Trigeminal neuralgia is a severe sharp shooting pain that occurs in the distribution of one of the branches of the trigeminal nerve that supplies the face. In MS trigeminal neuralgia results from a lesion in the area of the brain where the trigeminal nerve leaves the brain stem. The pain is often described as being like and electric shock and is often triggered by sensory stimuli, for example eating, brushing your teeth, touching your face, etc. The pain is typically very severe and frequently debilitating. It has many different causes. When it occurs as a complication of MS it is often very difficult to treat.
Stereotactic radiosurgery (very precise delivery of radiation therapy) is one of a number of recognised treatments for the management of trigeminal neuralgia refractory to drug therapy.
The reported success of stereotactic radiosurgery in managing patients with trigeminal neuralgia varies in different units from 22 to 75%.
This study reports the outcomes of patients with trigeminal neuralgia who were treated at the National Centre for Stereotactic Radiosurgery in Sheffield, UK.
The study reports the outcome of 72 patients. Fourteen patients had secondary trigeminal neuralgia (8 multiple sclerosis). Secondary in this context refers to an identified cause.
The percentage of patients defined as having an excellent outcome (pain free without medication) was 39% after 6 months, 36% after 12 months and 64% after 24 months.
The percentage of patients who reported being very satisfied with treatment was 71% after 6 months, 57% after 12 months and 53% after 24 months.
Half the patients with secondary trigeminal neuralgia were pain free without medication after treatment, and 60% of patients who underwent a second treatment were pain free.
A new trigeminal sensory deficit, numbness on the face, was reported by 31% of patients after radiosurgical treatment.
Epub ahead of print: Loescher et al. Stereotactic radiosurgery for trigeminal neuralgia: outcomes and complications. Br J Neurosurg. 2011 Aug 4.
"In my personal experience of trigeminal neuralgia, which is of about 10 MS'ers with trigeminal neuralgia, this is one of the most disabling and difficult pain syndromes to treat. Having a treatment option such as stereotactic radiosurgery is invaluable. I am sure those patients with treatment resistant trigeminal neuralgia who have been treated with this procedure will vouch for it. Are there any of you out there?"
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Additional reading: trigeminal neuralgia, stereotactic radiosurgery