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Radiofrequency Ablation for Craniofacial Pain Syndromes. Phys Med Rehabil Clin N Am 2021; 32:601-645. [PMID: 34593133 DOI: 10.1016/j.pmr.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Headache disorders and trigeminal neuralgia are common conditions representing the types of craniofacial pain syndrome that can significantly impact quality of life. Many cases are refractory to traditional pharmacologic treatments, whether oral or intravenous. Radiofrequency ablation has been increasingly used as a tool to treat resistant, chronic pain of both of these disorders. Multiple studies have been reported that illustrate the efficacy of radiofrequency ablation in the treatment of the numerous headache subtypes and trigeminal neuralgia.
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Lee JH, Lee JM, Choi CH. Personal experience with microvascular decompression and partial sensory rhizotomy for trigeminal neuralgia. Yeungnam Univ J Med 2020; 38:202-207. [PMID: 33222427 PMCID: PMC8225491 DOI: 10.12701/yujm.2020.00745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022] Open
Abstract
Background Trigeminal neuralgia (TN) is a severe, paroxysmal pain in the distribution of the fifth cranial nerve. Microvascular decompression (MVD) is the most widely used surgical treatment for TN. We undertook this study to analyze the effects of and complications of MVD and to refine the surgical procedure for treating TN. Methods A total of 88 patients underwent for TN underwent surgery at our hospital. Among them, 77 patients underwent MVD alone, and 11 underwent partial sensory rhizotomy (PSR) with or without MVD. The medical records of these patients were retrospectively analyzed for patient characteristics, clinical results, offending vessels, and complications if any. Results The mean follow-up duration was 43.2 months (range, 3–216 months). The most common site of pain was V2+V3 territory (n=27), followed by V2 (n=25) and V3 (n=23). The most common offending vessels were the superior cerebellar artery and anterior inferior cerebellar artery in that order. The overall rate of postoperative complications was 46.1%; however, most complications were transient. There were two cases of permanent partial hearing disturbance. In the MVD alone group, the cure rate was 67.5%, and the improvement rate was 26.0%. Among 11 patients who underwent PSR with or without MVD, the cure rate was 50.0%, and the improvement rate was 30.0%. Conclusion The clinical results of MVD were satisfactory. Although the outcomes of PSR were not as favorable as those of pure MVD in this study, PSR can be considered in cases where there is no significant vascular compressive lesion or uncertainty of the causative vessel at the surgery.
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Affiliation(s)
- Jung Hwan Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan, Korea
| | - Jae Meen Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan, Korea
| | - Chang Hwa Choi
- Department of Neurosurgery, Pusan National University Hospital, Busan, Korea
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Nova CV, Zakrzewska JM, Baker SR, Riordain RN. Treatment Outcomes in Trigeminal Neuralgia-A Systematic Review of Domains, Dimensions and Measures. World Neurosurg X 2020; 6:100070. [PMID: 32123867 PMCID: PMC7036566 DOI: 10.1016/j.wnsx.2020.100070] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/16/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a painful disorder characterized by sudden electric shock-like pain. It is a rare condition for which multiple treatments are available, including medical and surgical. The best treatment option is yet to be defined, and this is related to the lack of definition in the treatment outcomes and outcome measures. The aim of this systematic review was to summarize all the outcomes and outcomes measures that have been published to date and highlight variability in their use. METHODS We have conducted a literature search using a wide range of databases (1946-2019 for medical and 2008-2019 for surgical treatment), for all intervention studies in TN. Four hundred and sixty-seven studies were selected for data extraction on TN classification, data collection method, intervention, and treatment outcomes mapped to the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT guidelines). RESULTS Most studies collected data on pain (n = 459) and side effects (n = 386) domains; however, very few collected data on the impact of treatment on physical (n = 46) and emotional functioning (n = 17) and on patient satisfaction (n = 35). There was high variability on outcome measures used for pain relief (n = 10), pain intensity (n = 9), and frequency of pain episodes (n = 3). CONCLUSIONS A clear definition of what are the important outcomes for patients with TN is essential. The choice of standardized outcome measures allowing for consistent reporting in TN treatment will allow for comparison of studies and facilitate treatment choice for patients and clinicians thus, improving health outcomes and reducing health care cost.
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Affiliation(s)
| | | | - Sarah R. Baker
- School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - Richeal Ni Riordain
- UCL Eastman Dental Institute, London, United Kingdom
- Department of Oral Medicine, Cork University Dental School and Hospital, Cork, Ireland
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Baldauf J, Rosenstengel C, Schroeder HWS. Nerve Compression Syndromes in the Posterior Cranial Fossa. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:54-60. [PMID: 30855007 DOI: 10.3238/arztebl.2019.0054] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 03/29/2018] [Accepted: 10/04/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nerve compression syndromes in the posterior cranial fossa can severely impair patients' quality of life. There is often uncertainty about the best treatment. In this article, we provide an overview of these conditions and the corresponding treatment strategies. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed and on a scientific analysis of the authors' patient collective. RESULTS These syndromes are caused by compression of a cranial nerve by an artery or vein at the zone of the nerve's entry to or exit from the brainstem. The best-known neurovascular compression syndrome is trigeminal neuralgia, followed by hemifacial spasm. Less well known are glossopharyngeal neuralgia, nervus intermedius neuralgia, and vestibular paroxysmia. The initial treatment of trigeminal neuralgia is medical: the first line of treatment is with sodium-blocking anticon- vulsants, such as carbamazepine. For patients with hemifacial spasm, botulinum toxin injection is the recommended initial treatment and often leads to a satisfactory regression of the spasms. If these treatments fail, a microvascular decompression operation is indicated. The aim of the procedure is to separate the irritating vessel from the nerve and to keep these structures apart permanently. There is hardly any available evidence on these treatment strategies from randomized controlled trials. CONCLUSION Nerve compression syndromes in the posterior cranial fossa can generally be treated nonsurgically at first. Over the course of the condition, however, treatment failure or intolerable side effects may arise. In such cases, a microvascu- lar decompression operation is indicated. This is a causally directed form of treat- ment that generally yields very good results.
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Affiliation(s)
- Jörg Baldauf
- Department of Neurosurgery, University Medicine Greifswald
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Helis CA, McTyre E, Munley MT, Bourland JD, Lucas JT, Cramer CK, Tatter SB, Laxton AW, Chan MD. Gamma Knife Radiosurgery for Multiple Sclerosis-Associated Trigeminal Neuralgia. Neurosurgery 2019; 85:E933-E939. [PMID: 31173108 PMCID: PMC8786494 DOI: 10.1093/neuros/nyz182] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/29/2019] [Indexed: 12/09/2023] Open
Abstract
BACKGROUND Trigeminal neuralgia in the setting of multiple sclerosis (MS-TN) is a challenging condition to manage that is commonly treated with Gamma Knife radiosurgery (GKRS; Elekta AB). However, data regarding the efficacy of this treatment are somewhat limited, particularly for repeat GKRS. OBJECTIVE To report outcomes of GKRS for MS-TN from a cohort study. METHODS Retrospective review of our GKRS database identified 77 cases of unilateral MS-TN (UMSTN) in 74 patients treated with GKRS between 2001 and 2016, with 37 cases undergoing repeat GKRS. Background medical history, treatment outcomes and complications, and dosimetric data were obtained by retrospective chart reviews and telephone interviews. RESULTS Eighty-two percent of UMSTN cases achieved Barrow Neurological Institute (BNI) IIIb or better pain relief following initial GKRS for a median duration of 1.1 yr. Estimated rates of pain relief at 1, 3, and 5 yr were 51, 39, and 29% respectively. Eighty-eight percent achieved BNI IIIb or better pain relief after repeat GKRS for a median duration of 4.0 yr. Estimated rates of pain relief at 1 and 3 yr were 70 and 54%, respectively. Median doses for initial and repeat GKRS were 85 and 80 Gy to the 100% isodose line, respectively. Those with MS-TN had a shorter duration of BNI IIIb or better pain relief after initial (4.6 vs 1.1 yr), but not repeat GKRS (3.8 vs 4.0 yr) compared to a historical cohort from our institution. CONCLUSION GKRS is an effective, well-tolerated treatment for patients with MS-TN. More durable relief is often achieved with repeat GKRS.
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Affiliation(s)
- Corbin A Helis
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Emory McTyre
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Michael T Munley
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - J Daniel Bourland
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - John T Lucas
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
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Bigder MG, Krishnan S, Cook EF, Kaufmann AM. Microsurgical rhizotomy for trigeminal neuralgia in MS patients: technique, patient satisfaction, and clinical outcomes. J Neurosurg 2019; 130:1877-1888. [PMID: 30004276 DOI: 10.3171/2017.12.jns171647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/19/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with multiple sclerosis (MS)-associated trigeminal neuralgia (TN) have higher recurrence and retreatment rates than non-MS patients. The optimal management strategy and role for microsurgical rhizotomy (MSR) for MS-TN remains to be determined. The aim of this study was to report time to treatment failure (TTF) and pain scores following MSR compared to percutaneous and Gamma Knife procedures. METHODS Time to treatment failure was analyzed after MSR (n = 14) versus prior procedures (n = 53) among MS-TN patients. Kaplan-Meier curves and log-rank test were utilized to compare TTF after MSR versus prior procedures using the same cohort of patients as their own control group. Subsequent analysis compared TTF after MSR to TTF after 93 other procedures among a second cohort of 18 MS-TN patients not undergoing MSR. BNI pain scores were compared between MSR and other procedures among the MS-TN cohort using a chi-square test. RESULTS TTF was significantly longer after MSR than after other procedures in the MSR cohort (median TTF 79 vs 10 months, respectively, p < 0.0001). Similarly, TTF was longer after MSR than after prior procedures in the non-MSR cohort (median TTF 79 vs 13 months, respectively, p < 0.001). MSR resulted in a higher proportion of excellent pain scores when compared to other procedures in the non-MSR cohort (77% vs 29%, p < 0.001). Probability of treatment survival was higher after MSR than after other procedures at all time points (3, 6, 12, 24, 36, and 48 months). There were no deaths or major complications after MSR. CONCLUSIONS TTF was significantly longer following MSR compared to prior procedures in MS-TN patients. Additionally, a higher proportion of patients achieved excellent BNI pain scores after MSR.
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Affiliation(s)
- Mark G Bigder
- 1Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; and
- 2Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Sandeep Krishnan
- 1Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; and
| | - E Francis Cook
- 2Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Anthony M Kaufmann
- 1Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; and
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Deora H, Tripathi M, Modi M, Mohindra S, Batish A, Gurnani J, Agrahari A. Letter to the Editor. Microsurgical rhizotomy as treatment for trigeminal neuralgia in patients with multiple sclerosis: turnpike or dirt road? J Neurosurg 2019; 130:1775-1778. [PMID: 30485220 DOI: 10.3171/2018.8.jns182227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Harsh Deora
- 1Sanjay Gandhi Post Graduate Institute of Medical Education and Research, Lucknow, India; and
| | - Manjul Tripathi
- 2Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Modi
- 2Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Mohindra
- 2Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Batish
- 2Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jenil Gurnani
- 2Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhinav Agrahari
- 2Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Zakrzewska JM, Wu J, Brathwaite TSL. A Systematic Review of the Management of Trigeminal Neuralgia in Patients with Multiple Sclerosis. World Neurosurg 2017; 111:291-306. [PMID: 29294398 DOI: 10.1016/j.wneu.2017.12.147] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients with trigeminal neuralgia (TN) and multiple sclerosis (MS) are often treated with medications or a surgical procedure. However, there is little evidence that such treatments result in 50% pain reduction and improvement in quality of life. The aim of this systematic review is to evaluate the clinical effectiveness of treatments in patients with MS and trigeminal neuralgia. METHODS We searched Medline, EMBASE, and the Cochrane Collaboration database from inception until October 2016. Two authors independently selected studies for inclusions, data extraction, and bias assessment. RESULTS All studies were of low quality using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. For medical management, 10 studies were included, of which one was a randomized controlled trial. Two studies were on the use of misopropol, unique to patients with MS. For surgical therapy, 26 studies with at least 10 patients and a minimum of 2 years follow-up were included. All types of surgical procedures are reported and the results are poorer for TN with MS, with 50% having a recurrence by 2 years. The main complication was sensory loss. Many patients had to undergo further procedures to become pain free and there were no agreed prognostic factors. CONCLUSIONS There was insufficient evidence to support any 1 medical therapy and so earlier surgery may be preferable. A patient with TN and MS has therefore to make a decision based on low-level evidence, beginning with standard drug therapy and then choosing a surgical procedure.
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Affiliation(s)
- Joanna M Zakrzewska
- Facial Pain Unit, Eastman Dental Hospital, UCLH NHS Foundation Trust, London, United Kingdom.
| | - Jianhua Wu
- Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - Tricia S-L Brathwaite
- Department of Oral & Maxillofacial Surgery, Eastman Dental Hospital, UCLH NHS Foundation Trust, London
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Gao J, Fu Y, Guo SK, Li B, Xu ZX. Efficacy and Prognostic Value of Partial Sensory Rhizotomy and Microvascular Decompression for Primary Trigeminal Neuralgia: A Comparative Study. Med Sci Monit 2017; 23:2284-2291. [PMID: 28502974 PMCID: PMC5441416 DOI: 10.12659/msm.901510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background This study aimed to compare the efficacy and prognostic value of partial sensory rhizotomy (PSR) and microvascular decompression (MVD) for primary trigeminal neuralgia (PTN). Material/Methods From June 2010 to June 2012, 117 patients with PTN were recruited for the study, of which 52 cases were treated with MVD (the MVD group) and 65 cases were treated with PSR (the PSR group). Visual Analog Scoring (VAS) was performed at 1 and 2 weeks, and at 1, 3, and 6 month after surgery. The overall response rate (ORR) was determined 1 month after surgery. Barrow Neurological Institute score was adopted to value the reoccurrence at 6, 12, 24, and 36 months after surgery. A 3-year follow-up was conducted and the complications were recorded. Results The ORR 2 weeks after surgery in the MVD and PSR groups was 98.08% and 84.62%, respectively. One and 2 weeks after surgery, the VAS was lower in the MVD group than in the PSR group, but there was no significant difference in VAS between the 2 groups at 1, 3, and 6 months after surgery. Three years after surgery, the recurrence rate was significantly lower in the MVD group than in the PSR group. The recurrence-free survival time was longer in the MVD group than in the PSR group. The occurrence rates of herpes and total postoperative complications were significantly higher in the PSR group than in the MVD group. Conclusions Compared with PSR, MVD is more suitable for PTN treatment, with less disturbance, lower recurrence rate, and better efficacy.
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Affiliation(s)
- Jian Gao
- Department of Neurosurgery, The China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Yao Fu
- Department of Neurosurgery, The First People's Hospital of Shangqiu, Shangqiu, Henan, China (mainland)
| | - Shi-Kun Guo
- Department of Neurosurgery, The First People's Hospital of Shangqiu, Shangqiu, Henan, China (mainland)
| | - Bing Li
- Department of Neurosurgery, The First People's Hospital of Shangqiu, Shangqiu, Henan, China (mainland)
| | - Zhong-Xin Xu
- Department of Neurology, The China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
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Abstract
Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Type 1 as intermittent and Type 2 as constant pain represent distinct clinical, pathological, and prognostic entities. Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Diagnosis is essentially clinically; magnetic resonance imaging is useful to rule out secondary causes, detect pathological changes in affected root and neurovascular compression (NVC). Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine, phenytoin, and topiramate are also useful. Multidrug regimens and multidisciplinary approaches are useful in selected patients. Microvascular decompression is surgical treatment of choice in TN resistant to medical management. Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures. Partial sensory root sectioning is indicated in negative vessel explorations during surgery and large intraneural vein. Endoscopic technique can be used alone for vascular decompression or as an adjuvant to microscope. It allows better visualization of vascular conflict and entire root from pons to ganglion including ventral aspect. The effectiveness and completeness of decompression can be assessed and new vascular conflicts that may be missed by microscope can be identified. It requires less brain retraction.
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Affiliation(s)
- Yad Ram Yadav
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Yadav Nishtha
- Department of Radio Diagnosis and Imaging, All India Institute of Medical Science, New Delhi, India
| | - Pande Sonjjay
- Department of Radio Diagnosis and Imaging, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Parihar Vijay
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Ratre Shailendra
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Khare Yatin
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
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Phillips DB, Del Bigio MR, Kaufmann AM. Gamma Knife rhizotomy-induced histopathology in multiple sclerosis–related trigeminal neuralgia. J Neurosurg 2014; 121:1508-13. [DOI: 10.3171/2014.8.jns131545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
In this report, the authors describe the pathological changes in the human trigeminal nerve after Gamma Knife radiosurgery.
Methods
Three trigeminal nerves of patients with multiple sclerosis (MS)–related trigeminal neuralgia (MSTN) after Gamma Knife radiosurgery and other ablative procedures were examined by a neuropathologist. These cases were compared with 3 patients with typical TN who underwent partial surgical rhizotomy following recurrent symptoms after gasserian injury procedures, as well as with autopsy specimens from patients with and without MSTN.
Results
The three irradiated MS-TN specimens exhibited axon loss, demyelination, myelin debris, and fibrosis. Mild lymphocytic infiltrate was present in all 3 samples from MS-TN patients. The nonirradiated trigeminal nerve samples were generally well myelinated with rare degenerating axons. The microscopic findings in trigeminal nerve autopsy specimens were normal in patients without TN, with MS but not TN, and MS-TN.
Conclusions
The inflammation observed in MS-TN specimens collected following Gamma Knife radiosurgery has not previously been described in the literature. These data provide new insight into the changes that occur in trigeminal nerve following stereotactic radiosurgery.
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Affiliation(s)
| | - Marc R. Del Bigio
- 2Department of Pathology and Diagnostic Services Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
There is a high prevalence of pain, depression, and cognitive dysfunction in patients with Multiple Sclerosis (MS). These symptoms affect daily tasks resulting in a significant reduction in quality of life. Pain and cognitive changes have been studied across various animal models of MS. In these models the onset of pain and cognitive dysfunction occur early, and do not coincide with the pattern of motor deficits. This is likely underpinned by a number of different mechanisms including changes in glutamate transmission, glial cell activation, and increased levels of pro-inflammatory cytokines. Changes in pain and cognition have been described as belonging to a cluster of symptoms and have been linked through centrally driven processes. In particular, the overactive immune response can induce a state of "sickness-like behaviours" that can influence both pain and cognition. Investigating the mechanism of inflammatory sickness behaviors in MS could lead to a better understanding of the links between pain and cognition. There are currently few effective treatments for pain and cognition dysfunction in MS. Studying the relationship between these symptoms will allow better management of both symptoms.
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Affiliation(s)
- Curtis Benson
- Centre for Neuroscience, University of Alberta, Clinical Sciences Building, 8-120, Edmonton, AB, T6G 2G3, Canada
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