia (TN) is a real nightmare, like getting zapped with electric shocks in your face, making daily life almost impossible. In this story, we're talking about a 32-year-old woman who suffered from TN in her mandibular nerve (V3). For over a year, she tried every medication under the sun, but nothing worked, so she finally decided to go for surgery. After thorough testing, we figured out that her mandibular nerve was the main problem. She chose the Ginwala Technique for the surgery because it's known for being precise and safe. In the operating room, we made an inverted Y-shaped cut to reach and remove the nerve causing all the trouble. To make sure the pain wouldn't come back, we sealed the nerve's exit point with a titanium screw. Thankfully, the surgery was a success, and she got much-needed relief, though she did have some numbness afterward, which we expected. This story shows how the Ginwalla Technique can really be a lifeline for people who can't find relief from TN with other treatments.
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Affiliation(s)
- Moushumi Shil
- Department of Oral and Maxillofacial Surgery, Awadh Dental College and Hospital, Jamshedpur, India
| | - Nikil Kumar Jain
- Department of Oral and Maxillofacial Surgery, Awadh Dental College and Hospital, Jamshedpur, India
| | - Devanshu Sinha
- Department of Oral and Maxillofacial Surgery, Awadh Dental College and Hospital, Jamshedpur, India
| | - Nishant Kumar
- Department of Oral and Maxillofacial Surgery, Awadh Dental College and Hospital, Jamshedpur, India
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Lam JLW, Sankar T, Sekula RF, Senatus PB, Patil PG. Trigeminal Neuralgia: Disease Characterization and Prediction of Response to Surgical Intervention. Curr Pain Headache Rep 2025; 29:37. [PMID: 39873810 DOI: 10.1007/s11916-024-01316-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2024] [Indexed: 01/30/2025]
Abstract
PURPOSE OF REVIEW Trigeminal neuralgia (TN) is a highly heterogeneous condition with a wide choice of successful treatment options. However, differences between subtypes are poorly understood and it remains unknown which patients will respond to different treatments. This review aims to summarize the current state of the TN field and explore the problem of predicting surgical outcomes. RECENT FINDINGS Attempts have been made to standardize classification, outcome reporting, and treatment guidelines. Identification of risk factors for poor surgical treatment outcomes has led to the development of prognostic scoring systems to predict outcomes and guide management. Advances in imaging techniques including diffusion tensor imaging show promise in better understanding the underlying pathophysiology and predicting surgical outcomes. Progress is hampered by lack of understanding of the pathophysiology in TN and differences between disease subtypes. Further work needs to be done to create accurate prediction tools for widespread use, including use of advanced imaging and computing tools, multicenter collaboration, and prospective validation.
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Affiliation(s)
- Jordan L W Lam
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Tejas Sankar
- Department of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Raymond F Sekula
- Department of Neurosurgery, Columbia University, New York, NY, USA
| | | | - Parag G Patil
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
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6
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Yang J, Xie S, Guo J, Zhou Y, Yang Y, Sun Z, Cai P, Zhang C, Jiang S, Cao X, Fan Y, Chen X, Li X, Zhang Y. Restoration of mitochondrial function alleviates trigeminal neuropathic pain in mice. Free Radic Biol Med 2025; 226:185-198. [PMID: 39528053 DOI: 10.1016/j.freeradbiomed.2024.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 10/25/2024] [Accepted: 11/05/2024] [Indexed: 11/16/2024]
Abstract
Craniofacial pain is prevalent and a debilitating condition. Managing craniofacial pain is particularly challenging due to its multifaceted nature. Among the most severe forms of craniofacial pain is trigeminal neuralgia, often described as one of the most excruciating pain syndromes encountered in clinical practice. Utilizing a mouse model of trigeminal neuropathic pain, we found severe mitochondrial impairment in the injured trigeminal ganglion (TG), spanning transcription and translation to functionality. Our findings demonstrated that rejuvenating mitochondria by boosting NAD+ levels enhanced mitochondrial fitness and significantly ameliorated trigeminal neuropathic pain. Additionally, we showed that the analgesic effects of nicotinamide riboside (NR) supplementation mainly depend on Sirt1. Importantly, our multi-omics studies revealed that activated Sirt1 by NR suppresses a broad range of key pain genes and exerts anti-inflammatory effects in the TG. Together, we present a comprehensive view of how mitochondrial dysfunction is involved in trigeminal neuropathic pain. Therefore, targeting mitochondrial dysfunction offers a novel and promising approach to craniofacial pain management.
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Affiliation(s)
- Jiajun Yang
- Zhejiang Provincial Key Laboratory of Medical Genetics, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China; Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China
| | - Song Xie
- Zhejiang Provincial Key Laboratory of Medical Genetics, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China; Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China
| | - Jiahao Guo
- Zhejiang Provincial Key Laboratory of Medical Genetics, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China; Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China
| | - Yujuan Zhou
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China
| | - Yaning Yang
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China
| | - Zhaoxia Sun
- Zhejiang Provincial Key Laboratory of Medical Genetics, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China; Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China
| | - Peng Cai
- Zhejiang Provincial Key Laboratory of Medical Genetics, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China; Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China
| | - Chenchen Zhang
- Zhejiang Provincial Key Laboratory of Medical Genetics, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China; Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China
| | - Shangying Jiang
- Zhejiang Provincial Key Laboratory of Medical Genetics, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China; Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China
| | - Xuxia Cao
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China
| | - Yuanlan Fan
- Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, 330006, China
| | - Xing Chen
- School of Informatics, University of Edinburgh, Edinburgh, EH8 9AB, UK
| | - Xiaokun Li
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China.
| | - Yi Zhang
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China; Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325035, China; Oujiang Laboratory, Zhejiang Lab for Regenerative Medicine, Vision and Brain Health, Wenzhou, Zhejiang Province, 325101, China.
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7
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Meylakh N, Crawford LS, Mills EP, Macefield VG, Vickers ER, Macey PM, Keay KA, Henderson LA. Altered Corticobrainstem Connectivity during Spontaneous Fluctuations in Pain Intensity in Painful Trigeminal Neuropathy. eNeuro 2024; 11:ENEURO.0522-23.2024. [PMID: 38997145 PMCID: PMC11277291 DOI: 10.1523/eneuro.0522-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 07/14/2024] Open
Abstract
Chronic neuropathic pain can result from nervous system injury and can persist in the absence of external stimuli. Although ongoing pain characterizes the disorder, in many individuals, the intensity of this ongoing pain fluctuates dramatically. Previously, it was identified that functional magnetic resonance imaging signal covariations between the midbrain periaqueductal gray (PAG) matter, rostral ventromedial medulla (RVM), and spinal trigeminal nucleus are associated with moment-to-moment fluctuations in pain intensity in individuals with painful trigeminal neuropathy (PTN). Since this brainstem circuit is modulated by higher brain input, we sought to determine which cortical sites might be influencing this brainstem network during spontaneous fluctuations in pain intensity. Over 12 min, we recorded the ongoing pain intensity in 24 PTN participants and classified them as fluctuating (n = 13) or stable (n = 11). Using a PAG seed, we identified connections between the PAG and emotional-affective sites such as the hippocampal and posterior cingulate cortices, the sensory-discriminative posterior insula, and cognitive-affective sites such as the dorsolateral prefrontal (dlPFC) and subgenual anterior cingulate cortices that were altered dependent on spontaneous high and low pain intensity. Additionally, sliding-window functional connectivity analysis revealed that the dlPFC-PAG connection anticorrelated with perceived pain intensity over the entire 12 min period. These findings reveal cortical systems underlying moment-to-moment changes in perceived pain in PTN, which likely cause dysregulation in the brainstem circuits previously identified, and consequently alter the appraisal of pain across time.
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Affiliation(s)
- Noemi Meylakh
- School of Medical Sciences (Neuroscience), Brain and Mind Centre, University of Sydney, Sydney, New South Wales 2050, Australia
| | - Lewis S Crawford
- School of Medical Sciences (Neuroscience), Brain and Mind Centre, University of Sydney, Sydney, New South Wales 2050, Australia
| | - Emily P Mills
- School of Medical Sciences (Neuroscience), Brain and Mind Centre, University of Sydney, Sydney, New South Wales 2050, Australia
| | - Vaughan G Macefield
- Department of Neuroscience, Monash University, Melbourne, Victoria 3800, Australia
| | - E Russell Vickers
- School of Medical Sciences (Neuroscience), Brain and Mind Centre, University of Sydney, Sydney, New South Wales 2050, Australia
| | - Paul M Macey
- UCLA School of Nursing and Brain Research Institute, University of California, Los Angeles, California 90095
| | - Kevin A Keay
- School of Medical Sciences (Neuroscience), Brain and Mind Centre, University of Sydney, Sydney, New South Wales 2050, Australia
| | - Luke A Henderson
- School of Medical Sciences (Neuroscience), Brain and Mind Centre, University of Sydney, Sydney, New South Wales 2050, Australia
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8
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Pergolizzi JV, LeQuang JAK, El-Tallawy SN, Ahmed RS, Wagner M, Varrassi G. The Challenges in Clinical Diagnosis of Trigeminal Neuralgia: A Review. Cureus 2024; 16:e61898. [PMID: 38978896 PMCID: PMC11228405 DOI: 10.7759/cureus.61898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/07/2024] [Indexed: 07/10/2024] Open
Abstract
The lack of established laboratory tests or biomarkers for trigeminal neuralgia (TN) makes diagnosing this relatively rare condition extremely challenging. Trigeminal nerve compression observable on magnetic resonance imaging may indicate TN, but many patients do not have visible lesions or compression. In particular, TN may be confused with migraine, cluster headache, temporomandibular disorder, and other types of headache. An accurate diagnosis is imperative for proper treatment since these conditions do not respond to the same treatment. Many symptoms of these headaches can be vague or overlap, and clinicians depend in large measure on the subjective reports of their patients. Nevertheless, it is imperative to diagnose TN better, which can cause excruciating pain, reduce the quality of life, and even result in disability. It is possible that TN is underestimated.
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Affiliation(s)
| | | | - Salah N El-Tallawy
- Anesthesia and Pain Management, Faculty of Medicine, Minia University and NCI, Cairo University, Cairo, EGY
- Anesthesia and Pain Management, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, SAU
| | - Rania S Ahmed
- College of Medicine, Alfaisal University, Riyadh, SAU
| | - Morgan Wagner
- Entrepreneur Program, NEMA Research, Inc., Naples, USA
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Allam AK, Larkin MB, Sharma H, Viswanathan A. Trigeminal and Glossopharyngeal Neuralgia. Neurol Clin 2024; 42:585-598. [PMID: 38575268 DOI: 10.1016/j.ncl.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Trigeminal neuralgia and glossopharyngeal neuralgia are craniofacial pain syndromes characterized by recurrent brief shock-like pains in the distributions of their respective cranial nerves. In this article, the authors aim to summarize each condition's characteristics, pathophysiology, and current pharmacotherapeutic and surgical interventions available for managing and treating these conditions.
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Affiliation(s)
- Anthony K Allam
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - M Benjamin Larkin
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
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10
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Rugnath R, Orzechowicz C, Newell C, Carullo V, Rugnath A. A Literature Review: The Mechanisms and Treatment of Neuropathic Pain-A Brief Discussion. Biomedicines 2024; 12:204. [PMID: 38255308 PMCID: PMC10812949 DOI: 10.3390/biomedicines12010204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 01/24/2024] Open
Abstract
Classically, neuropathic pain is described as a pain caused by a lesion or disease of the somatosensory system. However, one must note that the presence of somatosensory pathology alone does not guarantee a progression to neuropathic pain. This is due, in part, to the fact that neuropathic pain is a notoriously complex disease process, involving sensitization of both the central and peripheral nervous systems. Its causes are also numerous and varied, including trauma, the compression of a nerve, autoimmune disorders, diabetes, and infections. Due to the various manifestations, causes, and symptoms of neuropathic pain, the treatment of this disease process has proved challenging for generations of physicians. This section aims to elaborate on newly proposed mechanisms for pharmacological and targeted therapies, such as neurostimulation, which aim to reduce the negative somatosensory effects of neuropathic pain.
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Affiliation(s)
| | | | | | | | - Anesh Rugnath
- Department and Anesthesiology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (R.R.)
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Zhou Q, Zhao R, Qin Z, Qi Y, Tang W, Liu L, Wang W, Liu JR, Du X. Altered intra- and inter-network functional activity among migraine, chronic migraine, and trigeminal neuralgia. Mol Pain 2024; 20:17448069241300939. [PMID: 39655771 PMCID: PMC11629411 DOI: 10.1177/17448069241300939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 10/22/2024] [Accepted: 10/22/2024] [Indexed: 12/13/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the specific manifestations and differences in brain network activity and functional connectivity between brain networks in patients with trigeminal neuralgia and migraine, aiming to reveal the neural basis of these two diseases. BACKGROUND Head and facial pain, including trigeminal neuralgia and migraine, is prevalent globally. However, the underlying neural mechanisms of these conditions remain unclear. Resting-state functional connectivity studies based on independent component analysis (ICA) may offer new insights into these diseases. METHODS The study involved 23 chronic migraine, 37 episodic migraine, 21 trigeminal neuralgia patients, and 33 age- and gender-matched controls. Resting-state functional magnetic resonance imaging was performed, and five sets of brain network components were extracted through ICA. Neuronal activity indicators were calculated for each participant's independent components, including amplitudes of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo). Functional connectivity was also assessed and compared among the four groups. RESULTS Trigeminal neuralgia patients showed reduced ALFF in the dorsal attention network versus episodic migraine patients and controls. Both trigeminal neuralgia and chronic migraine patients had decreased ReHo in this network. Migraine patients had weaker connectivity between the default mode and visual networks than controls. Trigeminal neuralgia patients also showed higher connectivity between the somatosensory motor and dorsal attention networks. Compared to episodic migraine, trigeminal neuralgia, and chronic migraine patients had increased connectivity between the visual and dorsal attention networks. CONCLUSION The study provides evidence that long-term chronic head and facial pain may contribute to abnormalities in the activation and connectivity of the dorsal attention network. Compared to migraine patients, trigeminal neuralgia patients exhibit abnormal brain network connectivity, particularly within the somatomotor network, which may explain the presence of significant "trigger points." These findings offer new perspectives for understanding the characteristics of different head and facial pain subtypes.
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Affiliation(s)
- Qichen Zhou
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Rong Zhao
- Department of Neurology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai China
| | - Zhaoxia Qin
- Department of Radiology, Medical Imaging Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yapeng Qi
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Wenshuang Tang
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Lan Liu
- Department of Neurology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai China
| | - Weikan Wang
- Department of Neurology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai China
| | - Jian-Ren Liu
- Department of Neurology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai China
| | - Xiaoxia Du
- School of Psychology, Shanghai University of Sport, Shanghai, China
- Center for Exercise and Brain Science, Shanghai University of Sport, Shanghai, China
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12
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Castelli N, Innocenti N, Ferroli P, Saladino A, Broggi G, Tramacere I, Carone G, Levi V, Rizzi M, Nazzi V. Microvascular decompression for trigeminal neuralgia: a single-center experience with 516 cases, including 32 patients with multiple sclerosis. Acta Neurochir (Wien) 2023; 165:3887-3893. [PMID: 37945996 DOI: 10.1007/s00701-023-05872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the effectiveness and long-term pain relief of microvascular decompression (MVD) for "typical" trigeminal neuralgia (TN), including patients affected by multiple sclerosis (MS). METHODS Between January 2011 and December 2022, 516 consecutive patients presenting with trigeminal neuralgia and a diagnosed neurovascular conflict at MRI underwent microvascular decompression surgery in our neurosurgery department. Ten surgeons with different ages and experiences performed the surgical procedures. Pain improvement, re-operation rate, and complication rates were retrospectively collected and analyzed. RESULTS 516 patients were included (214 males 302 females, ranging from 12 to 87 years), including 32 patients with multiple sclerosis. Neurovascular compression was found in all cases during surgery. Barrow Neurological Institute pain intensity scale with a score of I was achieved in 404 patients (78,29%), a score II or III was obtained in 100 cases (19,37%) and a score of IV and V in 12 patients (2,32%). In the multiple sclerosis subset of patients, a BNI score of I was achieved in 21/32 (65.62%). The pain recurrence rate of our series was 15.11%. The follow-up for all patients was at least of 13 months, with a mean follow-up of 41.93 months (± 17.75 months, range 13-91 months). Neither intraoperative mortality nor major intra-operative complications occurred in the analyzed series. The re-operation rate was 12.98%. Thermorhizotomy, percutaneous balloon compression, cyber-knife radiosurgery, or new MVD were the surgical techniques utilized for re-operations. CONCLUSIONS MVD may be considered an effective and safe surgical technique for TN, and in patients affected by multiple sclerosis, it may be proposed even if a less favorable outcome has to be expected with respect to classic TN patients. Larger studies focusing on the relation of multiple sclerosis with neurovascular compression are required.
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Affiliation(s)
- Nicolò Castelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Niccolò Innocenti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Saladino
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Carone
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vincenzo Levi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Michele Rizzi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vittoria Nazzi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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13
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Quidé Y, Norman-Nott N, Hesam-Shariati N, McAuley JH, Gustin SM. Depressive symptoms moderate functional connectivity within the emotional brain in chronic pain. BJPsych Open 2023; 9:e80. [PMID: 37161479 DOI: 10.1192/bjo.2023.61] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Depressive symptoms are often comorbid with chronic pain. These conditions share aberrant emotion processing and regulation, as well as having common brain networks. However, the relationship between depressive symptoms and chronic pain and the effects on emotional brain function are unclear. AIMS The present study aimed to disentangle the effects of chronic pain and depressive symptoms on functional connectivity between regions implicated in both these conditions. METHOD Twenty-six individuals with chronic pain (referred to as the pain group) and 32 healthy controls underwent resting-state functional magnetic resonance imaging and completed the Beck Depression Inventory. Main effects of group, depressive symptoms (total severity score) and their interaction on the functional connectivity of three seed regions (the left and right amygdalae and the medial prefrontal cortex; mPFC) with the rest of the brain were evaluated. In cases of significant interaction, moderation analyses were conducted. RESULTS The group × depressive symptoms interaction was significantly associated with changes in connectivity between the right amygdala and the mPFC (family-wise error-corrected P-threshold (pFWEc = 0.008). In the moderation analysis, the pain group showed weaker connectivity between these regions at lower levels of depressive symptoms (P = 0.020), and stronger connectivity at higher levels of depressive symptoms (P = 0.003), compared with the healthy controls. In addition, the strength of connectivity decreased in the healthy controls (P = 0.005) and increased in the pain group (P = 0.014) as the severity of depressive symptoms increased. CONCLUSIONS Depressive symptoms moderate the impact of chronic pain on emotional brain function, with potential implications for the choice of treatment for chronic pain.
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Affiliation(s)
- Yann Quidé
- NeuroRecovery Research Hub, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia; and Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Nell Norman-Nott
- NeuroRecovery Research Hub, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia; and Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Negin Hesam-Shariati
- NeuroRecovery Research Hub, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia; and Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia; and School of Health Sciences, The University of New South Wales, Sydney, New South Wales, Australia
| | - Sylvia M Gustin
- NeuroRecovery Research Hub, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia; and Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
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14
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Nascimento RFV, Pipek LZ, de Aguiar PHP. Is percutaneous balloon compression better than microvascular decompression to treat trigeminal neuralgia? A systematic review and meta-analysis. J Clin Neurosci 2023; 109:11-20. [PMID: 36634472 DOI: 10.1016/j.jocn.2023.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a neuropathic pain that affects one or more branches of the trigeminal nerve. Surgical options after pharmacological failure are Microvascular Decompression (MVD) or percutaneous procedures, which include Balloon Compression (PBC). This study aims to describe pain outcomes and complications after PBC and MVD procedures for patients with trigeminal neuralgia. METHODS We performed a systematic review and meta-analysis on PubMed, EMBASE, LILACS, and Web of Science databases up to April 2022, following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and meta-Analysis). Articles that separately describe pain outcome for MVD and PBC were included. MINORS tool was used for bias assessment. Meta-analysis results are presented in forest plot and funnel plot. RESULTS 853 studies were assessed for screening, and 11 studies met the inclusion criteria for this review. A total of 1046 patients underwent PBC and 1324 underwent MVD. The subgroup analysis for patients without multiple sclerosis shows that MVD was associated with lower number of patients with pain than PBC, with an OR value of 0.54 (95 % CI 0.34-0.84). All other analyses evidenced a tendency for better outcomes after the MVD procedure, but with no statistically significant difference. CONCLUSION Considering short and long pain relief, recurrence of pain and total complications for MVD and PBC, our study found that MVD is the best surgical option available for trigeminal neuralgia.
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Affiliation(s)
| | | | - Paulo Henrique Pires de Aguiar
- Department of Neurosurgery, Santa Paula Hospital, São Paulo, Brazil; Department of Research and Innovation, Laboratory of Cellular and Molecular Biology, FMABC, Santo André, São Paulo, Brazil; Department of Neurology, School of Medicine of Pontifical Catholic University of São Paulo, Sorocaba, São Paulo, Brazil; State Serviant Public Hospital, São Paulo, Brazil
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15
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Allam AK, Sharma H, Larkin MB, Viswanathan A. Trigeminal Neuralgia. Neurol Clin 2023; 41:107-121. [DOI: 10.1016/j.ncl.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Akhter F. Examining the Clinical Characteristics of Trigeminal Neuralgia at a Dental Hospital: A Prospective Study. Cureus 2023; 15:e34862. [PMID: 36923198 PMCID: PMC10010314 DOI: 10.7759/cureus.34862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/13/2023] Open
Abstract
Background and objective Trigeminal neuralgia (TN) is a paroxysmal shock-like neuropathic pain condition that causes sudden, typically unilateral, severe, brief, stabbing, and recurrent sensations in the distribution of one or more trigeminal nerve branches. Although the clinical profile of TN patients has been generally established, there has never been a study on the condition among the population of Northeast India. Furthermore, there is scarce research describing the clinical features of TN in patients who visit a dental college. In light of this, we conducted this study to assess the clinical characteristics and parameters of TN in an Indian population. Methods Medical records of 60 patients with TN were reviewed prospectively for patient demographics, characteristics of the pain, and treatment modalities. Results Of the 60 patients, 55% were male, and 45% were female. The peak incidence was found in the age range of 55-64 years. Pain occurred equally on the right and left sides of the face. The maxillary division of the trigeminal nerve was the most frequently affected (40%) region, followed by mandibular division (35%) and the combined maxillary and mandibular division alone (25%). Most patients described their attacks as shock-like (78.33%) and of spontaneous onset (86.67%). Conclusion In the present study, TN affected males more than females and occurred most frequently in patients aged 55-64 years. A comparative analysis of the pain characteristics between different age groups and genders is useful for the management of these patients.
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Affiliation(s)
- Fatema Akhter
- Surgical and Diagnostic Sciences, Dar Al Uloom University, Riyadh, SAU
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17
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Somatosensory and trigeminal pathway abnormalities in Chinese patients with trigeminal neuralgia. Odontology 2023; 111:217-227. [PMID: 36094685 DOI: 10.1007/s10266-022-00737-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 07/14/2022] [Indexed: 01/06/2023]
Abstract
This study aimed to evaluate somatosensory function in Chinese patients with trigeminal neuralgia (TN) using a standard quantitative sensory testing (QST) battery and electrophysiological tests consisting of contact heat-evoked potentials (CHEPs) and blink reflex (BR). Twenty patients with TN and 20 sex- and age-matched healthy controls were recruited for this study. A standard QST protocol recommended by the German Research Network on Neuropathic Pain was carried out on the patients' painful and contralateral faces, the controls' right faces, and all participants' right hands. The CHEPs and BR were recorded at the Cz electrode and bilateral lower bellies of the orbicularis oculi, respectively, with thermal stimuli applied to both sides of the patient's face and the control's right face. The cold detection threshold, heat pain threshold, and mechanical pain threshold on the painful face were lower than those of healthy controls (P < 0.05), whereas the cold pain threshold and mechanical detection threshold were higher (P < 0.05) on the painful faces than those of the contralateral faces from patients or healthy controls. Mechanical pain sensitivity was higher in both test sites than in healthy controls (P < 0.05). Significantly longer N latencies (P < 0.05) and lower N-P amplitudes (P < 0.01) were detected in the patients' painful sites than in the contralateral sites and those of healthy controls. Comprehensive somatosensory abnormalities were found in painful facial sites in patients with TN, suggesting disturbances in the processing of somatosensory stimuli. Deficiencies in electrophysiological tests further revealed unilaterally impaired function of the trigeminal pathway in TN patients.
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18
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Muacevic A, Adler JR, Tople J, Akre DS, Wanjari MB. Radiofrequency Ablation of Gasserian Ganglion in Trigeminal Neuralgia With Multiple Sclerosis: A Rare Clinical Case. Cureus 2022; 14:e32595. [PMID: 36686115 PMCID: PMC9848682 DOI: 10.7759/cureus.32595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
In rare instances, the extremely painful disorder trigeminal neuralgia (TN) may develop as a result of multiple sclerosis (MS). In this article, we will be discussing the case of a 56-year-old female with TN. Antidepressants and analgesics can lessen the pain, although they were not very effective, and higher doses led to greater drowsiness and a poorer quality of life. Radiofrequency ablation helped this patient significantly lower the pain and led to an improved lifestyle. This case presents right-side radiofrequency ablation of Gasserian ganglion in a patient with unilateral TN with MS.
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19
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Seong H, Yun D, Yoon KS, Kwak JS, Koh JC. Development of pre-procedure virtual simulation for challenging interventional procedures: an experimental study with clinical application. Korean J Pain 2022; 35:403-412. [PMID: 36175339 PMCID: PMC9530692 DOI: 10.3344/kjp.2022.35.4.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background Most pain management techniques for challenging procedures are still performed under the guidance of the C-arm fluoroscope although it is sometimes difficult for even experienced clinicians to understand the modified three-dimensional anatomy as a two-dimensional X-ray image. To overcome these difficulties, the development of a virtual simulator may be helpful. Therefore, in this study, the authors developed a virtual simulator and presented its clinical application cases. Methods We developed a computer program to simulate the actual environment of the procedure. Computed tomography (CT) Digital Imaging and Communications in Medicine (DICOM) data were used for the simulations. Virtual needle placement was simulated at the most appropriate position for a successful block. Using a virtual C-arm, the authors searched for the position of the C-arm at which the needle was visualized as a point. The positional relationships between the anatomy of the patient and the needle were identified. Results For the simulations, the CT DICOM data of patients who visited the outpatient clinic was used. When the patients revisited the clinic, images similar to the simulated images were obtained by manipulating the C-arm. Transforaminal epidural injection, which was difficult to perform due to severe spinal deformity, and the challenging procedures of the superior hypogastric plexus block and Gasserian ganglion block, were successfully performed with the help of the simulation. Conclusions We created a pre-procedural virtual simulation and demonstrated its successful application in patients who are expected to undergo challenging procedures.
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Affiliation(s)
- Hyunyoung Seong
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Daehun Yun
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Kyung Seob Yoon
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Ji Soo Kwak
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jae Chul Koh
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
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20
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De Stefano G, Leone C, Di Pietro G, Esposito N, Falco P, Galosi E, Litewczuk D, Mollica C, Truini A, Di Stefano G. Unravelling the role of unmyelinated nerve fibres in trigeminal neuralgia with concomitant continuous pain. Clin Neurophysiol 2022; 142:52-58. [DOI: 10.1016/j.clinph.2022.07.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/13/2022] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
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21
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Liu H, Hou H, Li F, Zheng R, Zhang Y, Cheng J, Han S. Structural and Functional Brain Changes in Patients With Classic Trigeminal Neuralgia: A Combination of Voxel-Based Morphometry and Resting-State Functional MRI Study. Front Neurosci 2022; 16:930765. [PMID: 35844235 PMCID: PMC9277055 DOI: 10.3389/fnins.2022.930765] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Brain structural and functional abnormalities have been separately reported in patients with classic trigeminal neuralgia (CTN). However, whether and how the functional deficits are related to the structural alterations remains unclear. This study aims to investigate the anatomical and functional deficits in patients with CTN and explore their association. Methods A total of 34 patients with CTN and 29 healthy controls (HCs) with age- and gender-matched were recruited. All subjects underwent structural and resting-state functional magnetic resonance imaging (fMRI) scanning and neuropsychological assessments. Voxel-based morphometry (VBM) was applied to characterize the alterations of gray matter volume (GMV). The amplitude of low-frequency fluctuation (ALFF) method was used to evaluate regional intrinsic spontaneous neural activity. Further correlation analyses were performed between the structural and functional changes and neuropsychological assessments. Results Compared to the HCs, significantly reduced GMV was revealed in the right hippocampus, right fusiform gyrus (FFG), and temporal-parietal regions (the left superior/middle temporal gyrus, left operculo-insular gyrus, left inferior parietal lobule, and right inferior temporal gyrus) in patients with CTN. Increased functional activity measured by zALFF was observed mainly in the limbic system (the bilateral hippocampus and bilateral parahippocampal gyrus), bilateral FFG, basal ganglia system (the bilateral putamen, bilateral caudate, and right pallidum), left thalamus, left cerebellum, midbrain, and pons. Moreover, the right hippocampus and FFG were the overlapped regions with both functional and anatomical deficits. Furthermore, GMV in the right hippocampus was negatively correlated with pain intensity, anxiety, and depression. GMV in the right FFG was negatively correlated with illness duration. The zALFF value in the right FFG was positively correlated with anxiety. Conclusion Our results revealed concurrent structural and functional changes in patients with CTN, indicating that the CTN is a brain disorder with structural and functional abnormalities. Moreover, the overlapping structural and functional changes in the right hippocampus and FFG suggested that anatomical and functional changes might alter dependently in patients with CTN. These findings highlight the vital role of hippocampus and FFG in the pathophysiology of CTN.
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Affiliation(s)
- Hao Liu
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research medicine of Henan Province, Zhengzhou, China
- Henan Engineering Research Center of Brain Function Development and Application, Zhengzhou, China
| | - Haiman Hou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fangfang Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruiping Zheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research medicine of Henan Province, Zhengzhou, China
- Henan Engineering Research Center of Brain Function Development and Application, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research medicine of Henan Province, Zhengzhou, China
- Henan Engineering Research Center of Brain Function Development and Application, Zhengzhou, China
- *Correspondence: Yong Zhang,
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research medicine of Henan Province, Zhengzhou, China
- Henan Engineering Research Center of Brain Function Development and Application, Zhengzhou, China
- Jingliang Cheng,
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research medicine of Henan Province, Zhengzhou, China
- Henan Engineering Research Center of Brain Function Development and Application, Zhengzhou, China
- Shaoqiang Han,
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Pergolizzi JV, Gharibo C, Magnusson P, Breve F, LeQuang JA, Varrassi G. Pharmacotherapeutic management of trigeminal neuropathic pain: an update. Expert Opin Pharmacother 2022; 23:1155-1164. [PMID: 35695796 DOI: 10.1080/14656566.2022.2087507] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Guidelines recommend a number of pharmacotherapeutic options used as monotherapy or in combination with others for treating the pain of trigeminal neuropathy. AREAS COVERED The authors examine the pharmacotherapeutic options for treating trigeminal neuralgia and supporting evidence in the literature. Guidelines reported the most effective treatment for trigeminal neuropathy, in particular trigeminal neuralgia, appears to be carbamazepine or oxcabazepine, but side effects can be treatment limiting. Lamotrigine and gabapentin are also recommended in guidance. In real-world clinical practice, baclofen, cannabinoids, eslicarbazepine, levetiracetam, brivaracetam, lidocaine, misoprostol, opioids, phenytoin, fosphenytoin, pimozide, sodium valproate, sumatriptan, tizanidine, tocainide, tricyclic antidepressants, and vixotrigine are sometimes used, either as monotherapy or in combination. The relatively small patient population has limited the number of large-scale studies and there is limited evidence on which to base prescribing choices. EXPERT OPINION While there is no optimal pharmacotherapy for treating trigeminal neuropathy, advancements in our understanding of the underlying mechanisms of this condition and drug development indicate promise for NaV inhibitors, despite the fact that not all patients respond to them and they may have potentially treatment-limiting side effects. Nevertheless, better understanding of NaV channels may be important avenues for future drug development for trigeminal neuropathy.
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Affiliation(s)
| | | | - Peter Magnusson
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden.,Department of Medicine, Cardiology Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Frank Breve
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, Pennsylvania, USA
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23
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Neuralgia and Atypical Facial, Ear, and Head Pain. Otolaryngol Clin North Am 2022; 55:595-606. [DOI: 10.1016/j.otc.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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24
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Jayasinghe AU, Kumarihamy H. Unknown Etiology for Ataxia and Vertigo After Trigeminal Nerve Block: A Case Report. A A Pract 2022; 16:e01598. [DOI: 10.1213/xaa.0000000000001598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chen TY, Ko CC, Wu TC, Lin LC, Shih YJ, Hung YC, Chou MC. Longitudinal alterations of the cisternal segment of trigeminal nerve and brain pain-matrix regions in patients with trigeminal neuralgia before and after treatment. BMC Neurosci 2021; 22:77. [PMID: 34895146 PMCID: PMC8665543 DOI: 10.1186/s12868-021-00681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background Trigeminal neuralgia (TN) is the most common type of chronic neuropathic facial pain, but the etiology and pathophysiological mechanisms after treatment are still not well understood. The purpose of this study was to investigate the longitudinal changes of the cisternal segment of the trigeminal nerve and brain pain-related regions in patients with TN before and after treatment using readout segmentation of long variable echo-train (RESOLVE) diffusion tensor imaging (DTI) and transverse relaxation (T2)-weighted sampling perfection with application-optimized contrast at different flip angle evolutions (T2-SPACE). Methods Twelve patients with TN and four healthy controls were enrolled in this study. All patients underwent assessment of the visual analog scale (VAS), and acquisition of RESOLVE DTI and T2-SPACE images before and at 1, 6, and 12 months after treatments. Regions-of-interest were placed on the bilateral anterior, middle, and posterior parts of the cisternal segment of the trigeminal nerve, the bilateral root entry zone (REZ), bilateral nuclear zone, and the center of pontocerebellar tracts, respectively. Voxel-based morphometry (VBM) analysis was conducted with T2-SPACE images, and gray matter volumes (GMV) were measured from brain pain-matrix regions. Results The results demonstrated that the VAS scores, the axial diffusivity of the middle part of the affected cisternal trigeminal nerve, the fractional anisotropy of the bilateral nuclear zones, and the mean diffusivity of the center of pontocerebellar tract significantly changed over time before and after treatment. The changes of GMV in the pain-matrix regions exhibited similar trends to the VAS before and after treatment. Conclusion We conclude that magnetic resonance imaging with RESOLVE DTI and VBM with T2-SPACE images were helpful in the understanding of the pathophysiological mechanisms in patients with TN before and after treatment.
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Affiliation(s)
- Tai-Yuan Chen
- Department of Radiology, Chi-Mei Medical Center, Tainan, Taiwan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Ching-Chung Ko
- Department of Radiology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Te-Chang Wu
- Department of Radiology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Medical Sciences Industry, Chang Jung Christian University, Tainan, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Li-Ching Lin
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yun-Ju Shih
- Department of Radiology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yi-Chieh Hung
- Division of Neurosurgery, Departments of Surgery, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Ming-Chung Chou
- Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, 100, Shih-Chuan 1st Rd, Kaohsiung, 80708, Taiwan. .,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Ishak FH, Yusof Khan AHK, Mohd Yaakob MN, Al Khafiz Kamis MF, Abdul Rashid AM, Loh WC, Baharin J, Ibrahim A, Inche Mat LN, Wan Sulaiman WA, Hoo FK, Basri H. Giant intracavernous aneurysm presenting with isolated trigeminal neuralgia: a case report. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Trigeminal neuralgia (TN) commonly affects individuals aged more than 50 years and is mostly primary owing to trigeminal nerve neurovascular compression. We report a case of secondary TN attributed to a giant intracavernous aneurysm compressing the trigeminal nerve.
Case presentation
A 74-year-old female presented with classic TN symptoms, which were initially refractory to medical treatment. Imaging including MRI brain, MR angiography, and cerebral angiogram revealed a giant intracavernous aneurysm measuring 1.7 cm × 2.8 cm, inducing mass effect on the left Meckel's cave. Aneurysm embolization was challenging due to the difficult cannulation of the distal portion of the aneurysm. The patient opted for conservative management with mild improvement of symptoms.
Conclusions
Intracavernous aneurysm rarely present with isolated trigeminal neuralgia. This case report emphasizes that the assessment of the intracranial vasculature should be considered as part of the diagnostic imaging work-up for patients presenting with TN
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Noguchi T, Shimamoto Y, Fukuda KI. Clinical characteristics of trigeminal neuralgia in a dental hospital. J Dent Anesth Pain Med 2021; 21:431-440. [PMID: 34703892 PMCID: PMC8520837 DOI: 10.17245/jdapm.2021.21.5.431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Neurovascular compression (NVC) is a well-known cause of trigeminal neuralgia (TN). However, patients with idiopathic TN (ITN) do not have evidence of NVC on magnetic resonance imaging (MRI), and other patients may remain asymptomatic despite evidence of NVC on MRI. This suggests that there may be additional risk factors for TN development other than NVC. Although epidemiological factors, such as age and sex differences, are useful for understanding the pathophysiology of TN, detailed statistics for each TN subtype are currently unavailable. Therefore, this study aimed to classify patients with TN into the following groups based on data extracted from past medical records: classical TN (CTN), secondary TN, and ITN. Methods The characteristics of the groups and their differences were explored. Results CTN was more common in women than in men, as previously reported, whereas ITN was more common in men than in women. The ratio of pain sites located on the right side of the face was high in all groups. Patients with CTN were also prone to NVC on the asymptomatic side. Conclusion By investigating TN subtype, it may be possible to elucidate the pathophysiology of TN. This would greatly improve treatment outcomes.
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Affiliation(s)
- Tomoyasu Noguchi
- Division of Special Needs Dentistry and Orofacial Pain, Department of Oral Health and Clinical Science, Tokyo Dental College, Tokyo, Japan
| | | | - Ken-Ichi Fukuda
- Division of Special Needs Dentistry and Orofacial Pain, Department of Oral Health and Clinical Science, Tokyo Dental College, Tokyo, Japan
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Peterson-Houle GM, AbdelFattah MR, Padilla M, Enciso R. Efficacy of medications in adult patients with trigeminal neuralgia compared to placebo intervention: a systematic review with meta-analyses. J Dent Anesth Pain Med 2021; 21:379-396. [PMID: 34703889 PMCID: PMC8520835 DOI: 10.17245/jdapm.2021.21.5.379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 12/31/2022] Open
Abstract
Background Trigeminal neuralgia (TN) is characterized by brief, unilateral, sharp, stabbing, and shooting pain of the fifth cranial nerve. The objective of this systematic review with meta-analysis was to determine the effect of medications compared to placebo in adult patients with TN. Methods Review authors identified randomized placebo-controlled trials (RCTs) from PubMed, Web of Science, Cochrane, and EMBASE up to February 2021. We assessed the inclusion and exclusion criteria as well as the risk of bias of the studies based on the Cochrane Handbook. A total of 324 unduplicated references were scanned independently and reduced to eight relevant RCTs, with 89 patients included. Medications investigated included oral carbamazepine, subcutaneous sumatriptan, lidocaine (intranasal, 8% spray on the oral mucosa or intravenous), buprenorphine (ganglionic local opioid analgesia), and oral Nav1.7, a selective sodium channel blocker. Results Meta-analyses showed that overall patients receiving lidocaine reported a significantly lower post-treatment intensity of pain -3.8 points on a 0-10 scale (95% Cl = -4.653 to -2.873; P < 0.001). Patients who received lidocaine were 8.62 times more likely to have pain improvement than patients on placebo (P < 0.001). In one RCT, patients receiving oral carbamazepine showed a significant improvement in pain intensity of -32% compared to the placebo (P < 0.001). In one trial, patients receiving 3 mg subcutaneous sumatriptan had a significantly lower intensity of pain on average -6.1 points on a scale of 0-10 compared to placebo (P < 0.001) and a significant improvement in pain intensity of -75% compared to the improvement in the placebo group (P < 0.001). Patients who received subcutaneous sumatriptan were 10 times more likely to have pain improvement than those who received placebo (P = 0.001) in one study. Due to the unclear/high risk of bias and small sample size, the quality of the evidence for lidocaine in the treatment of TN was low. Conclusion Further studies are needed for carbamazepine, sumatriptan, buprenorphine, and oral Nav1.7 sodium channel blockers, as only one study reported outcomes.
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Affiliation(s)
- Georgia M Peterson-Houle
- Master of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry, University of South California, Los Angeles, California, USA
| | - Magda R AbdelFattah
- Department of Restorative Dentistry and Prosthodontics, University of Texas Health Science Center School of Dentistry, Houston, Texas, USA
| | - Mariela Padilla
- Assistant Director of Online Masters & Certificates, Herman Ostrow School of Dentistry, University of South California, Los Angeles, California, USA
| | - Reyes Enciso
- Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
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Historical aspects of the problem of treatment of trigeminal neuralgia and the role of neurosurgical methods in its solution (literature review). ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.4.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The trigeminal nerve is a mixed fifth cranial nerve, consisting of motor and sensory components. The sensitive component receives somesthetic information from the skin and mucous membranes of the face into the central nervous system, and the motor component is responsible for the innervation of chewing muscles. One of the manifestations of the pathology of the trigeminal nerve is pain syndrome. Trigeminal neuralgia occupies the main place among neurogenic pain syndrome in the face, is characterized by а severe course and the absence of sufficiently effective methods of treatment. According to the World Health Organization (WHO), the prevalence of trigeminal neuralgia in different countries is 2–5 cases per 100 thousand people per year. Trigeminal neuralgia is classified into 3 etiologic categories. Idiopathic trigeminal neuralgia occurs without apparent cause. Classical trigeminal neuralgia is caused by vascular compression of the trigeminal nerve root. Secondary trigeminal neuralgia is the consequence of a major neurologic disease, e. g., a tumor of the cеrеbеllоpоntine angle or multiple sclerosis. Today, there are many different options for the surgical treatment of trigeminal neuralgia. microvascular decompression of the root, radiosurgical destruction of the Gasser’s node, radiofrequency destruction, glycerol rhizotomy, balloon microcompression are considered the main effective and proven surgical methods for treating trigeminal neuralgia. But the questions of diagnosing the cause of the disease and choosing an adequate surgical method for treating therapeutically resistant trigeminal neuralgia for a particular patient remain open. The development of surgical methods begins from ancient times to the present day. The main stages in the development of neurosurgical treatment methods are presented. The following surgical techniques are described: open method – microvascular decompression, and closed percutaneous destructive methods – radiofrequency destruction, glycerol rhizotomy, balloon compression, radiosurgery, cryodestruction, laser destruction, botulinum toxin injections.
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Araújo DO, Tabarelli LFP, Lynch LF. Trigeminal neuralgia after corneal transplantation – a case report. REVISTA BRASILEIRA DE OFTALMOLOGIA 2021. [DOI: 10.37039/1982.8551.20210027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Affiliation(s)
- Kaj Fried
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Per T Hansson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Division of Emergencies and Critical Care, Department of Pain Management and Research & Norwegian National Advisory Unit on Neuropathic Pain, Oslo University Hospital, Oslo, Norway
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Kang D, Hesam-Shariati N, McAuley JH, Alam M, Trost Z, Rae CD, Gustin SM. Disruption to normal excitatory and inhibitory function within the medial prefrontal cortex in people with chronic pain. Eur J Pain 2021; 25:2242-2256. [PMID: 34242465 DOI: 10.1002/ejp.1838] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Growing evidence indicates a link between changes in the medial prefrontal cortex and the pathophysiology of chronic pain. In particular, chronic pain is associated with altered medial prefrontal anatomy and biochemistry. Due to the comorbid affective disorders seen across all pain conditions, the medial prefrontal cortex is a region of significance as it is involved in emotional processing. We have recently reported that a decrease in medial prefrontal N-acetylaspartate and glutamate is associated with increased emotional dysregulation, indicating there are neurotransmitter imbalances in chronic pain. Therefore, we compared medial prefrontal neurochemistry in 24 people with chronic pain conditions to 24 age and sex-matched healthy controls with no history of chronic pain. METHOD GABA-edited MEGA-PRESS was used to measure GABA+ levels, and short TE PRESS was used to measure glutamate levels in the medial prefrontal cortex. Psychometric measures regarding pain intensity a week before scanning, during the scan and the total duration of chronic pain, were also recorded and compared to measured GABA+ and glutamate levels. RESULTS This study reveals that the presence of chronic pain is associated with significant decreases in medial prefrontal GABA+ and glutamate. These findings support the hypothesis that chronic pain is associated with altered medial prefrontal biochemistry. CONCLUSION The dysregulation of glutamatergic and GABAergic neurotransmitter systems supports a model of disinhibition of chronic pain, which may play a key role in both the experience of persistent pain and its associated affective disturbances. SIGNIFICANCE This study reveals a significant reduction in γ-aminobutyric acid (GABA+ ) and glutamate within the medial prefrontal cortex in chronic pain sufferers. While the current findings should be considered with reference to a small sample size, the disruption to normal excitatory and inhibitory medial prefrontal cortex function may be key in the development and maintenance of chronic pain and comorbid mental health disorders.
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Affiliation(s)
- David Kang
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Negin Hesam-Shariati
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Psychology, University of New South, Sydney, NSW, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Monzurul Alam
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Psychology, University of New South, Sydney, NSW, Australia
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Psychology, University of New South, Sydney, NSW, Australia
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Maarbjerg S, Benoliel R. The changing face of trigeminal neuralgia-A narrative review. Headache 2021; 61:817-837. [PMID: 34214179 DOI: 10.1111/head.14144] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/11/2021] [Accepted: 04/21/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This narrative review aims to update the reader on the new classification of trigeminal neuralgia (TN), clinical signs, pathophysiologic evidence, and their implications on management. This review is based on the authors' collective experience and knowledge of the literature in addition to a literature search. BACKGROUND In recent years, the phenotype of TN has been intensively studied leading to discrete groups of patients. These include patients with TN with additional continuous pain, and patients with and without neurovascular compression of the trigeminal dorsal root entry zone. A number of associated clinical signs such as tearing and sensory changes need further research. METHODS The literature on TN was searched in PubMed with the aims of providing evidence for the recently published third edition of the International Classification of Headache Disorders (ICHD) and update the clinical phenotype and management of the TN subcategories. RESULTS The ICHD's new classification for TN is based on reliable clinical data, imaging, and neurophysiologic studies. The TN classification reflects current knowledge and has improved the possibility for clinicians to choose adequate management options. However, there is a lack of effective, safe drugs for the management of TN and sparse, robust data on neurosurgical options. CONCLUSION Research into all aspects of TN-diagnosis, pharmacotherapy, surgery, long-term management prognosis, and natural history-is needed. Research should adhere to the ICHD's schema for TN. Improved drugs are needed along with rigorous research into surgical options and their efficacy for different subtypes of TN.
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Affiliation(s)
- Stine Maarbjerg
- Danish Headache Center, Department of Neurology, Rigshospitalet, Glostrup, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Copenhagen, Denmark
| | - Rafael Benoliel
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
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Tohyama S, Walker MR, Zhang JY, Cheng JC, Hodaie M. Brainstem trigeminal fiber microstructural abnormalities are associated with treatment response across subtypes of trigeminal neuralgia. Pain 2021; 162:1790-1799. [PMID: 33306503 PMCID: PMC8120686 DOI: 10.1097/j.pain.0000000000002164] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 01/03/2023]
Abstract
ABSTRACT Neurosurgical treatments for trigeminal neuralgia (TN) can provide long-lasting pain relief; however, some patients fail to respond and undergo multiple, repeat procedures. Surgical outcomes can vary depending on the type of TN, but the reasons for this are not well understood. Neuroimaging studies of TN point to abnormalities in the brainstem trigeminal fibers; however, whether this is a common characteristic of treatment nonresponse across different subtypes of TN is unknown. Here, we used diffusion tensor imaging (DTI) to determine whether the brainstem trigeminal fiber microstructure is a common biomarker of surgical response in TN and whether the extent of these abnormalities is associated with the likelihood of response across subtypes of TN. We studied 98 patients with TN (61 classical TN, 26 TN secondary to multiple sclerosis, and 11 TN associated with a solitary pontine lesion) who underwent neurosurgical treatment and 50 healthy controls. We assessed treatment response using pain intensity measures and examined microstructural features by extracting pretreatment DTI metrics from the proximal pontine segment of the trigeminal nerves. We found that microstructural abnormalities in the affected pontine trigeminal fibers (notably, lower fractional anisotropy and higher radial diffusivity) highlight treatment nonresponders (n = 47) compared with responders (n = 51) and controls, and that the degree of abnormalities is associated with the likelihood of surgical response across subtypes of TN. These novel findings demonstrate the value of DTI as an objective, noninvasive tool for the prediction of treatment response and elucidate the features that distinguish treatment responders from nonresponders in the TN population.
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Affiliation(s)
- Sarasa Tohyama
- Division of Brain, Imaging, and Behaviour—Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew R. Walker
- Division of Brain, Imaging, and Behaviour—Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Jia Y. Zhang
- Division of Brain, Imaging, and Behaviour—Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Joshua C. Cheng
- Stony Brook University School of Medicine, Stony Brook, NY, United States
| | - Mojgan Hodaie
- Division of Brain, Imaging, and Behaviour—Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Nagy MR, Mahmoud B. Peripheral Neurectomy for Trigeminal Neuralgia: A Report of Seventeen Cases and Review of the Literature. Asian J Neurosurg 2021; 16:281-287. [PMID: 34268152 PMCID: PMC8244708 DOI: 10.4103/ajns.ajns_361_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/22/2020] [Accepted: 03/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Surgical intervention for trigeminal neuralgia (TN) is indicated if there is a failure of the medical treatment. Peripheral neurectomy is one of the oldest surgical procedures for TN. Objective: The aim is to evaluate the clinical outcome and the recurrence rate following peripheral neurectomy for the management of TN. Patients and Methods: This was a retrospective cohort study of 17 patients with classical TN treated by peripheral neurectomy. The visual analogue scale (VAS) was used for pain assessment preoperatively and during the follow-up period. The outcome of surgery was graded as a marked, moderate, or mild improvement. Kaplan–Meier analysis was used for the time to recurrence to predict the probability of recurrence at any given time following the procedure. Results: The mean pain-free interval was 29.3 ± 16.3 months. At 2 and 5 years of the follow-up period, the mean VAS improved significantly (P < 0.001 and P = 0.042 respectively). Thirteen patients had marked improvement of pain. There was recurrence of pain in 4 patients (23.5%). By Kaplan–Meier analysis, the survival rate without recurrence at 2, 3, 4, and 5 years following the procedure were 92.9%, 79.6%, 59.7%, and 29.8%, respectively. The mean preoperative Hospital Anxiety and Depression Scale-Anxiety and Depression scores significantly improved on the last follow-up visit following the procedure (P < 0.001 for both). Conclusion: Peripheral neurectomy provides short to medium-term good pain control for patients with TN. The preoperative severity of pain, anxiety, and depression levels improved markedly after the procedure.
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Affiliation(s)
- Mohamed Ragab Nagy
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Bokhary Mahmoud
- Department of Neurosurgery, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
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Balloon compression vs radiofrequency for primary trigeminal neuralgia: a randomized, controlled trial. Pain 2021; 162:919-929. [PMID: 32947541 DOI: 10.1097/j.pain.0000000000002070] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022]
Abstract
ABSTRACT Surgical procedures are necessary in up to 50% of trigeminal neuralgia patients. Although radiofrequency (RF) is more widely used, it is associated with high intraprocedural costs and long technical learning time. Other simpler procedures such as balloon compression (BC) require a lower training period and have significant lower costs. We evaluated the effects of BC and RF in pain control in primary trigeminal neuralgia in a randomized, double-blinded, head-to-head trial. Individuals were randomly allocated in 1 of 2 groups: BC and RF. Throughout pain, psychological and quality of life measurements were performed at baseline and after surgery. The main outcome was the worst pain in the last 24 hours (0-10) at 6 months postoperatively. After the inclusion of half of the estimated sample, a preplanned interim analysis was performed when 33 patients (62.1 ± 9.4 y.) completed the study. Pain intensity (confidence interval [CI] 95% 0.6 to 3.8, and -0.6 to 2.2, for BC and RF) did not significantly differ. Complications, interference of pain in daily life (CI 95% -0.1 to 2.3 and -0.4 to 2.3, for BC and RF), neuropathic pain symptoms (CI 95% 1.7 to 3.6 and 3.0 to 5.7, for BC and RF), mood (CI 95% 4.8 to 11.5 and 5.5 to 15.1, BC and RF, respectively), medication use, and quality of life (CI 95% 80.4 to 93.1 and 83.9 to 94.2, for BC and RF) were also not different. Radiofrequency presented more paresthetic symptoms than BC at 30 days after intervention. Based on these results, the study was halted due to futility because BC was not superior to RF.
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Trigeminal neuralgia associated with a solitary pontine lesion: clinical and neuroimaging definition of a new syndrome. Pain 2021; 161:916-925. [PMID: 31842151 PMCID: PMC7170433 DOI: 10.1097/j.pain.0000000000001777] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Patients with trigeminal neuralgia associated with solitary pontine lesion have clinical symptoms of trigeminal neuralgia and a single pontine lesion along the trigeminal nerve pathway. They are refractory to surgical treatment. Conventional magnetic resonance imaging of patients with trigeminal neuralgia (TN) does not typically reveal associated brain lesions. Here, we identify a unique group of TN patients who present with a single brainstem lesion, who do not fulfill diagnostic criteria for multiple sclerosis (MS). We aim to define this new clinical syndrome, which we term TN associated with solitary pontine lesion (SPL-TN), using a clinical and neuroimaging approach. We identified 24 cases of SPL-TN, 18 of which had clinical follow-up for assessment of treatment response. Lesion mapping was performed to determine the exact location of the lesions and site of maximum overlap across patients. Diffusion tensor imaging was used to assess the white-matter microstructural properties of the lesions. Diffusivity metrics were extracted from the (1) SPL-TN lesions, (2) contralateral, unaffected side, (3) MS brainstem plaques from 17 patients with TN secondary to MS, (4) and healthy controls. We found that 17/18 patients were nonresponders to surgical treatment. The lesions were uniformly located along the affected trigeminal pontine pathway, where the site of maximum overlap across patients was in the area of the trigeminal nucleus. The lesions demonstrated abnormal white-matter microstructure, characterized by lower fractional anisotropy, and higher mean, radial, and axial diffusivities compared with the unaffected side. The brainstem trigeminal fiber microstructure within a lesion highlighted the difference between SPL-TN lesions and MS plaques. In conclusion, SPL-TN patients have identical clinical features to TN but have a single pontine lesion not in keeping with MS and are refractory to surgical management.
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Song D, Li J, Zhai Y, Yang F, Wang M, Zhao C, Wei X. Effects of Preoperative Carbamazepine Treatment on Microvascular Decompression for Classical Trigeminal Neuralgia. World Neurosurg 2021; 149:e63-e70. [PMID: 33647489 DOI: 10.1016/j.wneu.2021.02.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Carbamazepine (CBZ) is the first-line therapy for trigeminal neuralgia (TN), and microvascular decompression (MVD) is considered to be an effective surgical treatment for TN. However, the effect of preoperative CBZ treatment on MVD outcome is not clear. METHODS From 2013 to 2019, 63 patients with classical TN underwent MVD at the First Affiliated Hospital of Zhengzhou University, China. Data were collected through telephone follow-up and electronic medical records in April 2020. Short-term surgical outcome and long-term follow-up data were estimated by univariate and multivariate analysis. RESULTS Multivariate analysis indicated that preoperative CBZ treatment was not a significant predictor for short-term outcomes of MVD (P > 0.05). Multivariate analysis for the long-term outcome of MVD indicated that preoperative CBZ treatment could predict postoperative recurrence of TN (P < 0.05). CONCLUSIONS For patients with classical TN, a longer preoperative medication history of CBZ treatment had no significant effect on short-term outcome of MVD, but CBZ treatment was associated with a poor long-term outcome following MVD.
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Affiliation(s)
- Dixiang Song
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianguo Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yixuan Zhai
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fengdong Yang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Minkai Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinting Wei
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Greve T, Tonn JC, Mehrkens JH. Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety. J Neurol 2021; 268:532-540. [PMID: 32862244 PMCID: PMC7880960 DOI: 10.1007/s00415-020-10187-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/15/2020] [Accepted: 08/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The safety and efficacy of surgical microvascular decompression (MVD) in elderly patients with trigeminal neuralgia (TN) is controversially discussed in the literature. A widespread reluctance to expose this cohort to major intracranial surgery persists. Our aim was to compare the efficacy and safety between older and younger patients with TN. METHODS In this cross-sectional study, 139 MVD procedures (103 patients < 70 and 36 patients ≥ 70) were included. Surgical fitness was assessed by the American Society of Anesthesiology (ASA) grade. The pain-free interval was evaluated using Kaplan-Meier analysis only in patients with a recent follow-up visit. Independent risk factors for recurrence in patients with a minimum 12-month follow-up were determined. RESULTS Patients ≥ 70 showed a significantly higher number of comorbidities. Pain intensity, affection of trigeminal branches and symptom duration was similar between groups. No significant difference in treatment associated complications and permanent neurological deficits was shown. There was no treatment-related mortality. A tendency towards a lower recurrence rate in patients < 70 did not reach statistical significance (17.6% vs. 28.6%, P = 0.274). Pain-free interval was not different between both cohorts (78.7 vs. 73.5 months, P = 0.391). CONCLUSION Despite a higher prevalence of comorbidities in elderly patients, complication rates and neurological deficits after MVD were comparable to younger patients. Rates of immediate and long-term pain relief compared favorably to previous studies and were similar between elderly and younger patients. These data endorse MVD as a safe and effective first-line surgical procedure for elderly patients with TN and neurovascular conflict on MRI.
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Affiliation(s)
- Tobias Greve
- Department of Neurosurgery, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
| | - Joerg-Christian Tonn
- Department of Neurosurgery, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jan-Hinnerk Mehrkens
- Department of Neurosurgery, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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Agarwal A, Rastogi S, Bansal M, Kumar S, Malviya D, Thacker AK. Radiofrequency Treatment of Idiopathic Trigeminal Neuralgia (Conventional vs. Pulsed): A Prospective Randomized Control Study. Anesth Essays Res 2021; 15:14-19. [PMID: 34667342 PMCID: PMC8462427 DOI: 10.4103/aer.aer_56_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Idiopathic trigeminal neuralgia (TGN) is a chronic pain disorder causing unilateral, severe brief stabbing recurrent pain in the distribution of one or more branches of the trigeminal nerve. Conventional radiofrequency (CRF) and pulsed radiofrequency (PRF) are two types of minimally invasive treatment. CRF selectively ablates the part of ganglion to provide the relief, but it has been found to be associated with some side effects such as dysesthesia or sensory loss in 6%-28% and loss of corneal reflex in 3%-8% of patients. PRF is a comparatively newer modality which is a nondestructive and neuromodulatory method of delivering radiofrequency energy to the gasserian ganglion to produce a therapeutic effect. AIMS We aimed to compare the efficacy of CRF with long-duration, fixed voltage PRF in the treatment of idiopathic TGN. SETTING This study was conducted in a tertiary care center research institute. STUDY DESIGN This was a prospective randomized trial. MATERIALS AND METHODS Twenty-seven adult patients of TGN were included in the study and randomly allocated into two groups (CRF and PRF). All procedures were performed operation suite with C-arm fluoroscopic guidance. Both, pre- and postprocedure, the patients were assessed for pain on the Visual Analog Scale (VAS) and Barrow Neurological Institute (BNI) Pain Intensity Scale at 1 week and thereafter at 1, 2, 3, and 6 months. Patients with a BNI score ≥4 after 1 month were considered a failure and offered other modes of treatment. A reduction in VAS score ≥50% and a BNI score <4 were considered as effective. STATISTICAL ANALYSIS Discreet variables were recorded as proportions, ordinal variables and continuous variables with non-Gaussian distribution as medians with interquartile range, and continuous variables with Gaussian distribution as mean ± standard deviation. Association between ordinal variables was tested by Fisher's exact test/Chi-square test whenever appropriate. Equality of means/median was tested by using paired/unpaired t-test or nonparametric tests depending upon the distribution of data. P ≤ 0.5 was considered statistically significant. Data analysis was performed using STATA version 13.04 windows. RESULTS Efficacy in terms of decrease in VAS ≥50% at 1 month was 33.33% and 83.33% in the PRF and CRF groups, respectively, which was statistically significant(P = 0.036). Effective reduction in BNI scores at the 7th day, 1 month, and 2 months postprocedure was evaluated and found in 41.67% and 83.33% of patients in the PRF and CRF groups, respectively, which was statistically insignificant (P = 0.089). There was a statistically significant reduction in BNI scores in PRF and CRF group patients at 3 and 6 months (at 3 months, 33.33% and 83.33%, P = 0.036 and at 6 months, 25% and 83.33%, P = 0.012). In the CRF group, mild hypoesthesia was evident in three patients which improved by the end of 1 month while no side effects were seen in the PRF group. CONCLUSION CRF is a more effective procedure to decrease pain in comparison to long-duration, fixed voltage PRF for the treatment of idiopathic TGN. Although the side effects are more with CRF, they are mild and self-limiting.
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Affiliation(s)
- Anurag Agarwal
- Department of Anesthesiology, CCM and Pain Medicine, Dr. RMLIMS, Lucknow, Uttar Pradesh, India
| | - Shivani Rastogi
- Department of Anesthesiology, CCM and Pain Medicine, Dr. RMLIMS, Lucknow, Uttar Pradesh, India
| | - Manjari Bansal
- Department of Anesthesiology, CCM and Pain Medicine, Dr. RMLIMS, Lucknow, Uttar Pradesh, India
| | - Suraj Kumar
- Department of Anesthesiology, CCM and Pain Medicine, Dr. RMLIMS, Lucknow, Uttar Pradesh, India
| | - Deepak Malviya
- Department of Anesthesiology, CCM and Pain Medicine, Dr. RMLIMS, Lucknow, Uttar Pradesh, India
| | - Anup K. Thacker
- Department of Neurology, Dr. RMLIMS, Lucknow, Uttar Pradesh, India
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Shahab A, Hashmi MS, Ahmed Z, Haider AS, Haider A. A Case of Trigeminal Neuralgia Treated With Combination of Antihistamine, Montelukast, and Corticosteroid Nasal Spray. Cureus 2020; 12:e12223. [PMID: 33489627 PMCID: PMC7815261 DOI: 10.7759/cureus.12223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Liu J, Wu G, Xiang H, Liu R, Li F, Hei B, Qian W, Song H, Liu Z. Long-Term Retrospective Analysis of Microvascular Decompression in Patients With Recurrent Trigeminal Neuralgia. Front Neurol 2020; 11:584224. [PMID: 33408683 PMCID: PMC7779790 DOI: 10.3389/fneur.2020.584224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To explore the clinical characteristics of patients with recurrent trigeminal neuralgia (TN) and the experience of microvascular decompression (MVD) in the treatment of such patients. Methods: We retrospectively analyzed clinical data, imaging examination results, surgical methods, and treatment efficacies in 127 patients with recurrent typical TN from January 2005 to December 2014. Results: The age of the recurrent group was higher than that of the non-recurrent group (p < 0.05). The duration of pain before the first MVD procedure was longer in the recurrent group than in the non-recurrent group (p < 0.05). Patients in the recurrent group were more likely to have compression of the trigeminal nerve by the vertebrobasilar artery (VBA) or multiple vessels than patients in the non-recurrent group (p < 0.05). A Kaplan-Meier curve showed a median pain-free survival of 12 months after the first MVD procedure. The severity of pain (preoperative visual analog scale [VAS] score) in patients with recurrence was lower than that in patients with first-onset TN (p < 0.05). Vessel compression, Teflon compression or granuloma and arachnoid adhesion were considered the main causes of recurrence. Postoperative Barrow Neurological Institute (BNI) scores in the redo MVD group were excellent (T = 2) for 69 patients (53.33%) and good (T = 3) for 46 patients (36.22%). The postoperative follow-up was 63-167 months (105.92 ± 25.66). During the follow-up, no recurrence was noted. All complications were cured or improved. Conclusions: Microvascular decompression (MVD) is an effective surgical method for the treatment of TN. For recurrent patients, reoperation can achieve good results.
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Affiliation(s)
- Jiayu Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Guangyong Wu
- Department of Neurosurgery, The Hospital of Shunyi District Beijing, Beijing, China
| | - Hui Xiang
- Department of Neurosurgery Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Ruen Liu
- Department of Neurosurgery Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China.,Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Fang Li
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Bo Hei
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Weiqiang Qian
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Haidong Song
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Zhi Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
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Mills EP, Alshelh Z, Kosanovic D, Di Pietro F, Vickers ER, Macey PM, Henderson LA. Altered Brainstem Pain-Modulation Circuitry Connectivity During Spontaneous Pain Intensity Fluctuations. J Pain Res 2020; 13:2223-2235. [PMID: 32943915 PMCID: PMC7481287 DOI: 10.2147/jpr.s252594] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Chronic pain, particularly that following nerve injury, can occur in the absence of external stimuli. Although the ongoing pain is sometimes continuous, in many individuals the intensity of their pain fluctuates. Experimental animal studies have shown that the brainstem contains circuits that modulate nociceptive information at the primary afferent synapse and these circuits are involved in maintaining ongoing continuous neuropathic pain. However, it remains unknown if these circuits are involved in regulating fluctuations of ongoing neuropathic pain in humans. Methods We used functional magnetic resonance imaging to determine whether in 19 subjects with painful trigeminal neuropathy, brainstem pain-modulation circuitry function changes according to moment-to-moment fluctuations in spontaneous pain intensity as rated online over a 12-minute period. Results We found that when pain intensity was spontaneously high, connectivity strengths between regions of the brainstem endogenous pain-modulating circuitry-the midbrain periaqueductal gray, rostral ventromedial medulla (RVM), and the spinal trigeminal nucleus (SpV)-were high, and vice-versa (when pain was low, connectivity was low). Additionally, sliding-window connectivity analysis using 50-second windows revealed a significant positive relationship between ongoing pain intensity and RVM-SpV connectivity over the duration of the 12-minute scan. Conclusion These data reveal that moment-to-moment changes in brainstem pain-modulation circuitry functioning likely contribute to fluctuations in spontaneous pain intensity in individuals with chronic neuropathic pain.
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Affiliation(s)
- Emily P Mills
- Department of Anatomy and Histology, University of Sydney, Sydney, NSW 2006, Australia
| | - Zeynab Alshelh
- Department of Anatomy and Histology, University of Sydney, Sydney, NSW 2006, Australia
| | - Danny Kosanovic
- Department of Anatomy and Histology, University of Sydney, Sydney, NSW 2006, Australia
| | - Flavia Di Pietro
- Department of Anatomy and Histology, University of Sydney, Sydney, NSW 2006, Australia
| | - E Russell Vickers
- Department of Anatomy and Histology, University of Sydney, Sydney, NSW 2006, Australia
| | - Paul M Macey
- School of Nursing and Brain Research Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Luke A Henderson
- Department of Anatomy and Histology, University of Sydney, Sydney, NSW 2006, Australia
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Affiliation(s)
- Giorgio Cruccu
- From the Department of Human Neuroscience, Sapienza University of Rome, Rome
| | - Giulia Di Stefano
- From the Department of Human Neuroscience, Sapienza University of Rome, Rome
| | - Andrea Truini
- From the Department of Human Neuroscience, Sapienza University of Rome, Rome
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Di Stefano G, De Stefano G, Leone C, Cruccu G, Tardioli S, Cartocci G, Fiorelli M, Truini A, Caramia F. Concomitant continuous pain in patients with trigeminal neuralgia is associated with trigeminal nerve root atrophy. Cephalalgia 2020; 40:1502-1510. [DOI: 10.1177/0333102420949206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction Trigeminal neuralgia is an exemplary neuropathic pain condition characterized by paroxysmal electric-shock-like pain. However, up to 50% of patients also experiences concomitant continuous pain. In this neuroimaging study, we aimed to identify the specific anatomical features of trigeminal nerve root in patients with concomitant continuous pain. Methods We enrolled 73 patients with a definitive diagnosis of classical and idiopathic trigeminal neuralgia and 40 healthy participants. The diagnosis of trigeminal neuralgia was independently confirmed by two clinicians. Patients were grouped as patients with purely paroxysmal pain (45 patients) and patients also with concomitant continuous pain (28 patients). All participants underwent a structured clinical examination and a 3T MRI with sequences dedicated to the anatomical study of the trigeminal nerve root, including volumetric study. Images analysis was independently performed by two investigators, blinded to any clinical data. Results In most patients with concomitant continuous pain, this type of pain, described as burning, throbbing or aching, manifested at the disease onset. Demographic and clinical variables did not differ between the two groups of patients; the frequency of neurovascular compression and nerve dislocation were similar. Conversely, trigeminal nerve root atrophy was more severe in patients with concomitant continuous pain than in those with purely paroxysmal pain ( p = 0.006). Conclusions Our clinical and neuroimaging study found that in patients with trigeminal neuralgia, concomitant continuous pain was associated with trigeminal nerve root atrophy, therefore suggesting that this type of pain is likely related to axonal loss and abnormal activity in denervated trigeminal second-order neurons.
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Affiliation(s)
| | | | - Caterina Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Giorgio Cruccu
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Stefano Tardioli
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Gaia Cartocci
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Marco Fiorelli
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
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Meltz L, Ortiz D, Chiang P. The Anatomical Relationship Between Acupoints of the Face and the Trigeminal Nerve. Med Acupunct 2020; 32:181-193. [PMID: 32879645 DOI: 10.1089/acu.2020.1413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Acupuncture continues to gain popularity as a first treatment option for a variety of conditions; however, an in-depth understanding of the relationships between the acupoints and the underlying anatomy of the human body is often unclear. This article updates the anatomical relationship between facial acupoints and the trigeminal nerve (CN V) and contrasts the results against the standard textbook Chinese Acupuncture and Moxibustion. Methods: A literature review, cadaver dissection, and a neuroanatomical stimulation of the CN V was conducted, focusing on the anatomical locations of the acupoints along the CN V on the face and nerve block targets. The results were contrasted against the standard acupoint location and nerve targets described in Chinese Acupuncture and Moxibustion. Results: The present article classifies CN V acupuncture targets according to 4 different types: (1) trunk; (2) bifurcation; (3) branch; and (4) anastomoses. The results of this exploration highlight the specificity with which acupoints are located in relation to the CN V. Areas of high nerve density correspond to several acupoints. Consequently, acupoints overlay closely with CN V branches as they emerge and bifurcate on the face. Conclusions: There is a clear and neuroanatomically relevant relationship between facial acupoints and the CN V.
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Affiliation(s)
- Leah Meltz
- River Clinic Integrative Medicine, Markham, Ontario, Canada
| | - Daniel Ortiz
- Integrative Medicine-Acupuncture, Institute for Advanced Medicine, Mount Sinai St. Luke's and West Hospitals, New York, NY, USA
| | - Poney Chiang
- River Clinic Integrative Medicine, Markham, Ontario, Canada.,Faculty of Health, Department of Health Science, School of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
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Willsey MS, Collins KL, Conrad EC, Chubb HA, Patil PG. Diffusion tensor imaging reveals microstructural differences between subtypes of trigeminal neuralgia. J Neurosurg 2020; 133:573-579. [PMID: 31323635 DOI: 10.3171/2019.4.jns19299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is an uncommon idiopathic facial pain syndrome. To assist in diagnosis, treatment, and research, TN is often classified as type 1 (TN1) when pain is primarily paroxysmal and episodic or type 2 (TN2) when pain is primarily constant in character. Recently, diffusion tensor imaging (DTI) has revealed microstructural changes in the symptomatic trigeminal root and root entry zone of patients with unilateral TN. In this study, the authors explored the differences in DTI parameters between subcategories of TN, specifically TN1 and TN2, in the pontine segment of the trigeminal tract. METHODS The authors enrolled 8 patients with unilateral TN1, 7 patients with unilateral TN2, and 23 asymptomatic controls. Patients underwent DTI with parameter measurements in a region of interest within the pontine segment of the trigeminal tract. DTI parameters were compared between groups. RESULTS In the pontine segment, the radial diffusivity (p = 0.0049) and apparent diffusion coefficient (p = 0.023) values in TN1 patients were increased compared to the values in TN2 patients and controls. The DTI measures in TN2 were not statistically significant from those in controls. When comparing the symptomatic to asymptomatic sides in TN1 patients, radial diffusivity was increased (p = 0.025) and fractional anisotropy was decreased (p = 0.044) in the symptomatic sides. The apparent diffusion coefficient was increased, with a trend toward statistical significance (p = 0.066). CONCLUSIONS Noninvasive DTI analysis of patients with TN may lead to improved diagnosis of TN subtypes (e.g., TN1 and TN2) and improve patient selection for surgical intervention. DTI measurements may also provide insights into prognosis after intervention, as TN1 patients are known to have better surgical outcomes than TN2 patients.
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Affiliation(s)
- Matthew S Willsey
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Kelly L Collins
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
- 2Department of Neurosurgery, University of Washington, Seattle, Washington
| | - Erin C Conrad
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
- 3Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Heather A Chubb
- 4Neuroscience and Sensory CTSU, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Parag G Patil
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Abstract
Neuropathic pain caused by a lesion or disease of the somatosensory nervous system is a common chronic pain condition with major impact on quality of life. Examples include trigeminal neuralgia, painful polyneuropathy, postherpetic neuralgia, and central poststroke pain. Most patients complain of an ongoing or intermittent spontaneous pain of, for example, burning, pricking, squeezing quality, which may be accompanied by evoked pain, particular to light touch and cold. Ectopic activity in, for example, nerve-end neuroma, compressed nerves or nerve roots, dorsal root ganglia, and the thalamus may in different conditions underlie the spontaneous pain. Evoked pain may spread to neighboring areas, and the underlying pathophysiology involves peripheral and central sensitization. Maladaptive structural changes and a number of cell-cell interactions and molecular signaling underlie the sensitization of nociceptive pathways. These include alteration in ion channels, activation of immune cells, glial-derived mediators, and epigenetic regulation. The major classes of therapeutics include drugs acting on α2δ subunits of calcium channels, sodium channels, and descending modulatory inhibitory pathways.
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Affiliation(s)
- Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; and Department of Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Rohini Kuner
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; and Department of Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Troels Staehelin Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; and Department of Pharmacology, Heidelberg University, Heidelberg, Germany
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Abu Hamdeh S, Khoonsari PE, Shevchenko G, Gordh T, Ericson H, Kultima K. Increased CSF Levels of Apolipoproteins and Complement Factors in Trigeminal Neuralgia Patients-In Depth Proteomic Analysis Using Mass Spectrometry. THE JOURNAL OF PAIN 2020; 21:1075-1084. [PMID: 32553624 DOI: 10.1016/j.jpain.2020.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/27/2019] [Accepted: 03/14/2020] [Indexed: 01/03/2023]
Abstract
The main cause of trigeminal neuralgia (TN) is compression of a blood vessel at the root entry zone of the trigeminal nerve. However, a neurovascular conflict does not seem to be the only etiology and other mechanisms are implicated in the development of the disease. We hypothesized that TN patients may have distinct protein expression in the CSF. In this study, lumbar CSF from TN patients (n = 17), scheduled to undergo microvascular decompression, and from controls (n = 20) was analyzed and compared with in depth mass spectrometry TMTbased quantitative proteomics. We identified 2552 unique proteins, of which 46 were significantly altered (26 increased, and 20 decreased, q-value < .05) in TN patients compared with controls. An over-representation analysis showed proteins involved in high-density lipoprotein, such as Apolipoprotein A4, Apolipoprotein M, and Apolipoprotein A1, and the extracellular region, including proteins involved in the complement cascade to be over-represented. We conclude that TN patients have distinct protein expression in the CSF compared to controls. The pathophysiological background of the protein alterations found in this study warrants further investigation in future studies. PERSPECTIVE: In this article, cerebrospinal fluid from patients with trigeminal neuralgia was analyzed using in depth shotgun proteomics, revealing 46 differentially expressed proteins compared to controls. Among these, apolipoproteins and proteins involved in the complement system were elevated and significantly over-represented, implying an inflammatory component in the pathophysiology of the disease.
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Affiliation(s)
- Sami Abu Hamdeh
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden.
| | - Payam Emami Khoonsari
- Department of Medical Sciences, Chemical Chemistry, Uppsala University, Uppsala, Sweden
| | - Ganna Shevchenko
- Department of Chemistry-BMC, Analytical Chemistry, Uppsala University, Uppsala, Sweden
| | - Torsten Gordh
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Hans Ericson
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Kim Kultima
- Department of Medical Sciences, Chemical Chemistry, Uppsala University, Uppsala, Sweden; Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
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Lee YL, Chen ST, Yang JT, Weng HH, Wang HL, Tsai YH. Diffusivity parameters of diffusion tensor imaging and apparent diffusion coefficient as imaging markers for predicting the treatment response of patients with trigeminal neuralgia. J Neurosurg 2020; 132:1993-1999. [PMID: 31100729 DOI: 10.3171/2019.2.jns183008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/19/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is facial pain that is usually caused by neurovascular compression syndrome and is characterized by suddenly intense and paroxysmal pain. Radiofrequency lesioning (RFL) is one of the major treatments for TN, but the treatment response for RFL is sometimes inconsistent, and the recurrence of TN is not uncommon. This study aimed to estimate the outcome predictors of TN treated with RFL by using the parameters of diffusion tensor imaging (DTI). METHODS Fifty-one patients with TN who were treated with RFL were enrolled in the study. MRI was performed in all patients within 1 week before surgery. The visual analog scale was used to evaluate symptom severity at three time points: before, 1 week after, and 3 months after RFL. The involved cisternal segment of the trigeminal nerves was manually selected, and the histograms of each of the diffusivity metrics-including the apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD)-were measured. The differences in the means, as well as the kurtosis and skewness of each of the diffusivity metrics between the nonrecurrent and recurrent groups, were then analyzed using the Mann-Whitney U-test. RESULTS There were significantly lower kurtosis values (a broader peak of the distributional curves) for both FA and ADC in the recurrent group (p = 0.0004 and 0.015, respectively), compared to the nonrecurrent group. The kurtoses of AD and RD, as well as the mean and skewness of all other diffusivity metrics, did not show significant differences between the two groups. CONCLUSIONS The pretreatment diffusivity metrics of DTI and ADC may be feasible imaging biomarkers for predicting the outcome of TN after RFL. A clarification of the kurtosis value of FA and ADC is helpful for determining the prognosis of patients after RFL.
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Affiliation(s)
- Yu-Li Lee
- Departments of1Diagnostic Radiology and
| | | | - Jen-Tsung Yang
- 2Neurosurgery, Chang Gung Memorial Hospital, Chiayi branch, Chiayi; and
| | | | | | - Yuan-Hsiung Tsai
- Departments of1Diagnostic Radiology and
- 3College of Medicine, Chang Gung University, Taoyuan, Taiwan
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