2023 American Academy of Neurology Abstract Website

Objective:

To describe the clinical characteristics, MRI correlates, and treatment outcomes of the University of Utah Multiple Sclerosis (MS) patient population with Trigeminal Neuralgia (TN).

Background:

MS related TN is known to be a challenge to effectively treat and is a major cause of debility for these patients. Despite its impact on quality of life, clinical features and management strategies specific to TN secondary to MS are limited.

Design/Methods:

A prospective review was conducted of patients within the University of Utah Healthcare system who met the following criteria: (1) clinically definite MS (McDonald 2017) (2) met American Academy of Neurology ‘s (AAN) diagnostic criteria for TN (3) were seen at University of Utah MS clinic between the dates of 1/2017 and 9/2022. TN pain was assessed with a questionnaire to determine pain characteristics and severity over time. MRI brain and cervical spine were evaluated for relevant lesions. Treatment (including both pharmacologic and non-pharmacologic) along with outcomes were monitored.

Results:

Fourteen MS patients met inclusion criteria, (11 female, 3 male) with average age being 65 years old. The neurogenic pain quality was electric (10), burning (6), tingling (5), and pins/needles sensation (5) with average severity of 6. Sensory deficits in cranial nerve V (CNV) distribution were noted in 6 patients. Imaging studies were available for 13 patients. Demyelinating lesions were identified in brainstem and CN V (8), dorsolateral upper cervical cord (6), or both brainstem and cord (4). Most patients were treated with oxcarbazepine followed by gabapentin with 1 patient benefiting from 2 gamma knife procedures.

Conclusions:

MS patients with TN experienced neurogenic pain of multiple types and high severity. MRI correlates of TN in brainstem or cervical cord were frequently observed. Pharmacological interventions, especially oxcarbazepine and gabapentin were frequently beneficial. Further evaluation of gamma knife procedure in MS related TN should be investigated.