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Poullet Z, Redon S, Gravier-Dumonceau R, Donnet A. "Status trigeminal neuralgia": Analysis of 39 cases and proposal for diagnostic criteria. Rev Neurol (Paris) 2024; 180:689-697. [PMID: 38789382 DOI: 10.1016/j.neurol.2024.03.014] [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: 10/06/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE The aim of this descriptive study was to propose diagnostic criteria for acute exacerbation of trigeminal neuralgia (TN) based on the analysis of retrospective cases. BACKGROUND TN is a rare and extremely painful condition whose evolution can be punctuated by major exacerbations, leading to significant functional impairment. Several denominations are used for these exacerbations: "acute exacerbation", "status of trigeminal neuralgia", and "status trigeminus". There is currently no clinical definition of this state. In this manuscript, we used the term "status trigeminal neuralgia" (STN). METHODS We conducted a retrospective study, in a tertiary care specialist headache center, in France. Patients were selected from January 2015 to October 2022, with the French translation of the keyword "STN", in the medical records (outpatients) or the codage for trigeminal neuralgia (inpatients). Additional cases of STN were prospectively recruited from October 2022 to February 2023. We analyzed the clinical and paraclinical data of these patients. RESULTS Thirty-nine patients presenting with STN were included. There was a preponderance of women (64%) with 24 cases of classic TN (62%) and 15 cases of secondary TN (38%). Concerning STN, 39 episodes were described. Pain was very severe in all patients. Cranial autonomic signs were present in 23% of cases. Pain extended beyond the usual territory in 44% of cases. A continuous pain background was present in 35% of cases. With regard to triggering factors, paroxysms of facial pain were triggered by eating (97% of patients), speaking (90%) or drinking (62% of patients). Repercussions on weight, hydration, or mood disorders were observed in 67%, 56% and 59% of the cases, respectively. CONCLUSION STN is a rare clinical presentation of TN. We proposed criteria and a new denomination for this condition.
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Affiliation(s)
- Z Poullet
- Department of Evaluation and Treatment of Pain, FHU INOVPAIN, CHU Timone, AP-HM, Marseille, France
| | - S Redon
- Department of Evaluation and Treatment of Pain, FHU INOVPAIN, CHU Timone, AP-HM, Marseille, France.
| | - R Gravier-Dumonceau
- APHM, INSERM, IRD, SESSTIM, sciences economiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Hop Timone, BioSTIC, biostatistique et technologies de l'information et de la communication, Aix Marseille Univ, Marseille, France
| | - A Donnet
- Department of Evaluation and Treatment of Pain, FHU INOVPAIN, CHU Timone, AP-HM, Marseille, France; Inserm U-1107, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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Costa CMM, Santos DS, Opretzka LCF, de Assis Silva GS, Santos GC, Evangelista AF, Soares MBP, Villarreal CF. Different mechanisms guide the antinociceptive effect of bone marrow-mononuclear cells and bone marrow-mesenchymal stem/stromal cells in trigeminal neuralgia. Life Sci 2024; 354:122944. [PMID: 39111567 DOI: 10.1016/j.lfs.2024.122944] [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: 05/20/2024] [Revised: 07/21/2024] [Accepted: 08/04/2024] [Indexed: 08/10/2024]
Abstract
AIMS Trigeminal neuralgia (TN) is a type of chronic orofacial pain evoked by trivial stimuli that manifests as episodes of excruciating and sudden, recurrent paroxysmal pain. Most patients are refractory to pharmacological therapy used for the treatment of TN. Mononuclear cells (MNC) and mesenchymal stem/stromal cells (MSC) have shown therapeutic potential in painful neuropathies, but their mechanism of action is not fully understood. The present work aimed to investigate the antinociceptive effect and mechanism of action of MNC and MSC in experimental TN. MATERIALS AND METHODS Mice submitted to the chronic constriction injury of the infraorbital nerve (CCI-ION) mouse model of TN received a single intravenous injection of saline, MNC, or MSC (1 × 106 cells/mouse). The effect of the treatments on the behavioral signs of painful neuropathy, morphological aspects of the infraorbital nerve, and inflammatory and oxidative stress markers in the infraorbital nerve were assessed. KEY FINDINGS MNC and MSC improved behavioral painful neuropathy, activated key cell signaling antioxidant pathways by increasing Nrf2 expression, and reduced the proinflammatory cytokines IL-1β and TNF-α. However, treatment with MSC, but not MNC, was associated with a sustained increase of IL-10 and with the re-establishment of the morphometric pattern of the infraorbital nerve, indicating a difference in the mechanism of action between MNC and MSC. In line with this result, in IL-10 knockout mice, MSC transplantation did not induce an antinociceptive effect. SIGNIFICANCE Importantly, these data suggest an IL-10-induced disease-modifying profile related to MSC treatment and reinforce cell therapy's potential in treating trigeminal neuralgia.
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Affiliation(s)
| | | | | | | | - Girlaine Café Santos
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador 40296-710, BA, Brazil.
| | | | - Milena Botelho Pereira Soares
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador 40296-710, BA, Brazil; Institute of Advanced Systems in Health, SENAI CIMATEC, Salvador 41650-010, BA, Brazil.
| | - Cristiane Flora Villarreal
- Faculty of Pharmacy, Federal University of Bahia, Salvador 40170-115, BA, Brazil; Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador 40296-710, BA, Brazil.
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Gomes-da Silva de Rosenzweig P, Pastrana-Brandes S, Merikansky-Gerson S, Victoria-Garcia LO, Curtius-Caruso MS, Carrillo-Ruiz JD. Factors associated with outcomes following microvascular decompression for the treatment of primary trigeminal neuralgia in adults: a systematic review and meta-analysis. J Dent Anesth Pain Med 2024; 24:227-243. [PMID: 39118815 PMCID: PMC11304043 DOI: 10.17245/jdapm.2024.24.4.227] [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: 06/04/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
This study aimed to evaluate pain assessment strategies and factors associated with outcomes after microvascular decompression for the treatment of primary trigeminal neuralgia in adults. We conducted a systematic review and meta-analysis of English, Spanish, and French literature. We searched three databases, PubMed, Ovid, and EBSCO, from 2010 to 2022 and selected studies including patients with primary trigeminal neuralgia, clear pain assessment, and pain outcomes. Population means and standard deviations were calculated. Studies that included factors associated with postoperative outcomes were included in the meta-analysis. A total of 995 studies involving 5673 patients with primary trigeminal neuralgia following microvascular decompression were included. Patients with arteries compressing the trigeminal nerve demonstrated optimal outcomes following microvascular decompression (odds ratio [OR]= 0.39; 95% confidence interval [CI] = 0.19-0.80; X2 = 46.31; Dof = 15; I2 = 68%; P = < 0.0001). Conversely, when comparing arterial vs venous compression of the trigeminal nerve (OR = 2.72; 95% CI = 1.16-6.38; X2 = 23.23; Dof = 10; I2 = 57%; P = 0.01), venous compression demonstrated poor outcomes after microvascular decompression. Additionally, when comparing single-vessel vs multiple-vessel compression (OR = 2.72; 95% CI = 1.18-6.25; X2 = 21.17; Dof = 9; I2 = 57%; P = 0.01), patients demonstrated unfavorable outcomes after microvascular decompression. This systematic review and meta-analysis evaluated factors associated with outcomes following microvascular decompression (MVD) for primary trigeminal neuralgia (PTN). Although MVD is an optimal treatment strategy for PTN, a gap exists in interpreting the results when considering the lack of evidence for most pain assessment strategies.
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Affiliation(s)
- Pablo Gomes-da Silva de Rosenzweig
- Facultad de Ciencias de la Salud, Centro de Investigación en Ciencias de la Salud (CICSA), Universidad Anáhuac México Norte Huixquilucan, Estado de México, Mexico
| | | | - Salomon Merikansky-Gerson
- Facultad de Ciencias de la Salud, Centro de Investigación en Ciencias de la Salud (CICSA), Universidad Anáhuac México Norte Huixquilucan, Estado de México, Mexico
| | - Luis Octavio Victoria-Garcia
- Facultad de Ciencias de la Salud, Centro de Investigación en Ciencias de la Salud (CICSA), Universidad Anáhuac México Norte Huixquilucan, Estado de México, Mexico
| | - Magdalena Sophia Curtius-Caruso
- Facultad de Ciencias de la Salud, Centro de Investigación en Ciencias de la Salud (CICSA), Universidad Anáhuac México Norte Huixquilucan, Estado de México, Mexico
| | - José Damián Carrillo-Ruiz
- Coordinación de Neurociencias, Facultad de Psicología, Universidad Anáhuac México, Mexico
- Servicio de Neurocirugía Funcional y Estereotaxia, Hospital General de México Dr Eduardo Liceaga, Mexico City, Mexico
- Dirección de Investigación, Hospital General de México Dr Eduardo Liceaga, Mexico City, Mexico
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Li R, Sun J, Luo K, Luo N, Sun R, Gao F, Wang Y, Xia Y, Li X, Chen L, Ma R, Shao X, Liang Y, Fang J. Electroacupuncture and carbamazepine for patients with trigeminal neuralgia: a randomized, controlled, 2 × 2 factorial trial. J Neurol 2024; 271:5122-5136. [PMID: 38816482 PMCID: PMC11319385 DOI: 10.1007/s00415-024-12433-x] [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: 01/09/2024] [Revised: 05/04/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is difficult to treat due to its severe pain intensity and recurring episodes, which significantly impact quality of life. OBJECTIVES We aimed to assess the effectiveness of electroacupuncture (EA) in alleviating the pain intensity in TN, and to determine whether EA combined with low-dosage carbamazepine (CBZ) has a synergistic effect. METHODS A multi-centre, randomized, 2 × 2 factorial trial was conducted. Participants who met the inclusion criteria received active EA or sham EA for 60 min, three times a week for four weeks; CBZ (300 mg per day) or placebo for four weeks. The primary outcome was the change in visual analog scale (VAS) score from baseline to weeks 2, 4, 16, and 28. Secondary outcomes included quality of life and adverse events. RESULTS A total of 120 participants (75 females and 45 males; mean (SD) age, 58.5 (15.3) years) were included. The main effects of EA and CBZ were significant (P < 0.001), and there was a significant interaction was identified between the interventions (P = 0.041). Participants who received EA (mean difference [MD], -0.3 [95% CI, -0.40 to -0.20] at week 2; -1.6 [-1.70 to -1.50] at week 4; -1.1 [-1.31 to -0.89] at week 16; -0.8 [-1.01 to -0.59] at week 28), CBZ (MD, -0.6 [95% CI, -0.70 to -0.50] at week 2; -0.9 [-1.03 to -0.77] at week 4, -0.2 [-0.41 to 0.01] at week 16, 0.2 [-0.01 to 0.41] at week 28), and the combination of both (MD, -1.8 [95% CI, -1.90 to -1.70] at week 2; -3.7 [-3.83 to -3.57] at week 4, -3.4 [-3.61 to -3.19] at week 16, -2.9 [-3.11 to -2.69] at week 28) had a greater reduction in VAS score over the treatment phase than their respective control groups (sham EA, placebo, and sham EA plus placebo). EA-related adverse events (6/59, 10.17%) were lower than that of CBZ (15/59, 25.42%) during the whole phases. CONCLUSIONS EA or CBZ alone are effective treatments for TN, while the combination of EA and low-dosage CBZ exerts a greater benefit. These findings in this trial demonstrate that the combination of EA and low-dosage CBZ may be clinically effective under certain circumstances. TRIAL REGISTRATION NCT03580317.
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Affiliation(s)
- Rongrong Li
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jing Sun
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Kaitao Luo
- Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Ning Luo
- The Third Clinical Medical College of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, Zhejiang, China
| | - Ruohan Sun
- The Third Clinical Medical College of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, Zhejiang, China
| | - Feng Gao
- Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Yiyi Wang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, Zhejiang, China
| | - Yunfan Xia
- The Third Clinical Medical College of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, Zhejiang, China
| | - Xiaoyu Li
- The Third Clinical Medical College of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, Zhejiang, China
| | - Lifang Chen
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Ruijie Ma
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaomei Shao
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, 219 Moganshan Road, Hangzhou, Zhejiang, China
| | - Yi Liang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, Zhejiang, China.
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, 219 Moganshan Road, Hangzhou, Zhejiang, China.
| | - Jianqiao Fang
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, 219 Moganshan Road, Hangzhou, Zhejiang, China.
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You S, Qin X, Zhao G, Feng Z. Personalized 3D Printed Tooth-Supported Template as a Novel Strategy for Radiofrequency Thermocoagulation for Trigeminal Neuralgia After the Failure of CT-Guided Puncture. J Pain Res 2024; 17:2347-2356. [PMID: 38983246 PMCID: PMC11232956 DOI: 10.2147/jpr.s449447] [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: 12/08/2023] [Accepted: 06/15/2024] [Indexed: 07/11/2024] Open
Abstract
Background Trigeminal neuralgia (TN) is a common form of craniofacial pain, and Radiofrequency thermocoagulation (RFT) has become a commonly utilized treatment modality for TN. However, the complex anatomical configuration of the maxillofacial region and the difficulties inherent in positioning the neck in a hyperextended manner can present challenges for CT-guided punctures. Aim The objective of this study is to assess the effectiveness and safety of 3D printed tooth-supported template(3D-PTST) guided RFT in patients who have previously undergone unsuccessful CT-guided puncture. Methods Patients with TN undergoing RFT at the Department of Pain Medicine, PLA General Hospital, from January 2018 to January 2023, were assessed. 3D-PTST guided RFT was employed as an alternative when percutaneous puncture failed. Clinical, demographic, and follow-up data were collected. The duration of the procedure was determined by subtracting the time of anesthesia administration from the time of surgical drape removal. Pain intensity was assessed using the Numerical Rating Scale-11 scale. Treatment effects were evaluated utilizing the Barrow Neurological Institute scale. Incidences of complications related to RFA were documented. Results Six TN patients underwent 3D-PTST guided RFT. With tooth-supported template guidance, five patients achieved therapeutic target puncture in one attempt with one CT scan. One patient required two attempts with two CT scans. Operation duration ranged from 18 to 46 mins (mean 30 mins). All completed 3D-PTST-guided RFT without difficulty, significantly improving pain symptoms. Four patients had no pain recurrence at 12, 18, 36 and 37 months follow-up, respectively. Recurrence occurred in two patients (at 1 and 13 months). No serious treatment-related complications were observed. Conclusion 3D-PTST guided RFT is an effective, repeatable, safe, and minimally invasive treatment method for patients with TN who have failed due to difficulty in puncture.
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Affiliation(s)
- Shaohua You
- Department of Pain Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Xiaoyan Qin
- Department of Clinical Laboratory, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, 100049, People's Republic of China
| | - Guoli Zhao
- Department of Pain Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Zeguo Feng
- Department of Pain Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
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Lafta MS, Sokolov AV, Landtblom AM, Ericson H, Schiöth HB, Abu Hamdeh S. Exploring biomarkers in trigeminal neuralgia patients operated with microvascular decompression: A comparison with multiple sclerosis patients and non-neurological controls. Eur J Pain 2024; 28:929-942. [PMID: 38158702 DOI: 10.1002/ejp.2231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a severe facial pain condition often associated with a neurovascular conflict. However, neuroinflammation has also been implicated in TN, as it frequently co-occurs with multiple sclerosis (MS). METHODS We analysed protein expression levels of TN patients compared to MS patients and controls. Proximity Extension Assay technology was used to analyse the levels of 92 proteins with the Multiplex Neuro-Exploratory panel provided by SciLifeLab, Uppsala, Sweden. Serum and CSF samples were collected from TN patients before (n = 33 and n = 27, respectively) and after (n = 28 and n = 8, respectively) microvascular decompression surgery. Additionally, we included samples from MS patients (n = 20) and controls (n = 20) for comparison. RESULTS In both serum and CSF, several proteins were found increased in TN patients compared to either MS patients, controls, or both, including EIF4B, PTPN1, EREG, TBCB, PMVK, FKBP5, CD63, CRADD, BST2, CD302, CRIP2, CCL27, PPP3R1, WWP2, KLB, PLA2G10, TDGF1, SMOC1, RBKS, LTBP3, CLSTN1, NXPH1, SFRP1, HMOX2, and GGT5. The overall expression of the 92 proteins in postoperative TN samples seems to shift towards the levels of MS patients and controls in both serum and CSF, as compared to preoperative samples. Interestingly, there was no difference in protein levels between MS patients and controls. CONCLUSIONS We conclude that TN patients showed increased serum and CSF levels of specific proteins and that successful surgery normalizes these protein levels, highlighting its potential as an effective treatment. However, the similarity between MS and controls challenges the idea of shared pathophysiology with TN, suggesting distinct underlying mechanisms in these conditions. SIGNIFICANCE This study advances our understanding of trigeminal neuralgia (TN) and its association with multiple sclerosis (MS). By analysing 92 protein biomarkers, we identified distinctive molecular profiles in TN patients, shedding light on potential pathophysiological mechanisms. The observation that successful surgery normalizes many protein levels suggests a promising avenue for TN treatment. Furthermore, the contrasting protein patterns between TN and MS challenge prevailing assumptions of similarity between the two conditions and point to distinct pathophysiological mechanisms.
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Affiliation(s)
- Muataz S Lafta
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Aleksandr V Sokolov
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Anne-Marie Landtblom
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Hans Ericson
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Helgi B Schiöth
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Sami Abu Hamdeh
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
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Aji A, Zhang C, Liu W, Chen T, Liu Z, Zuo J, Li H, Mi W, Mao-Ying QL, Wang Y, Zhao Q, Chu YX. Foxg1 Modulation of the Prkcd Gene in the Lateral Habenula Mediates Trigeminal Neuralgia-Associated Anxiety-Like Behaviors in Mice. Mol Neurobiol 2024; 61:4335-4351. [PMID: 38085455 DOI: 10.1007/s12035-023-03856-0] [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: 04/20/2023] [Accepted: 11/28/2023] [Indexed: 07/11/2024]
Abstract
Trigeminal Neuralgia (TN) is a debilitating disorder frequently accompanied by mood complications such as depression and anxiety. The current study sought to elucidate the molecular underpinnings that contribute to the pathogenesis of TN and its associated anxiety. Employing a partial transection of the infraorbital nerve (pT-ION) in a murine model, we successfully induced sustained primary and secondary orofacial allodynia alongside anxiety-like behavioral manifestations. Transcriptome-wide gene microarray analyses revealed a marked upregulation of Foxg1 subsequent to pT-ION. Targeted knockdown of Foxg1, achieved through bilateral microinjection of adeno-associated virus harboring Foxg1-specific shRNA into the lateral habenula (LHb), resulted in a significant attenuation of both orofacial pain and anxiety-like behaviors. Subsequent RNA sequencing implicated Prkcd as a downstream effector gene modulated by Foxg1. Pharmacological inhibition of protein kinase C delta, encoded by Prkcd, within the LHb markedly ameliorated pT-ION-induced symptomatology. The dual luciferase assay revealed that Foxg1 substantially enhances the transcriptional activity of the Prkcd gene. Collectively, these findings indicate that trigeminal nerve injury leads to Foxg1 upregulation in the LHb, which in turn elevates the expression of Prkcd, culminating in the manifestation of orofacial pain and anxiety-like behaviors. This work offers promising therapeutic targets and a conceptual framework for the clinical management of TN and its psychological comorbidities.
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Affiliation(s)
- Abudula Aji
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Institutes of Integrative Medicine, Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Institute of Acupuncture Research, Fudan University, Shanghai, China
| | - Chen Zhang
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Institutes of Integrative Medicine, Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Institute of Acupuncture Research, Fudan University, Shanghai, China
| | - Wenbo Liu
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Institutes of Integrative Medicine, Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Institute of Acupuncture Research, Fudan University, Shanghai, China
| | - Teng Chen
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Institutes of Integrative Medicine, Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Institute of Acupuncture Research, Fudan University, Shanghai, China
| | - Zhechen Liu
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Institutes of Integrative Medicine, Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Institute of Acupuncture Research, Fudan University, Shanghai, China
| | - Jiaxin Zuo
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Institutes of Integrative Medicine, Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Institute of Acupuncture Research, Fudan University, Shanghai, China
| | - Haojun Li
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Institutes of Integrative Medicine, Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Institute of Acupuncture Research, Fudan University, Shanghai, China
| | - Wenli Mi
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Institutes of Integrative Medicine, Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Institute of Acupuncture Research, Fudan University, Shanghai, China
| | - Qi-Liang Mao-Ying
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Institutes of Integrative Medicine, Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Institute of Acupuncture Research, Fudan University, Shanghai, China
| | - Yanqing Wang
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Institutes of Integrative Medicine, Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Institute of Acupuncture Research, Fudan University, Shanghai, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China
| | - Qing Zhao
- Shanghai Sunshine Rehabilitation Center, Shanghai Yangzhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Yu-Xia Chu
- Department of Integrative Medicine and Neurobiology, School of Basic Medical Sciences, Shanghai Medical College, Institutes of Integrative Medicine, Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Institute of Acupuncture Research, Fudan University, Shanghai, China.
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Ashina S, Robertson CE, Srikiatkhachorn A, Di Stefano G, Donnet A, Hodaie M, Obermann M, Romero-Reyes M, Park YS, Cruccu G, Bendtsen L. Trigeminal neuralgia. Nat Rev Dis Primers 2024; 10:39. [PMID: 38816415 DOI: 10.1038/s41572-024-00523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 06/01/2024]
Abstract
Trigeminal neuralgia (TN) is a facial pain disorder characterized by intense and paroxysmal pain that profoundly affects quality of life and presents complex challenges in diagnosis and treatment. TN can be categorized as classical, secondary and idiopathic. Epidemiological studies show variable incidence rates and an increased prevalence in women and in the elderly, with familial cases suggesting genetic factors. The pathophysiology of TN is multifactorial and involves genetic predisposition, anatomical changes, and neurophysiological factors, leading to hyperexcitable neuronal states, central sensitization and widespread neural plasticity changes. Neurovascular compression of the trigeminal root, which undergoes major morphological changes, and focal demyelination of primary trigeminal afferents are key aetiological factors in TN. Structural and functional brain imaging studies in patients with TN demonstrated abnormalities in brain regions responsible for pain modulation and emotional processing of pain. Treatment of TN involves a multifaceted approach that considers patient-specific factors, including the type of TN, with initial pharmacotherapy followed by surgical options if necessary. First-line pharmacological treatments include carbamazepine and oxcarbazepine. Surgical interventions, including microvascular decompression and percutaneous neuroablative procedures, can be considered at an early stage if pharmacotherapy is not sufficient for pain control or has intolerable adverse effects or contraindications.
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Affiliation(s)
- Sait Ashina
- BIDMC Comprehensive Headache Center, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- BIDMC Comprehensive Headache Center, Department of Anaesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | - Anan Srikiatkhachorn
- Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Giulia Di Stefano
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Anne Donnet
- Department of Evaluation and Treatment of Pain, FHU INOVPAIN, Centre Hospitalier Universitaire de Marseille, Hopital de la Timone, Assistance Publique-Hopitaux de Marseille, Marseille, France
| | - Mojgan Hodaie
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontairo, Canada
| | - Mark Obermann
- Department of Neurology, Hospital Weser-Egge, Hoexter, Germany
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Marcela Romero-Reyes
- Department of Pain and Neural Sciences, Brotman Facial Pain Clinic, University of Maryland, School of Dentistry, Baltimore, MD, USA
| | - Young Seok Park
- Department of Medical Neuroscience, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
- Department of Neurosurgery, Gamma Knife Icon Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Giorgio Cruccu
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Lars Bendtsen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, University of Copenhagen, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Glostrup, Copenhagen, Denmark
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9
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Alzeeralhouseini A, Moisak G, Labzina E, Rzaev J. Trigeminal neuralgia caused by venous compression: a comprehensive literature review. J Med Life 2024; 17:462-470. [PMID: 39144685 PMCID: PMC11320616 DOI: 10.25122/jml-2024-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/03/2024] [Indexed: 08/16/2024] Open
Abstract
Trigeminal neuralgia (TN), a severe facial pain condition, is often treated with microvascular decompression (MVD). While MVD is effective for arterial neurovascular compression, its efficacy in cases of venous compression and the intraoperative management of such cases remain areas of debate. This review aimed to analyze the intraoperative management strategies for offending veins during MVD and evaluate the outcomes of these procedures in cases of TN with purely venous compression. An extensive review of studies reporting on the intraoperative handling of veins and the surgical outcomes of MVD in purely venous compression cases was conducted. Fifteen full-text studies were included, encompassing a total of 600 patients. Notably, 82.33% of these patients achieved a Barrow Neurological Institute (BNI) I pain score, with follow-up periods ranging from 3 months to 12 years. MVD is a viable and effective treatment option for TN in cases of venous compression, with a significant proportion of patients experiencing substantial pain relief.
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Affiliation(s)
| | - Galina Moisak
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
- Department of Neurosurgery, Novosibirsk State University, Novosibirsk, Russia
- Department of Neurosurgery, Federal Center of Neurosurgery, Ministry of Health, Novosibirsk, Russia
| | - Ekaterina Labzina
- Department of Neurosurgery, Novosibirsk State University, Novosibirsk, Russia
| | - Jamil Rzaev
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
- Department of Neurosurgery, Novosibirsk State University, Novosibirsk, Russia
- Department of Neurosurgery, Federal Center of Neurosurgery, Ministry of Health, Novosibirsk, Russia
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Bauer M, Krigers A, Schoen V, Thomé C, Freyschlag CF. Clinical Depression and Anxiety Are Relieved by Microvascular Decompression in Patients with Trigeminal Neuralgia-A Prospective Patient-Reported Outcome Study. J Clin Med 2024; 13:2329. [PMID: 38673601 PMCID: PMC11051355 DOI: 10.3390/jcm13082329] [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: 03/22/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Objective: Patients with idiopathic trigeminal neuralgia (TN) live in constant fear of triggering shock-like pain episodes, which may cause symptoms of depression and a reduction in quality of life. Microvascular decompressive surgery has been demonstrated to achieve satisfactory and stable results. With this study, we wanted to investigate prevalence and risk factors for depression and perceived stress in correlation with symptom relief after surgical treatment. Methods: In this prospective study, patients undergoing microvascular decompression (MVD) for TN were included. The Barrow Neurological Institute Pain Score (BNI), Beck Depression Inventory (BDI), Chronic Pain Acceptance Questionnaire (CPAQ), Perceived Stress Questionnaire (PSQ) and McGill questionnaire were used to evaluate depression, stress and anxiety disorders before and 3 months after MVD. Results: A total of 35 patients (16 male (46%)) with a mean age of 55.4 (SD 15) years were included in this study. The BDI revealed that 24 (68.8%) patients harbored mild-to-extreme depression preoperatively (2.4 ± 1.4), which improved to 1.2 (±0.6, p < 0.0001). Pain acceptance also changed from 64 (±11.3) to 67.7 (±9.3, p = 0.006). Perceived stress decreased from 46.9 (±21.9) to 19.6 (±18.6) (p < 0.0001) postoperatively, and pain decreased from 31.0 (±11.7) to 9.4 (±12.9, p < 0.0001). Microvascular decompression reduced the mean BNI pain score significantly from 4.6 to 1.8 postoperatively (p < 0.00001). Conclusions: Depression and perceived stress are prevalent in patients with idiopathic TN. Adequate treatment not only provides a high rate of satisfaction through pain relief, but also leads to immediate and significant improvements in depression and stress. Thus, in patients with TN who do not reach an adequate and timely pain reduction through medical management and develop signs of depression, early treatment with microvascular decompression should be considered.
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Affiliation(s)
| | | | | | | | - Christian F. Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (M.B.)
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11
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Queyrel É, Lanaret M, Khalil T, Al Gahatany M, Chaix R, Lemaire JJ, Moisset X, Chassin V, Brun L, Dedieu V, Biau J. [Frameless trigeminal neuralgia radiosurgery with a dedicated linear accelerator: From equipment commissioning to initial clinical results]. Cancer Radiother 2024; 28:164-173. [PMID: 38490925 DOI: 10.1016/j.canrad.2023.07.017] [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: 03/27/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 03/17/2024]
Abstract
PURPOSE Radiosurgery for the treatment of trigeminal neuralgia delivers a very high dose in a single fraction, over a few millimeters, at a single isocenter placed along the nerve. We present here the different steps that have been performed to validate small beams by conical collimators, and report the clinical results of the first patients treated on Novalis Tx®, frameless. MATERIAL AND METHODS First, the geometric accuracy of 4 and 6mm conical collimators was evaluated using Winston-Lutz tests; then dosimetric data acquisition was performed using high spatial resolution detectors (PTW 60019 microdiamond and a PTW 60017 E-diode). The corrective factors of the TRS 483 report were applied to calculate the collimator aperture factors. These dosimetric data were then compared with the data implemented in the iPlan® treatment planning system. Then end-to-end tests were performed to control the entire treatment process using an anthropomorphic phantom "STEEV". Between 2020 and 2022, 18 patients were treated for refractory trigeminal neuralgia on Novalis Tx®, frameless, with Exactrac® repositioning. A total of 17 patients were evaluated (one was lost to follow-up) using the BNI score for pain assessment and MRI with a median follow-up of 12 months. RESULTS The quality criteria of geometric and dosimetric accuracy were met for the 6-mm cone but not for the 4-mm cone. All patients were treated with a 6-mm cone with a dose of 90Gy prescribed at the isocenter at the root entry zone. Initial pain control was obtained in 70.5% of our patients, and 53% maintained pain control with a median follow-up of 12 months. All recurrences occurred within 3 to 6 months after radiosurgery. No brainstem toxicity was observed. Six patients had non-disabling facial hypoesthesia, half of whom already had pretreatment hypoesthesia. CONCLUSION The treatment of trigeminal neuralgia on a dedicated linear accelerator is a highly technical treatment whose accuracy and safety are paramount. The physical measurements allowed the commissioning of the technique with a 6mm cone. Our first clinical results are in accordance with the literature.
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Affiliation(s)
- É Queyrel
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France
| | - M Lanaret
- Département de physique médicale, centre Jean-Perrin, Clermont-Ferrand, France
| | - T Khalil
- Service de neurochirurgie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - M Al Gahatany
- Service de neurochirurgie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - R Chaix
- Service de neurochirurgie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - J-J Lemaire
- Service de neurochirurgie, CHU de Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, CNRS, Clermont-Auvergne INP, université Clermont-Auvergne, Clermont-Ferrand, France; Inserm U1240 IMoST, université Clermont-Auvergne, Clermont-Ferrand, France
| | - X Moisset
- Service de neurologie, Neuro-Dol, CHU de Clermont-Ferrand, université Clermont-Auvergne, Inserm U1107, Clermont-Ferrand, France
| | - V Chassin
- Département de physique médicale, centre Jean-Perrin, Clermont-Ferrand, France
| | - L Brun
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France
| | - V Dedieu
- Département de physique médicale, centre Jean-Perrin, Clermont-Ferrand, France; Institut Pascal, CNRS, Clermont-Auvergne INP, université Clermont-Auvergne, Clermont-Ferrand, France; Inserm U1240 IMoST, université Clermont-Auvergne, Clermont-Ferrand, France
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France; Institut Pascal, CNRS, Clermont-Auvergne INP, université Clermont-Auvergne, Clermont-Ferrand, France; Inserm U1240 IMoST, université Clermont-Auvergne, Clermont-Ferrand, France.
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12
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Wu FHW, Cheung CW, Leung YY. Neuronavigation-guided Percutaneous Rhizotomies to Trigeminal Neuralgia: A Systematic Review. Clin J Pain 2024; 40:253-266. [PMID: 38193245 DOI: 10.1097/ajp.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Neuronavigation improves intraoperative visualization of the cranial structures, which is valuable in percutaneous surgical treatments for patients with trigeminal neuralgia (TN) who are refractory to pharmacotherapy or reluctant to receive open surgery. The objective of this review was to evaluate the available neuronavigation-guided percutaneous surgical treatment modalities with cannulation of foramen ovale to TN, and their relative benefits and limitations. METHODS This review was conducted based on the PRISMA statement. An initial search was performed on electronic databases, followed by manual and reference searches. Study and patient characteristics, rhizotomy procedure and neuronavigation details, and treatment outcomes (initial pain relief and pain recurrence within 2 y, success rate of forman ovale cannulation, and complications) were evaluated. The risk of bias was assessed with a quality assessment based on the ROBINS-I tools. RESULTS Ten studies (491 operations, 403 participants) were analyzed. Three percutaneous trigeminal rhizotomy modalities identified were radiofrequency thermocoagulation rhizotomy (RFTR), percutaneous balloon compression, and glycerol rhizotomy. Intraoperative computed tomography and magnetic resonance imaging fusion-based RFTR had the highest initial pain relief rate of 97.0%. The success rate of foramen ovale cannulation ranged from 92.3% to 100% under neuronavigation. Facial hypoesthesia and masticatory muscle weakness were the most reported complications. DISCUSSION Neuronavigation-guided percutaneous trigeminal rhizotomies showed possible superior pain relief outcomes to that of conventional rhizotomies in TN, with the benefits of radiation reduction and lower complication development rates. The limitations of neuronavigation remain its high cost and limited availability. Higher-quality prospective studies and randomized clinical trials of neuronavigation-guided percutaneous trigeminal rhizotomy were lacking.
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Affiliation(s)
| | - Chi Wai Cheung
- Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry
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13
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Teshome AA, Walle Ayehu G, Ashagrie BK, Baye ND, Ayenew AA, Mengstie MA, Yazie TS, Gebeyehu AA, Sisay Chanie E, Molla YM, Taye Jemberie M, Abate AW. Systematic review on the frequency of occurrence in nerve branches and the side of the face involved in trigeminal neuralgia and its clinical implication. Front Neurol 2024; 15:1362602. [PMID: 38601341 PMCID: PMC11004464 DOI: 10.3389/fneur.2024.1362602] [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: 12/28/2023] [Accepted: 02/26/2024] [Indexed: 04/12/2024] Open
Abstract
Purpose The purpose of this systematic review is to answer the focused question, "What is the commonly affected nerve branch and the side of the face involved in trigeminal neuralgia?" Types of studies reviewed This systematic review included studies reporting commonly affected trigeminal nerve branches and the side of the face involved in trigeminal neuralgia. To find the potential studies published, the authors utilized specific search databases such as PubMed, and Google scholar. Results Among 132 published studies, the authors selected only 11 to be included for this systematic review. The sample size ranged from 50 to 43,518 study subjects. This review identified that the mandibular branches of the trigeminal nerve were the most affected, followed by the maxillary branch. The review also identified that the right side of the face was predominantly affected. Conclusion and practical implications The authors of this review identified a higher occurrence of trigeminal neuralgia in the mandibular division of the nerve, commonly affected on the right side of the face. Further prospective-based research and meta-analysis are required to validate the commonly occurring trigeminal nerve branch and sidedness of the face involved with its clinical implications in trigeminal neuralgia.
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Affiliation(s)
- Assefa Agegnehu Teshome
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Walle Ayehu
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berhanu Kindu Ashagrie
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Nega Dagnaw Baye
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Atalo Agemas Ayenew
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Taklo Simeneh Yazie
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asaye Alamneh Gebeyehu
- Department of Social and Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yalew Melkamu Molla
- Department of Pediatrics and Child Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Molla Taye Jemberie
- Department of Human Anatomy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Agmas Wassie Abate
- Department of Psychiatry, Dr. Ambachew Memorial Hospital, Amhara Regional Health Bureau, South Gondar Zone, Tach Gaynt, Ethiopia
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14
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Sun B, Zhang C, Huang K, Bhetuwal A, Yang X, Jing C, Li H, Lu H, Zhang Q, Yang H. The white matter characteristic of the genu of corpus callosum coupled with pain intensity and negative emotion scores in patients with trigeminal neuralgia: a multivariate analysis. Front Neurosci 2024; 18:1381085. [PMID: 38576866 PMCID: PMC10991788 DOI: 10.3389/fnins.2024.1381085] [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: 02/02/2024] [Accepted: 03/07/2024] [Indexed: 04/06/2024] Open
Abstract
Background Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder that not only causes intense pain but also affects the psychological health of patients. Since TN pain intensity and negative emotion may be grounded in our own pain experiences, they exhibit huge inter-individual differences. This study investigates the effect of inter-individual differences in pain intensity and negative emotion on brain structure in patients with TN and the possible pathophysiology mechanism underlying this disease. Methods T1 weighted magnetic resonance imaging and diffusion tensor imaging scans were obtained in 46 patients with TN and 35 healthy controls. All patients with TN underwent pain-related and emotion-related questionnaires. Voxel-based morphometry and regional white matter diffusion property analysis were used to investigate whole brain grey and white matter quantitatively. Innovatively employing partial least squares correlation analysis to explore the relationship among pain intensity, negative emotion and brain microstructure in patients with TN. Results Significant difference in white matter integrity were identified in patients with TN compared to the healthy controls group; The most correlation brain region in the partial least squares correlation analysis was the genus of the corpus callosum, which was negatively associated with both pain intensity and negative emotion. Conclusion The genu of corpus callosum plays an important role in the cognition of pain perception, the generation and conduction of negative emotions in patients with TN. These findings may deepen our understanding of the pathophysiology of TN.
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Affiliation(s)
- Baijintao Sun
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chuan Zhang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Kai Huang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Anup Bhetuwal
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xuezhao Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chuan Jing
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hongjian Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hongyu Lu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Qingwei Zhang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hanfeng Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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15
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Baggio DF, da Luz FMR, Zortea JM, Lejeune VBP, Chichorro JG. Sex differences in carbamazepine effects in a rat model of trigeminal neuropathic pain. Eur J Pharmacol 2024; 967:176386. [PMID: 38311280 DOI: 10.1016/j.ejphar.2024.176386] [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: 12/11/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
Carbamazepine (CBZ) represents the first-line treatment for trigeminal neuralgia, a condition of facial pain that affects mainly women. The chronic constriction of the infraorbital nerve (CCI-ION) is a widely used model to study this condition, but most studies do not include females. Thus, this study aimed to characterize sensory and affective changes in female rats after CCI-ION and compare the effect of CBZ in both sexes. Mechanical allodynia was assessed 15 days after CCI-ION surgery in rats treated with CBZ (10 and 30 mg/kg, i.p.) or vehicle, together with the open-field test. Independent groups were tested on the Conditioned Place Preference (CPP) paradigm and ultrasonic vocalization (USV) analysis. Blood samples were collected for dosage of the main CBZ metabolite. CBZ at 30 mg/kg impaired locomotion of CCI-ION male and sham and CCI-ION female rats and resulted in significantly higher plasma concentrations of 10-11-EPX-CBZ in the latter. Only male CCI-ION rats showed increased facial grooming which was significantly reduced by CBZ at 10 mg/kg. CBZ at 10 mg/kg significantly reduced mechanical allodynia and induced CPP only in female CCI-ION rats. Also, female CCI-ION showed reduced emission of appetitive USV but did not show anxiety-like behavior. In conclusion, male and female CCI-ION rats presented differences in the expression of the affective-motivational pain component and CBZ was more effective in females than males. Further studies using both sexes in trigeminal neuropathic pain models are warranted for a better understanding of potential differences in the pathophysiological mechanisms and efficacy of pharmacological treatments.
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Affiliation(s)
- Darciane Favero Baggio
- Department of Pharmacology, Biological Sciences Sector, Federal University of Parana, Curitiba, PR, Brazil
| | | | - Julia Maria Zortea
- Department of Pharmacology, Biological Sciences Sector, Federal University of Parana, Curitiba, PR, Brazil
| | | | - Juliana Geremias Chichorro
- Department of Pharmacology, Biological Sciences Sector, Federal University of Parana, Curitiba, PR, Brazil.
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Lv SS, Lv XJ, Cai YQ, Hou XY, Zhang ZZ, Wang GH, Chen LQ, Lv N, Zhang YQ. Corticotropin-releasing hormone neurons control trigeminal neuralgia-induced anxiodepression via a hippocampus-to-prefrontal circuit. SCIENCE ADVANCES 2024; 10:eadj4196. [PMID: 38241377 PMCID: PMC10798562 DOI: 10.1126/sciadv.adj4196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
Anxiety and depression are frequently observed in patients suffering from trigeminal neuralgia (TN), but neural circuits and mechanisms underlying this association are poorly understood. Here, we identified a dedicated neural circuit from the ventral hippocampus (vHPC) to the medial prefrontal cortex (mPFC) that mediates TN-related anxiodepression. We found that TN caused an increase in excitatory synaptic transmission from vHPCCaMK2A neurons to mPFC inhibitory neurons marked by the expression of corticotropin-releasing hormone (CRH). Activation of CRH+ neurons subsequently led to feed-forward inhibition of layer V pyramidal neurons in the mPFC via activation of the CRH receptor 1 (CRHR1). Inhibition of the vHPCCaMK2A-mPFCCRH circuit ameliorated TN-induced anxiodepression, whereas activating this pathway sufficiently produced anxiodepressive-like behaviors. Thus, our studies identified a neural pathway driving pain-related anxiodepression and a molecular target for treating pain-related psychiatric disorders.
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Affiliation(s)
- Su-Su Lv
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Xue-Jing Lv
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Ya-Qi Cai
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Xin-Yu Hou
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Zhi-Zhe Zhang
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Guo-Hong Wang
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Li-Qiang Chen
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Ning Lv
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
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Ierano JJ, Richards DM. Atlas orthogonal chiropractic management of trigeminal neuralgia: A series of case reports. Explore (NY) 2024; 20:70-78. [PMID: 37344335 DOI: 10.1016/j.explore.2023.06.004] [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: 05/10/2023] [Accepted: 06/11/2023] [Indexed: 06/23/2023]
Abstract
CONTEXT Trigeminal neuralgia is a debilitating facial pain condition. Upper cervical chiropractic care has been mentioned as a possible solution OBJECTIVE: To determine the effects of Atlas Orthogonal upper cervical chiropractic technique adjustments on trigeminal neuralgia sufferers DESIGN: Case series SETTING: A private chiropractic practice PARTICIPANTS: Five persons with chronic, severe, daily trigeminal neuralgia pain, radiological findings of significant head tilt, pain upon upper cervical palpation, and supine leg length inequality INTERVENTIONS: Up to two consultations and/or Atlas Orthogonal adjustments a week for eight weeks OUTCOME MEASURES: Self-reported reduction in trigeminal neuralgia pain and changes in radiological findings, sensitivity to upper cervical palpation, and leg length inequality RESULTS: Four participants reported reduced trigeminal neuralgia pain, including two with complete cessation of pain. Three participants reduced medication dosages. One reported no change.
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18
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Jing F, Huang H, Li Y, Zang P. Vertebrobasilar dolichoectasia to trigeminal neuralgia: case report. J Surg Case Rep 2024; 2024:rjad737. [PMID: 38239380 PMCID: PMC10795936 DOI: 10.1093/jscr/rjad737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/26/2023] [Indexed: 01/22/2024] Open
Abstract
Vertebrobasilar dolichoectasia (VBD) is a dilated arterial disease with a diameter ˃4.5 mm. Trigeminal neuralgia (TN) is chronic neuropathic pain. Through the diagnosis and treatment of this case we believe that there is a significant risk associated with the endovascular treatment of VBD. The development of post-operative complications caused some functional impairment to the patient, but the improvement in TN symptoms with this endovascular treatment was unexpected. This treatment procedure was considered to be possibly related to the alteration of the tortuous path of the vessels, changing their course, allowing the displacement of vascular compression in the trigeminal root entry zone, and possibly also altering the hemodynamics of the posterior circulation, improving the progression of ischemia and hypoxia-induced demyelination of the trigeminal nerve. Due to the low incidence of this disease, there are not enough large sample studies for systematic statistical analysis.
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Affiliation(s)
- Fangkun Jing
- Department of Neurosurgery, The People's Hospital of Liaoning Province, Shenyang, Liaoning, China
| | - Haitao Huang
- Department of Neurosurgery, The People's Hospital of Liaoning Province, Shenyang, Liaoning, China
| | - Yanfeng Li
- Department of Neurosurgery, The People's Hospital of Liaoning Province, Shenyang, Liaoning, China
| | - Peizhuo Zang
- Department of Neurosurgery, The People's Hospital of Liaoning Province, Shenyang, Liaoning, China
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Feng D, Zhang Y, Li D, Wang K, Yang F, Ding J, Wu W, Wang Y, Jia H. Percutaneous ballon compression for recurrent TN -a retrospective study of 33 cases. Front Neurol 2023; 14:1292804. [PMID: 38116114 PMCID: PMC10728714 DOI: 10.3389/fneur.2023.1292804] [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: 09/12/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
Objective To investigate the clinical efficacy of percutaneous microballoon compression in the treatment of recurrent TN. Methods This retrospective study included 33 patients who underwent percutaneous microballoon compression for the treatment of recurrent TN from March 2019 to May 2022. Postoperative pain recurrence and facial numbness were assessed according to the Barrow Neurological Institute (BNI) pain score. Patients' anxiety and sleep status during follow-up were assessed according to the Self-rating Anxiety Scale (SAS) and Pittsburgh Sleep Quality Index (PSQI). Results All patients (33 cases) were followed up for 12-38 months, with an average follow-up time of 23 months. On postoperative day 1, 31 patients (93.9%) reported no pain, and 2 patients were given drug treatment for pain relief, The total efficacy was 93.9%. Moreover, 2 patients (6.1%) reported significant pain relief 2 weeks postoperatively. There are many complications during and after PBC. The incidence of the trigeminocardiac reflex (TCR) during surgery was 100%, and the incidence of facial numbness, masseter muscle weakness, labial herpes and headache was 97, 60.6, 12.1 and 3%. No patient experienced severe facial numbness, hearing impairment, diplopia, injury to cranial nerves, Meningitis, intracranial haemorrhage or keratitis. 1 patient had recurrence of pain at 6 months post-op, which was relieved by oral medication. 81.8% suffered from anxiety and 54.5% had poor sleep quality before surgery. After the period of PBC, SAS and PSQI scores decreased continuously. There were significant improvements in anxiety and sleep status postoperatively compared with preoperatively. Conclusion PBC is a safe and effective option for the treatment of recurrent TN. The arduous and demanding nature of the clinical course subjects the patient to severe pain, mental, and physical stress. Thankfully, it significantly improves the symptoms of anxiety, depression, and sleep quality.
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Affiliation(s)
- Dongwei Feng
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Yaxin Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Dong Li
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Kang Wang
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Fan Yang
- Nuclear magnetic laboratory, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Jianan Ding
- Interventional Department, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Weize Wu
- Department of Pathology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Yunhe Wang
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Heping Jia
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
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20
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Zakrzewska ZJ, Hosseini-Ashrafi P, Hussain I, Moulder ZJ, Subhash J, Tan M, Johnson ME, Zakrzewska JM. Management of trigeminal neuralgia: A multi-centre case study in general practice. Br J Pain 2023; 17:606-612. [PMID: 37974634 PMCID: PMC10642494 DOI: 10.1177/20494637231199332] [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: 11/19/2023] Open
Abstract
Background and aims Patients often first present with symptoms of trigeminal neuralgia (TN) to primary care. However, there has been little research to determine whether the diagnosis and management of this condition is carried out according to current guidelines. Furthermore, there is little up-to-date information regarding the prevalence of TN in the UK. The aim is to estimate the prevalence of TN and to audit the diagnosis and management process of TN in primary care. Methods Between 2019 and 2020 a search was made at five UK GP practices with a total patient population of 55,842 using EMIS and SystmOne patient record systems to review patient consultations to identify patients coded with TN or facial pain (FP). These records were reviewed to ascertain the basis for diagnosis, management in primary care and referral to secondary care. Results 157 patients were identified; 54 coded with FP and 103 with TN. These results indicate a prevalence of 22.3 in 10,000. There was no difference in documented symptoms between the two groups. Seven patients had all ICDH3 criteria recorded, with two meeting the requirements for TN diagnosis. 58.8% of patients with TN were started on carbamazepine, the current gold standard treatment, compared with 16.7% in the FP group. 38.2% of TN patients were referred to a range of different specialities. Conclusion The prevalence of TN may be higher than previously thought. Key diagnostic criteria are often omitted, leading to potential misdiagnosis or delays in diagnosis. Relatively few referrals are made, though all patients should be considered for imaging.
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Affiliation(s)
| | | | | | | | - Jithu Subhash
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Melissa Tan
- Medical School, University College London, London, UK
| | | | - Joanna M Zakrzewska
- Consultant Royal National ENT and Eastman Dental Hospitals and Pain Management Centre, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK
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21
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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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22
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Tereshko Y, Valente M, Belgrado E, Dalla Torre C, Dal Bello S, Merlino G, Gigli GL, Lettieri C. The Therapeutic Effect of Botulinum Toxin Type A on Trigeminal Neuralgia: Are There Any Differences between Type 1 versus Type 2 Trigeminal Neuralgia? Toxins (Basel) 2023; 15:654. [PMID: 37999517 PMCID: PMC10675382 DOI: 10.3390/toxins15110654] [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: 10/16/2023] [Revised: 11/03/2023] [Accepted: 11/11/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Botulinum toxin type A is an effective treatment for trigeminal neuralgia. Moreover, its efficacy in type 2 trigeminal neuralgia and comparative studies between type 1 and type 2 trigeminal neuralgia (TN) still need to be improved. METHODS We treated 40 TN patients with onabotulinumtoxinA; 18 had type 1 TN, and 22 had type 2 TN. We compared the baseline pain score with the Visual Analogue Scale (VAS) and paroxysm frequency (number per week) at the baseline with those obtained at 1-month and 3-month follow-ups. Nonetheless, we compared the baseline Penn Facial Pain Scale with the scores obtained at the 1-month follow-up. RESULTS BoNT/A effectively reduced pain intensity and frequency at the 1-month and 3-month follow-ups. Moreover, the type 1 TN and type 2 TN groups had baseline pain scores of 7.8 ± 1.65 and 8.4 ± 1.1, respectively. Pain significantly improved (p < 0.001) in both groups to 3.1 ± 2.3 (type 1 TN) and 3.5 ± 2.3 (type 2 TN) at the 1-month follow-up and to 3.2 ± 2.5 (type 1 TN) and 3.6 ± 2.5 (type 2 TN) at the 3-month follow-up. There was no difference between the two groups (p 0.345). The baseline paroxysm frequencies (number per week) were 86.7 ± 69.3 and 88.9 ± 62.2 for the type 1 and type 2 TN groups, respectively; they were significantly reduced in both groups at the 1-month and 3-month follow-ups without significant differences between the two groups (p 0.902). The Pain Facial Pain Scale improved at the 1-month follow-up, and no significant differences were found between the two groups. There was a strong correlation between background pain and paroxysm pain intensity (r 0.8, p < 0.001). CONCLUSIONS Botulinum toxin type A effectively reduced the pain, paroxysm frequency, and PFPS scores of type 1 and type 2 trigeminal neuralgia patients without statistically significant differences. Facial asymmetry was the only adverse event.
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Affiliation(s)
- Yan Tereshko
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; (Y.T.); (G.M.); (C.L.)
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy;
| | - Mariarosaria Valente
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; (Y.T.); (G.M.); (C.L.)
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy;
| | - Enrico Belgrado
- Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; (E.B.); (C.D.T.)
| | - Chiara Dalla Torre
- Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; (E.B.); (C.D.T.)
| | - Simone Dal Bello
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; (Y.T.); (G.M.); (C.L.)
| | - Giovanni Merlino
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; (Y.T.); (G.M.); (C.L.)
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy;
| | - Gian Luigi Gigli
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy;
| | - Christian Lettieri
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; (Y.T.); (G.M.); (C.L.)
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy;
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23
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Chen K, Wei X, Wang R, Yang L, Zou D, Wang Y. BMP7 alleviates trigeminal neuralgia by reducing oligodendrocyte apoptosis and demyelination. J Headache Pain 2023; 24:143. [PMID: 37875834 PMCID: PMC10594892 DOI: 10.1186/s10194-023-01681-3] [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: 09/11/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND BMP7 has been shown to have neuroprotective effects and to alleviate demyelination. However, its role in trigeminal neuralgia (TN) has not been well investigated. The current study aims to determine whether BMP7 plays a role in demyelination, its effects on pain behaviors and mechanism of action in rats with TN. METHODS We used an infraorbital-nerve chronic-constriction injury (ION-CCI) to establish a rat model of TN. Adeno-associated viruses (AAVs) were injected into the rats to upregulate or downregulate BMP7. The mechanical withdrawal thresholds (MWT) of the injured rats were detected using Von Frey filaments. The changes in expression levels of BMP7 and oligodendrocyte (OL) markers were examined by western blotting, quantitative real-time PCR, immunofluorescence, and transmission electron microscopy. RESULTS The ION-CCI induced mechanical allodynia, demyelination, and loss of OLs with a reduction of BMP7. Short-hairpin RNA (shRNA)-BMP7 that inhibited BMP7 expression also caused mechanical allodynia, demyelination, and loss of OLs, and its mechanism may be OL apoptosis. Overexpressing BMP7 in the trigeminal spinal subnucleus caudalis(VC) with AAV-BMP7 relieved all three phenotypes induced by the CCI, and its mechanism may be alleviating OLs apoptosis. Two signal pathways associated with apoptosis, STAT3 and p65, were significantly downregulated in the VC after CCI and rescued by BMP7 overexpression. CONCLUSION BMP7 can alleviate TN by reducing OLs apoptosis and subsequent demyelination. The mechanism behind this protection could be BMP7-mediated activation of the STAT3 and NF-κB/p65 signaling pathway and subsequent decrease in OL apoptosis. Importantly, our study presents clear evidence in support of BMP7 as a possible therapeutic target for the treatment of TN.
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Affiliation(s)
- Kai Chen
- Department of Pain Management and Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Pain Medicine in Hunan Province, Changsha, Hunan, China
| | - Xiaojin Wei
- Department of Pain Management and Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- School of Basic Medical Sciences, Capital Medical University, Beijing, 100054, China
| | - Ruixuan Wang
- Bourns Engineering, The University of California, Riverside, CA, 92521, USA
| | - Lin Yang
- Department of Pain Management and Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Pain Medicine in Hunan Province, Changsha, Hunan, China
| | - Dingquan Zou
- Department of Pain Management and Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Pain Medicine in Hunan Province, Changsha, Hunan, China
| | - Yaping Wang
- Department of Pain Management and Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Clinical Research Center for Pain Medicine in Hunan Province, Changsha, Hunan, China.
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24
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Bethamcharla R, Abou-Al-Shaar H, Maarbjerg S, Chang YF, Gacka CN, Sekula RF. Percutaneous glycerol rhizolysis of the trigeminal ganglion for the treatment of idiopathic and classic trigeminal neuralgia: Outcomes and complications. Eur J Neurol 2023; 30:3307-3313. [PMID: 37422922 DOI: 10.1111/ene.15977] [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: 01/20/2023] [Revised: 04/23/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND AND PURPOSE Patients with idiopathic trigeminal neuralgia (TN) with absent arterial contact or venous contact only and classic TN with morphological changes of the trigeminal nerve secondary to venous compression are not routinely recommended microvascular decompression at our institution. In patients with these anatomical subtypes of TN, limited data exists describing the outcomes of percutaneous glycerol rhizolysis (PGR) of the trigeminal ganglion (TG). METHODS We performed a retrospective single-center cohort study and analyzed outcomes and complications after PGR of the TG. Clinical outcome after PGR of the TG was assessed via the Barrow Neurological Institute (BNI) Pain Scale. RESULTS Forty-five patients underwent a total of 66 PGRs of the TG. At short-term follow-up, 58 procedures (87.9%) resulted in a BNI score of I (i.e., freedom from pain without medication). At a median follow-up of 3.07 years, 18 procedures (27.3%) resulted in a BNI score of I, 12 procedures (18.1%) resulted in BNI score of IIIa, and 36 procedures (54.5%) resulted in a BNI score of IIIb-V. The median length of freedom from pain without medication was 1.5 years. Eighteen procedures (27.3%) caused hypesthesia and two (3.0%) caused paresthesias. There were no serious complications. CONCLUSION In patients with these anatomical subtypes of TN there was a high rate of short-term pain relief for the first 1-2 years and thereafter a large proportion of patients experienced pain relapse. In this patient group, PGR of the TG represents a safe procedure that is efficacious in the short term.
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Affiliation(s)
- Raviteja Bethamcharla
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stine Maarbjerg
- Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
| | - Yue-Fang Chang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Caroline N Gacka
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Raymond F Sekula
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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25
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Hu S, Huang Z, Wang H, Chen K, Xia L, Dou N, Zhong J. The Value of a Headless Pear Shape in Percutaneous Balloon Compression for Trigeminal Neuralgia. Oper Neurosurg (Hagerstown) 2023; 25:372-378. [PMID: 37499245 DOI: 10.1227/ons.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/16/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Percutaneous balloon compression (PBC) has been regarded as a simple and effective remedy for trigeminal neuralgia. This study aims to retrospectively analyze the correlation between intraoperative balloon shapes and postoperative outcomes. METHOD Those consecutive PBC cases performed in our department between 2019 and 2022 were reviewed. According to the intraoperative balloon figures, they were cataloged as headless pear, slim pear, bottle gourd, and winter melon groups. The degree of pain or numbness was quantified using the visual analog scale. Those pain-free or pain score <3 and satisfied by the patient were called effective, and those numb score >3 were taken into account of numbness incidence. RESULTS Except for missing cases, 160 were finally recruited in this study with a mean follow-up for 23.6 ± 12.8 months. Postoperatively, the pain score plunged from 8.8 ± 1.0 to 0.8 ± 2.0 immediately, which rose slightly over time and maintained at 2.4 ± 3.1. The maximal pain score drop occurred in the headless pear group ( P < .001) and the minimal in the winter melon group ( P < .001). The early efficacy of PBC was 100%, 84.1%, 91.4%, and 50.0%, respectively. However, the long-term efficacy was 88.2%, 75.0%, 82.1% and 25.0%. The ipsilateral numbness occurred in most of the cases immediately after PBC with a score of 3.5 ± 2.3, which decreased significantly within 3 months to 2.3 ± 2.0 and turned to 1.7 ± 1.8 finally ( P < .05). The highest and lowest numb score appeared in bottle gourd and winter melon groups, respectively ( P < .05). CONCLUSION A headless pear shape emerged in lateral fluoroscopy as the balloon was fully inflated indicates that the entire Meckel cave is suffused, and hence, the anterior semilunar ganglion has been solidly compressed, which may lead to a successful outcome.
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Affiliation(s)
- Shaozhen Hu
- Department of Neurosurgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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26
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Silva J, Viguini Tolentino Correa A, Alves da Silva I, Silva Pinto de Carvalho C, Ramina R. Trigeminal Neuralgia Due to Unilateral Early Bifurcated Superior Cerebellar Artery: Case Report and Literature Review. Cureus 2023; 15:e46201. [PMID: 37905292 PMCID: PMC10613432 DOI: 10.7759/cureus.46201] [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] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Trigeminal neuralgia (TN) is considered a debilitating pain syndrome resulting from a neurovascular conflict in the prepontine cistern, usually through compression of the trigeminal nerve by the superior cerebellar artery (SCA), resulting in neural pathology at the root entry zone. This is a case report of a patient whose TN symptoms were attributed to an anatomical variant of the SCA, managed successfully through conservative treatment. Anatomical variants of the SCA have been related to TN. However, this is the first reported case in the PubMed literature of primary TN due to an unilateral early bifurcated SCA treated conservatively with first-line sodium channel blockers with a good outcome.
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Affiliation(s)
- Joseph Silva
- Neurosurgery, Instituto de Neurologia de Curitiba, Curitiba, BRA
| | | | | | | | - Ricardo Ramina
- Neurosurgery, Instituto de Neurologia de Curitiba, Curitiba, BRA
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27
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Xiromerisiou G, Lampropoulos IC, Dermitzakis EV, Vikelis M, Marogianni C, Mysiris D, Argyriou AA. Single OnabotulinumtoxinA Session Add-On to Carbamazepine or Oxcarbazepine in Treatment-Refractory Trigeminal Neuralgia: A Case Series with 24-Week Follow Up. Toxins (Basel) 2023; 15:539. [PMID: 37755965 PMCID: PMC10534438 DOI: 10.3390/toxins15090539] [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: 06/25/2023] [Revised: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
We sought to assess the efficacy of combining onabotulinumtoxinA (BoNTA) as add-on therapy to carbamazepine or oxcarbazepine in treatment-refractory patients with trigeminal neuralgia (TGN) who failed to respond (less than 30% response rate) to adequate monotherapy. We conducted a retrospective study on 15 patients with a definite diagnosis of TGN, according to the established criteria, and underwent BoNTA as part of their treatment plan. A single BoNTA session was administered subcutaneously, according to patients' perceived zone of pain, at different dosages ranging from 30 to 200 units (mean ± standard deviation: 87.3 ± 39.2). All patients (15/15; 100%) reported large reductions in the severity of their TGN-related neuropathic pain. The mean pain score on the VAS scale significantly decreased from 9.3 ± 1.1 to 3.7 ± 1.2 at 2 weeks after injecting BoNTA (p < 0.001) and remained stable at 4 and 24 weeks post-injection. Regarding the impact of BoNTA on patients' health-related quality of life, there were significant improvements in both the physical and mental health domains (p < 0.05) of SF-36 tool. BoNTA may be a safe and effective treatment option for patients with refractory TGN when added on to carbamazepine or oxcarbazepine. The use of a single BoNTA session for TGN treatment may be an alternative to surgical interventions and as add-on treatment to oral medications, providing patients with a minimally invasive, effective, safe and well-tolerated option.
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Affiliation(s)
- Georgia Xiromerisiou
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, 41110 Larissa, Greece
| | - Ioannis C. Lampropoulos
- Respiratory Medicine Department, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
| | | | - Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, 16675 Glyfada, Greece;
| | - Chrysoula Marogianni
- Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, 41110 Larissa, Greece; (C.M.); (D.M.)
| | - Dimitrios Mysiris
- Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, 41110 Larissa, Greece; (C.M.); (D.M.)
| | - Andreas A. Argyriou
- Headache Outpatient Clinic, Department of Neurology, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece;
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28
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Zhi HW, Jia YZ, Bo HQ, Li HT, Zhang SS, Wang YH, Yang J, Hu MZ, Wu HY, Cui WQ, Xu XD. Curcumin alleviates orofacial allodynia and improves cognitive impairment via regulating hippocampal synaptic plasticity in a mouse model of trigeminal neuralgia. Aging (Albany NY) 2023; 15:8458-8470. [PMID: 37632838 PMCID: PMC10496987 DOI: 10.18632/aging.204984] [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: 03/30/2023] [Accepted: 07/24/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE Cognitive impairment, one of the most prevalent complications of trigeminal neuralgia, is troubling for patients and clinicians due to limited therapeutic options. Curcumin shows antinociception and neuroprotection pharmacologically, suggesting that it may have therapeutic effect on this complication. This study aimed to investigate whether curcumin alleviates orofacial allodynia and improves cognitive impairment by regulating hippocampal CA1 region synaptic plasticity in trigeminal neuralgia. METHODS A mouse model of trigeminal neuralgia was established by partially transecting the infraorbital nerve (pT-ION). Curcumin was administered by gavage twice daily for 14 days. Nociceptive thresholds were measured using the von Frey and acetone test, and the cognitive functions were evaluated using the Morris water maze test. Dendritic spines and synaptic ultrastructures in the hippocampal CA1 area were observed by Golgi staining and transmission electron microscopy. RESULTS Curcumin intervention increased the mechanical and cold pain thresholds of models. It decreased the escape latency and distance to the platform and increased the number of platform crossings and dwell time in the target quadrant of models, and improved spatial learning and memory deficits. Furthermore, it partially restored the disorder of the density and proportion of dendritic spines and the abnormal density and structure of synapses in the hippocampal CA1 region of models. CONCLUSION Curcumin alleviates abnormal orofacial pain and cognitive impairment in pT-ION mice by a mechanism that may be related to the synaptic plasticity of hippocampal CA1, suggesting that curcumin is a potential strategy for repairing cognitive dysfunction under long-term neuropathic pain conditions.
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Affiliation(s)
- Hong-Wei Zhi
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Yu-Zhi Jia
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Huai-Qian Bo
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Hai-Tao Li
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Si-Shuo Zhang
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Ya-Han Wang
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Jie Yang
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Ming-Zhe Hu
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Hong-Yun Wu
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Wen-Qiang Cui
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, PR China
| | - Xiang-Dong Xu
- Experimental Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
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29
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Li S, Cheng G, Wu Y, Liao C, Zhang W. Long-term pain outcomes in trigeminal neuralgia patients with concomitant continuous pain: a comparison of first-time microvascular decompression and percutaneous balloon compression. Neurosurg Rev 2023; 46:183. [PMID: 37486589 DOI: 10.1007/s10143-023-02089-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Shuo Li
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo Cheng
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwei Wu
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenlong Liao
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenchuan Zhang
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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30
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Malicki M, Szmyd BM, Bobeff EJ, Karuga FF, Piotrowski MM, Kościołek D, Wanibuchi S, Radek M, Jaskólski DJ. The Superior Cerebellar Artery: Variability and Clinical Significance. Biomedicines 2023; 11:2009. [PMID: 37509648 PMCID: PMC10376954 DOI: 10.3390/biomedicines11072009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
The superior cerebellar artery (SCA) arises from the distal part of the basilar artery and passes by the oculomotor, trochlear, and trigeminal nerves. SCA is known to play a crucial role in the development of trigeminal neuralgia. However, due to its anatomical variability, it may also trigger other neurovascular compression (NVC), including hemifacial spasm, oculomotor nerve palsy, and ocular neuromyotonia. Additionally, it may be associated with ischemic syndromes and aneurysm development, highlighting its clinical significance. The most common anatomical variations of the SCA include duplication, a single vessel origin from the posterior cerebral artery (PCA), and a common trunk with PCA. Rarely observed variants include bifurcation and origin from the internal carotid artery. Certain anatomical variants such as early bifurcation and caudal course of duplicated SCA trunk may increase the risk of NVC. In this narrative review, we aimed to examine the impact of the anatomical variations of SCA on the NVCs based on papers published in Pubmed, Scopus, and Web of Science databases with a snowballing approach. Our review emphasizes the importance of a thorough understanding of the anatomical variability of SCA to optimize the management of patients with NVCs associated with this artery.
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Affiliation(s)
- Mikołaj Malicki
- Department of Neurosurgery, Spine and Peripheral Nerves Surgery, Medical University of Lodz, Zeromskiego St. 113, 90-549 Lodz, Poland; (M.M.); (M.R.)
| | - Bartosz M. Szmyd
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (B.M.S.); (M.M.P.); (D.J.J.)
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Sporna St. 36/50, 91-738 Lodz, Poland
| | - Ernest J. Bobeff
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (B.M.S.); (M.M.P.); (D.J.J.)
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowieka St. 6/8, 92-251 Lodz, Poland;
| | - Filip F. Karuga
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowieka St. 6/8, 92-251 Lodz, Poland;
| | - Michał M. Piotrowski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (B.M.S.); (M.M.P.); (D.J.J.)
| | - Dawid Kościołek
- Central Teaching Hospital, Medical University of Lodz, Pomorska St. 251, 92-208 Lodz, Poland;
| | - Sora Wanibuchi
- The Faculty of Medicine, Aichi Medical University, Nagakute 480-1195, Japan;
| | - Maciej Radek
- Department of Neurosurgery, Spine and Peripheral Nerves Surgery, Medical University of Lodz, Zeromskiego St. 113, 90-549 Lodz, Poland; (M.M.); (M.R.)
| | - Dariusz J. Jaskólski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (B.M.S.); (M.M.P.); (D.J.J.)
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31
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Teshima THN, Zakrzewska JM, Potter R. A systematic review of screening diagnostic tools for trigeminal neuralgia. Br J Pain 2023; 17:255-266. [PMID: 37342400 PMCID: PMC10278451 DOI: 10.1177/20494637221146854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Background and objective Trigeminal neuralgia (TN) is a rare chronic neuropathic pain condition of sudden and severe pain, often described as an electric shock. Diagnosis is challenging for non-expert clinicians, particularly in primary care settings. We wanted to identify and assess the diagnostic accuracy of existing screening tools for TN and orofacial pain that could be used to support the diagnosis of TN in primary care. Databases and data treatment We searched key databases (MEDLINE, ASSIA, Embase, and Web of Knowledge and PsycINFO) supplemented by citation tracking from January 1988 to 2021. We used an adapted version of the Quality of Diagnostic Accuracy Studies (QUADAS-2) to assess the methodological quality of each study. Results Searches identified five studies, from the UK, USA and Canada; three validated self-report questionnaires; and two artificial neural networks. All screened for multiple orofacial pain diagnoses, including dentoalveolar pain, musculoskeletal pain (temporomandibular disorders) and neurological pain (trigeminal neuralgia, headache, atypical facial pain and postherpetic neuralgia). The overall quality assessment was low for one study. Conclusions Diagnosis of TN can be challenging for non-expert clinicians. Our review found few existing screening tools to diagnose TN, and none is currently suitable to be used in primary care settings. This evidence supports the need to adapt an existing tools or to create a new tool for this purpose. The development of an appropriate screening questionnaire could assist non-expert dental and medical clinicians to identify TN more effectively and empower them to manage or refer patients for treatment more effectively.
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Affiliation(s)
- THN Teshima
- Department of Oral Medicine, UCL Eastman Dental Institute, London, UK
- Department of Oral Medicine and Pain Education Research Centre at ULCH NHS Foundation Trust, Royal National ENT & Eastman Dental Hospitals, ULCH NHS Foundation Trust, London, UK
| | - JM Zakrzewska
- Department of Oral Medicine, UCL Eastman Dental Institute, London, UK
- Department of Oral Medicine and Pain Education Research Centre at ULCH NHS Foundation Trust, Royal National ENT & Eastman Dental Hospitals, ULCH NHS Foundation Trust, London, UK
| | - R Potter
- Warwick Clinical Trials Unit, Coventry, UK
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32
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Zhu C, Jiang C, Xu W, Wang J, Chong Y, Liang W. Microvascular decompression for young onset primary trigeminal neuralgia: a single-center experience. Neurosurg Rev 2023; 46:69. [PMID: 36917289 DOI: 10.1007/s10143-023-01978-6] [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: 11/18/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
This study aims to explore the causes of primary young onset trigeminal neuralgia (TN) and the clinical outcomes of these patients. From May 2015 to December 2020, 19 primary TN patients with onset age under 30 years underwent microvascular decompression (MVD) in Nanjing Drum Tower Hospital. In this study, the clinical characteristics, surgical outcomes, and postoperative complications of these patients were analyzed retrospectively. Of the 19 patients, 5 were males and 14 were females, and the pain was located on the right side in 10 cases (52.6%). Vascular compression was observed in 17 patients, including 14 cases of superior cerebellar artery (SCA) alone, 2 cases of superior petrosal vein (SPV) alone, and 1 case of SCA and SPV combined. Two patients had no neurovascular conflict, and nerve combing was performed. After surgery, 18 patients got immediate pain relief; 1 patient improved but still had occasional pain. With a mean follow-up of 42.7 ± 22.3 months, one patient was found to have a relapse 45 months after MVD. Surgical complications including mild facial numbness in two patients and hearing impairment in one patient. Neurovascular compression is the main cause of young onset primary TN, and the most commonly encountered vascular was SCA. MVD is a safe and effective treatment for these patients.
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Affiliation(s)
- Chunran Zhu
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210009, Jiangsu, China.,Department of Neurosurgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu, China
| | - Chengrong Jiang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210009, Jiangsu, China
| | - Wu Xu
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210009, Jiangsu, China
| | - Jing Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210009, Jiangsu, China
| | - Yulong Chong
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210009, Jiangsu, China
| | - Weibang Liang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210009, Jiangsu, China. .,Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210009, Jiangsu, China.
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33
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He B, Wang W, Zhang R, Xu Y, Wei X, Yang Z, Cao Y. Fluorescence visualization of the neuropathic pain triad in trigeminal neuralgia. JOURNAL OF BIOPHOTONICS 2023; 16:e202200301. [PMID: 36369929 DOI: 10.1002/jbio.202200301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
Trigeminal neuralgia (TN), an exemplary condition of neuropathic facial pain, seriously affects the physical and mental health of patients, becoming a major medical and social problem. So far, the mechanism of TN and its relation to neuronal activity remain unclear, largely limited by the spatial resolution of visualization methods. In the meanwhile, current therapeutic strategies targeting neurons have not achieved satisfactory outcome. Here, we investigate the neuropathic pain triad in TN by establishing an animal model of TN by chronic constriction injury of the unilateral infraorbital nerve (ION-CCI) and leveraging the single-cell resolution of confocal microscopy, including neuronal hyperexcitability, glial activation, and macrophage polarization. These results can broaden the understanding of TN pathogenesis from neurons to the neuropathic pain triad, and suggest that optical microscopy can provide new opportunities for understanding the complex pathogenesis of TN at single-cell resolution, potentially contributing to the identification of more precise therapeutic targets and the development of more effective treatment modalities.
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Affiliation(s)
- Bin He
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Wenlong Wang
- School of Physics and Optoelectronics, State Key Laboratory of Luminescent Materials and Devices, Guangdong Engineering Technology Research and Development Center of Special Optical Fiber Materials and Devices, Guangdong Provincial Key Laboratory of Fiber Laser Materials and Applied Techniques, South China University of Technology, Guangzhou, China
| | - Runsen Zhang
- School of Physics and Optoelectronics, State Key Laboratory of Luminescent Materials and Devices, Guangdong Engineering Technology Research and Development Center of Special Optical Fiber Materials and Devices, Guangdong Provincial Key Laboratory of Fiber Laser Materials and Applied Techniques, South China University of Technology, Guangzhou, China
| | - Yue Xu
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Xiaoming Wei
- School of Physics and Optoelectronics, State Key Laboratory of Luminescent Materials and Devices, Guangdong Engineering Technology Research and Development Center of Special Optical Fiber Materials and Devices, Guangdong Provincial Key Laboratory of Fiber Laser Materials and Applied Techniques, South China University of Technology, Guangzhou, China
| | - Zhongmin Yang
- School of Physics and Optoelectronics, State Key Laboratory of Luminescent Materials and Devices, Guangdong Engineering Technology Research and Development Center of Special Optical Fiber Materials and Devices, Guangdong Provincial Key Laboratory of Fiber Laser Materials and Applied Techniques, South China University of Technology, Guangzhou, China
- Research Institute of Future Technology, South China Normal University, Guangzhou, China
| | - Yang Cao
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
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34
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Bromberg H, Guastella A, Haas M, Akel R, Craig D. Two Patients Experience Same-Day Analgesic Effect of Methadone on Trigeminal Neuralgia Secondary to Malignancy: A Case Report. J Palliat Med 2023. [PMID: 36633599 DOI: 10.1089/jpm.2022.0436] [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: 01/13/2023] Open
Abstract
Trigeminal neuralgia (TN) secondary to malignancy leads to significant distress and subsequently impacts a patient's quality of life. Use of methadone as a first-line opioid analgesic in this subset of oncology patients is uncommon and is rarely initiated after traditional first-line therapies have failed. We report two patients with TN secondary to tumor burden who experienced significant analgesia within 24 hours of methadone initiation.
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Affiliation(s)
- Hannah Bromberg
- Department of Supportive Care, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Ann Guastella
- Department of Supportive Care, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Meghan Haas
- Department of Supportive Care, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Reem Akel
- Department of Supportive Care, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Graduate Medical Education, University of South Florida, Tampa, Florida, USA
| | - David Craig
- Department of Supportive Care, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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Abstract
Trigeminal neuralgia (TN) is a rare neuropathic pain disorder characterized by recurrent, paroxysmal episodes of short-lasting severe electric shock-like pain along the sensory distribution of the trigeminal nerve. Recent classification systems group TN into 3 main categories depending on the underlying pathophysiology. This article will present a case history and review the epidemiology, diagnostic criteria, classification, clinical features, diagnostic investigations, pathophysiology, and management of TN.
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Affiliation(s)
- Shehryar Nasir Khawaja
- Orofacial Pain Medicine, Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Centers, Lahore, Pakistan.
| | - Steven J Scrivani
- Department of Diagnostic Sciences, Craniofacial Pain Center, Tufts University School of Dental Medicine, Boston, MA, USA
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36
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Venda Nova C, Ni Riordain R, Baker SR, Zakrzewska JM. An international Delphi survey and consensus meeting to define the core outcome set for trigeminal neuralgia clinical trials. Eur J Pain 2023; 27:86-98. [PMID: 36130737 PMCID: PMC10092666 DOI: 10.1002/ejp.2041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is an excruciating unilateral facial pain, which negatively affects patient's quality of life. Historically, it has been difficult to compare treatment efficacy due to the lack of standardized outcomes. In addition, patients' perspective has seldomly been acknowledged. The aim of this study was to reach consensus on what outcomes of treatment are important to different TN stakeholders (patients, clinicians and researchers), to identify the TN Core Outcome Set (TRINCOS). METHODS A list of outcomes identified through a systematic review and focus group work was used to develop the survey questionnaire. A three-round Delphi was conducted. Participants were asked to score the outcomes on scale from 1 to 9 (1-3 not important;4-6 important but not critical;7-9 critical). Outcomes scored as critical by ≥70% and not important by <15% were retained, and those for which no consensus was reached were discussed at a consensus meeting. RESULTS Of the 70 participants who completed the Delphi, 26 were patients, 38 were clinicians and six were researchers. Of the 40 outcomes presented, 17 were scored as critical and no consensus was met for 23 outcomes. Agreement was reached during a consensus meeting on 10 outcomes across six domains (pain, side effects, social impact, quality of life, global improvement, and satisfaction with treatment). CONCLUSION Implementation of TRINCOS in future clinical trials will improve homogeneity of studies' results, reduce the redundancy in the outcome assessment and effectively allow comparison of different treatments to better inform researchers, clinicians and most importantly patients, about the efficacy of the different treatments. SIGNIFICANCE Implementation of a 10-item core outcome set in trigeminal neuralgia will improve comparability between studies allowing patients to have faster access to better treatments.
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Affiliation(s)
| | - Richeal Ni Riordain
- University College London, Eastman Dental Institute, London, UK.,Cork University Dental School and Hospital, Cork, Ireland
| | - Sarah R Baker
- School of Clinical Dentistry, Sheffield University, Sheffield, UK
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37
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Donertas-Ayaz B, Caudle RM. Locus coeruleus-noradrenergic modulation of trigeminal pain: Implications for trigeminal neuralgia and psychiatric comorbidities. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2023; 13:100124. [PMID: 36974102 PMCID: PMC10038791 DOI: 10.1016/j.ynpai.2023.100124] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Abstract
Trigeminal neuralgia is the most common neuropathic pain involving the craniofacial region. Due to the complex pathophysiology, it is therapeutically difficult to manage. Noradrenaline plays an essential role in the modulation of arousal, attention, cognitive function, stress, and pain. The locus coeruleus, the largest source of noradrenaline in the brain, is involved in the sensory and emotional processing of pain. This review summarizes the knowledge about the involvement of noradrenaline in acute and chronic trigeminal pain conditions and how the activity of the locus coeruleus noradrenergic neurons changes in response to acute and chronic pain conditions and how these changes might be involved in pain-related comorbidities including anxiety, depression, and sleep disturbance.
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Affiliation(s)
| | - Robert M. Caudle
- Corresponding author at: Department of Oral and Maxillofacial Surgery, University of Florida College of Dentistry, PO Box 100416, 1395 Center Drive, Gainesville, FL 32610, United States.
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38
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Zhou Q, Li M, Fan Q, Chen F, Jiang G, Wang T, He Q, Fu S, Yin Y, Lin J, Yan J. Cerebral perfusion alterations in patients with trigeminal neuralgia as measured by pseudo-continuous arterial spin labeling. Front Neurosci 2022; 16:1065411. [PMID: 36601595 PMCID: PMC9807247 DOI: 10.3389/fnins.2022.1065411] [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: 10/09/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background Accumulating evidence suggests that trigeminal neuralgia (TN) causes structural and functional alterations in the brain. However, only a few studies have focused on cerebral blood flow (CBF) changes in patients with TN. This study aimed to explore whether altered cerebral perfusion patterns exist in patients with TN and investigate the relationship between abnormal regional CBF (rCBF) and clinical characteristics of TN. Materials and methods This study included 28 patients with TN and 30 age- and sex-matched healthy controls (HCs) who underwent perfusion functional MRI (fMRI) of the brain using pseudo-continuous arterial spin labeling (pCASL) in the resting state. The regions of significantly altered CBF in patients with TN were detected using group comparison analyses. Then, the relationships between the clinical characteristics and abnormal rCBF were further investigated. Results Compared to the control group, patients with TN exhibited increased rCBF, primarily in the thalamus, middle frontal gyrus (MFG), and left insula. Furthermore, the CBF values of the thalamus were negatively correlated with the pain intensity of TN and positively correlated with pain duration in patients with TN. Conclusion Primary alterations in rCBF in patients with TN occurred in different brain regions related to pain, which are involved in cognitive-affective interaction, pain perception, and pain modulation. These results indicate that non-invasive resting cerebral perfusion imaging may contribute complementary information to further understanding the neuropathological mechanism underlying TN.
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Affiliation(s)
- Qianling Zhou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Meng Li
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qisen Fan
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Feng Chen
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guihua Jiang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Tianyue Wang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qinmeng He
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shishun Fu
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yi Yin
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jinzhi Lin
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jianhao Yan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China,*Correspondence: Jianhao Yan,
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39
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Zhang H, Liu M, Guo W, He J, Li J. The Effect of Trigeminal Ganglion Block on Trigeminocardiac Reflex in Elderly Patients with Trigeminal Neuralgia Undergoing Percutaneous Balloon Compression: A Randomized Controlled Study. Ther Clin Risk Manag 2022; 18:1091-1098. [DOI: 10.2147/tcrm.s373370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
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40
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Andersen ASS, Heinskou TB, Rochat P, Springborg JB, Noory N, Smilkov EA, Bendtsen L, Maarbjerg S. Microvascular decompression in trigeminal neuralgia - a prospective study of 115 patients. J Headache Pain 2022; 23:145. [PMCID: PMC9675260 DOI: 10.1186/s10194-022-01520-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Trigeminal neuralgia is a severe facial pain disorder. Microvascular decompression is first choice surgical treatment of patients with classical TN. There exist few prospective studies with an independent evaluation of efficacy and complications after MVD. Objectives We aimed to assess outcome and complications after microvascular decompression from our center. Methods We prospectively recorded clinical characteristics, outcome, and complications from consecutive patients with either classical or idiopathic (only patients with a neurovascular contact) trigeminal neuralgia undergoing microvascular decompression. Neurovascular contact was evaluated by 3.0 Tesla MRI. Patients were assessed before and 3, 6, 12, and 24 months after surgery by independent assessors. Results Of 115 included patients, 86% had a clinically significant outcome (i.e., BNI I – BNI IIIb). There was a significant association between an excellent surgical outcome and the male sex (OR 4.9 (CI 1.9–12.8), p = 0.001) and neurovascular contact with morphological changes (OR 2.5 (CI 1.1–6.0), p = 0.036). Significantly more women (12/62 = 19%) than men (2/53 = 4%) had a failed outcome, p = 0.019. The most frequent major complications were permanent hearing impairment (10%), permanent severe hypoesthesia (7%), permanent ataxia (7%), and stroke (6%). Most patients (94%) recommend surgery to others. Conclusion Microvascular decompression is an effective treatment for classical and idiopathic (only patients with a neurovascular contact) trigeminal neuralgia with a high chance of a long-lasting effect. The chance of an excellent outcome was highest in men and in patients with classical trigeminal neuralgia. Complications are relatively frequent warranting thorough patient evaluation and information preoperatively. Trial registration Clinical.trials.gov registration no. NCT04445766. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01520-x.
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Affiliation(s)
- Anne Sofie Schott Andersen
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Tone Bruvik Heinskou
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Per Rochat
- grid.4973.90000 0004 0646 7373Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet – Blegdamsvej, 2100 Copenhagen, Denmark
| | - Jacob Bertram Springborg
- grid.4973.90000 0004 0646 7373Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet – Blegdamsvej, 2100 Copenhagen, Denmark
| | - Navid Noory
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Emil Andonov Smilkov
- grid.475435.4Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet – Glostrup, 2600 Glostrup, Denmark
| | - Lars Bendtsen
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Stine Maarbjerg
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
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Sun T, Huang Q, Li C, Yang W, Wang W, He L, Liu J, Yang C. Correlation study between multiplanar reconstruction trigeminal nerve angulation and trigeminal neuralgia. BMC Neurol 2022; 22:384. [PMID: 36224533 PMCID: PMC9555177 DOI: 10.1186/s12883-022-02906-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/28/2022] [Indexed: 12/08/2022] Open
Abstract
OBJECTIVES Neurovascular compression (NVC) produces morphological changes on the trigeminal nerve root is considered the cause of trigeminal neuralgia (TN), but there were some patients with TN found no NVC, and also NVC was found in asymptomatic individuals. Many studies found tight relationships of TN and morphological structures of trigeminal nerve. We designed this study to explore the correlation between multiplanar reconstruction (MPR) trigeminal nerve angulation (TNA) and TN. METHODS Patients with classical symptoms of TN were recruited as observation group (OG) in this study, 50 healthy controls were enrolled as control group (CG), the OG was further subtyped into young patients (YP), middle-aged patients (MP) and old patients (OP) based to the onset age of symptoms, and also divided into patients with or without trigger maneuvers (TM) based on the presence of TM or not. All the participants underwent magnetic resonance (MR) examinations in same device, bilateral TNA measurements were carried out in OG and CG, then TNA was compared between different groups or subgroups. All images were interpreted by two radiologists who were blinded to the study, diagnosis of TN was made by two senior neurosurgery professors. RESULT Ultimately, 95 patients with primary TN were recruited in OG, aged from 25 to 84 (61.15 ± 12.70) years with a course of 0.5 to 30 (5.03 ± 5.41) years, their onset age ranged from 24 to 82 (56.13 ± 11.98) years. There were 34 males and 61 females in OG, and 58 cases involved right side. The CG aged from 22 to 85 (61.86 ± 13.03) years. No statistical difference was found between the age of OG and CG(p = 0.76), and also the bilateral TNA of CG (154.92 ± 16.90° vs 155.55 ± 17.03°, p > 0.05), while TNA of OG was significantly smaller than CG (150.78 ± 11.29° vs 155.24 ± 16.88°, p = 0.019). In OG, TNA on the affected side was significantly smaller than the unaffected side (149.29 ± 12.44° vs 152.27 ± 9.85°, p = 0.014). TNA showed a positive correlation with onset age of patients with TN, as TNA on the affected side of YP was significantly smaller than MP and OP (139.00 ± 11.64° vs 148.86 ± 11.54°, 139.00 ± 11.64° vs 152.18 ± 12.61°, p = 0.004 and 0.026). Furthermore, patients with TM showed smaller TNA than those without TM (147.05 ± 11.30° vs 164.75 ± 8.39°, p < 0.001). CONCLUSIONS This study suggested that TNA might play a role in TN, small TNA could be a risk factor of TN. Furthermore, patients with small TNA are more likely to combine with TM, but more studies are needed to explore the exact role of TNA in TN.
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Affiliation(s)
- Tao Sun
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-Sen University, No 58th, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Qinghao Huang
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-Sen University, No 58th, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Chuangfeng Li
- Center of Universal Medical Imaging Diagnostic, No 80th, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Wensheng Yang
- Center of Universal Medical Imaging Diagnostic, No 80th, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Wentao Wang
- Department of Neurosurgery, First Affiliated Hospital of Guangdong Pharmaceutical University, No. 19, Nonglinxia Road, Yuexiu District, Guangzhou, 510080, China
| | - Longshuang He
- Department of Neurosurgery, First Affiliated Hospital of Guangdong Pharmaceutical University, No. 19, Nonglinxia Road, Yuexiu District, Guangzhou, 510080, China
| | - Jinlong Liu
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-Sen University, No 58th, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Chao Yang
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-Sen University, No 58th, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China.
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Jia YZ, Li HT, Zhang GM, Wu HY, Zhang SS, Zhi HW, Wang YH, Zhu JW, Wang YF, Xu XQ, Tian CJ, Cui WQ. Electroacupuncture alleviates orofacial allodynia and anxiety-like behaviors by regulating synaptic plasticity of the CA1 hippocampal region in a mouse model of trigeminal neuralgia. Front Mol Neurosci 2022; 15:979483. [PMID: 36277498 PMCID: PMC9582442 DOI: 10.3389/fnmol.2022.979483] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Trigeminal neuralgia (TN), one of the most severe and debilitating chronic pain conditions, is often accompanied by mood disorders, such as anxiety and depression. Electroacupuncture (EA) is a characteristic therapy of Traditional Chinese Medicine with analgesic and anxiolytic effects. This study aimed to investigate whether EA ameliorates abnormal TN orofacial pain and anxiety-like behavior by altering synaptic plasticity in the hippocampus CA1. Materials and methods A mouse infraorbital nerve transection model (pT-ION) of neuropathic pain was established, and EA or sham EA was used to treat ipsilateral acupuncture points (GV20-Baihui and ST7-Xiaguan). Golgi-Cox staining and transmission electron microscopy (TEM) were administrated to observe the changes of synaptic plasticity in the hippocampus CA1. Results Stable and persistent orofacial allodynia and anxiety-like behaviors induced by pT-ION were related to changes in hippocampal synaptic plasticity. Golgi stainings showed a decrease in the density of dendritic spines, especially mushroom-type dendritic spines, in hippocampal CA1 neurons of pT-ION mice. TEM results showed that the density of synapses, membrane thickness of the postsynaptic density, and length of the synaptic active zone were decreased, whereas the width of the synaptic cleft was increased in pT-ION mice. EA attenuated pT-ION-induced orofacial allodynia and anxiety-like behaviors and effectively reversed the abnormal changes in dendritic spines and synapse of the hippocampal CA1 region. Conclusion EA modulates synaptic plasticity of hippocampal CA1 neurons, thereby reducing abnormal orofacial pain and anxiety-like behavior. This provides evidence for a TN treatment strategy.
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Affiliation(s)
- Yu-Zhi Jia
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hai-Tao Li
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guang-Ming Zhang
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hong-Yun Wu
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Si-Shuo Zhang
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hong-Wei Zhi
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ya-Han Wang
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jing-Wen Zhu
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yi-Fan Wang
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiang-Qing Xu
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Cai-Jun Tian
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Wen-Qiang Cui
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Fayed ZY, Afify H. Long-term follow-up of microvascular decompression for management of trigeminal neuralgia. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00171-z] [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) is mostly caused by neurovascular compression of the trigeminal nerve and the root entry zone at the brain stem. Microvascular decompression (MVD) has been established as a standard treatment for trigeminal neuralgia in patients not adequately controlled by medications.
Objectives
Reporting the long-term outcome of MVD in our group of patients with follow-up period equal to or more than five years.
Patients and methods
Twenty-one patients operated by MVD for TN were followed up for at least five years, they were evaluated describing the patient criteria and operative findings, complications, and the long-term clinical outcome.
Results
Sixteen of the twenty-one patients had complete pain relief maintained for up to five years and three of them up to eight years. Two patients had significant improvement but with mild occasional pain not requiring medications only one of them had his occasional pain maintained till five years, three patients experienced persistent pain which was still there after five years one of them showed mild improvement in his pain after one year of follow-up. Complications were mild and/or transient most frequent were headache nausea and dizziness.
Conclusion
In the long-term follow-up, microvascular decompression still maintains its clinical benefit with most patients still pain free after at least five years and up to eight years. It is safe procedures and should be considered in every patient with failed medical treatment.
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Long term evaluation of a multidisciplinary trigeminal neuralgia service. J Headache Pain 2022; 23:114. [PMID: 36057552 PMCID: PMC9441024 DOI: 10.1186/s10194-022-01489-7] [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: 06/03/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Trigeminal neuralgia is an episodic severe neuralgic pain and can be managed both medically and surgically. If possible, this should be directed by a Multidisciplinary Team (MDT) of specialised surgeons, physicians, dentists, psychologists and specialist nurses with access to all treatment modalities, which enables patients to make an informed decision about their future management. Objective The aim of this study was to review the outcomes of patients managed by an MDT clinic, in a single institute over an eleven-year period. Methods A prospective database was used to identify patients with trigeminal neuralgia or its variants who had attended a joint MDT clinic. The electronic notes were examined for demographics, onset and duration of trigeminal neuralgia, medications history, pain scores and details of surgical procedures if any by two independent assessors. Results Three hundred thirty-four patients attended the MDT between 2008–2019. Forty-nine of them had surgery before being referred to the service and were included but analysed as a subgroup. Of the remaining patients, 54% opted to have surgery following the MDT either immediately or at a later date. At the last reported visit 55% of patients who opted to have surgery were pain free and off medications, compared to 15.5% of medically managed patients. Surgical complications were mostly attributable to numbness and in the majority of cases this was temporary. All patients who were not pain free, had complications after surgery or opted to remain on medical therapy were followed up in a facial pain clinic which has access to pain physicians, clinical nurse specialists and a tailored pain management program. Regular patient related outcome measures are collected to evaluate outcomes. Conclusion An MDT clinic offers an opportunity for shared decision making with patients deciding on their personal care pathway which is valued by patients. Not all patients opt for surgery, and some continue to attend a multidisciplinary follow up program. Providing a full range of services including psychological support, improves outcomes.
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Pinto MJ, Gomes A, Pinto M, Abreu P, Costa A. Treatment of acute exacerbations of trigeminal neuralgia in the emergency department: A retrospective case series. Headache 2022; 62:1002-1006. [DOI: 10.1111/head.14373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Maria João Pinto
- Department of Neurology Centro Hospitalar Universitário de São João Porto Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto Porto Portugal
| | - Alexandra Gomes
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto Porto Portugal
| | - Madalena Pinto
- Department of Neurology Centro Hospitalar Universitário de São João Porto Portugal
| | - Pedro Abreu
- Department of Neurology Centro Hospitalar Universitário de São João Porto Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto Porto Portugal
| | - Andreia Costa
- Department of Neurology Centro Hospitalar Universitário de São João Porto Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto Porto Portugal
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Schott Andersen AS, Maarbjerg S, Noory N, Heinskou TB, Forman JL, Cruccu G, Ashina M, Bendtsen L. Safety and efficacy of erenumab in patients with trigeminal neuralgia in Denmark: a double-blind, randomised, placebo-controlled, proof-of-concept study. Lancet Neurol 2022; 21:994-1003. [DOI: 10.1016/s1474-4422(22)00294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022]
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Du Y, Xu CL, Yu J, Liu K, Lin SD, Hu TT, Qu FH, Guo F, Lou GD, Nishibori M, Hu WW, Chen Z, Zhang SH. HMGB1 in the mPFC governs comorbid anxiety in neuropathic pain. J Headache Pain 2022; 23:102. [PMID: 35974316 PMCID: PMC9382735 DOI: 10.1186/s10194-022-01475-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/09/2022] [Indexed: 12/20/2022] Open
Abstract
Background Whether neuroinflammation causes comorbid mood disorders in neuropathic pain remains elusive. Here we investigated the role of high mobility group box 1 protein (HMGB1), a proinflammatory cytokine, in the medial prefrontal cortex (mPFC) in anxiety comorbidity of neuropathic pain. Methods Neuropathic pain was induced by partial transection of the infraorbital nerve (p-IONX) or partial sciatic nerve ligation (PSL) in mice and evaluated by measuring nociceptive thresholds to mechanical and heat stimulation. Anxiety-like behaviors were assessed by elevated plus maze, light dark box and open field tests. Aversive or anti-aversive effect was detected by conditioned place preference test. Neuronal activity was evaluated by single-unit and patch clamp recordings. The contribution of mPFC pyramidal neurons to anxiety was further examined by selectively inhibiting them by optogenetics. HMGB1 expression was measured by immunohistochemistry and western blotting. Antagonism of HMGB1 was achieved by injecting anti-HMGB1 monoclonal antibody (mAb) intracerebrally or intraperitoneally. Results Anxiety-like behaviors were presented earlier after p-IONX than after PSL. HMGB1 expression was upregulated in the mPFC temporally in parallel to anxiety onset, rather than in other regions associated with anxiety. The upregulation of HMGB1 expression and its translocation from the nucleus to cytoplasm in the mPFC occurred predominantly in neurons and were accompanied with activation of microglia and astrocytes. Infusion of anti-HMGB1 mAb into the mPFC during the early and late phases after either p-IONX or PSL alleviated anxiety-like behaviors and aversion without changing pain sensitization, while local infusion of exogenous ds-HMGB1, the proinflammatory form of HMGB1, into the mPFC induced anxiety and aversion but not pain sensitization in naïve mice. In addition to reversing established pain sensitization and anxiety simultaneously, intraperitoneal injection of anti-HMGB1 mAb reduced HMGB1 upregulation and suppressed the hyperexcitability of layer 2/3 pyramidal neurons in the mPFC after p-IONX. Moreover, optogenetic inhibition of mPFC pyramidal neurons alleviated anxiety in p-IONX mice. Conclusion These results demonstrate that HMGB1 in the mPFC drives and maintains anxiety comorbidity in neuropathic pain by increasing the excitability of layer 2/3 pyramidal neurons, and justify antagonism of HMGB1, e.g., neutralization by mAb, as a promising therapeutic strategy for neuropathic pain with anxiety comorbidity. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01475-z.
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Affiliation(s)
- Yu Du
- Department of Pharmacology and Department of Anesthesiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.,Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Ceng-Lin Xu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Jie Yu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Keyue Liu
- Department of Pharmacology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, 700-8558, Japan
| | - Shi-Da Lin
- Department of Pharmacology and Department of Anesthesiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Ting-Ting Hu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Feng-Hui Qu
- Department of Pharmacology and Department of Anesthesiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Fang Guo
- Department of Pharmacology and Department of Anesthesiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Guo-Dong Lou
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Masahiro Nishibori
- Department of Pharmacology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, 700-8558, Japan
| | - Wei-Wei Hu
- Department of Pharmacology and Department of Anesthesiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
| | - Zhong Chen
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
| | - Shi-Hong Zhang
- Department of Pharmacology and Department of Anesthesiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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Vasavda C, Xu R, Liew J, Kothari R, Dhindsa RS, Semenza ER, Paul BD, Green DP, Sabbagh MF, Shin JY, Yang W, Snowman AM, Albacarys LK, Moghekar A, Pardo-Villamizar CA, Luciano M, Huang J, Bettegowda C, Kwatra SG, Dong X, Lim M, Snyder SH. Identification of the NRF2 transcriptional network as a therapeutic target for trigeminal neuropathic pain. SCIENCE ADVANCES 2022; 8:eabo5633. [PMID: 35921423 PMCID: PMC9348805 DOI: 10.1126/sciadv.abo5633] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/16/2022] [Indexed: 05/28/2023]
Abstract
Trigeminal neuralgia, historically dubbed the "suicide disease," is an exceedingly painful neurologic condition characterized by sudden episodes of intense facial pain. Unfortunately, the only U.S. Food and Drug Administration (FDA)-approved medication for trigeminal neuralgia carries substantial side effects, with many patients requiring surgery. Here, we identify the NRF2 transcriptional network as a potential therapeutic target. We report that cerebrospinal fluid from patients with trigeminal neuralgia accumulates reactive oxygen species, several of which directly activate the pain-transducing channel TRPA1. Similar to our patient cohort, a mouse model of trigeminal neuropathic pain also exhibits notable oxidative stress. We discover that stimulating the NRF2 antioxidant transcriptional network is as analgesic as inhibiting TRPA1, in part by reversing the underlying oxidative stress. Using a transcriptome-guided drug discovery strategy, we identify two NRF2 network modulators as potential treatments. One of these candidates, exemestane, is already FDA-approved and may thus be a promising alternative treatment for trigeminal neuropathic pain.
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Affiliation(s)
- Chirag Vasavda
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason Liew
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruchita Kothari
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan S. Dhindsa
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX, USA
| | - Evan R. Semenza
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bindu D. Paul
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dustin P. Green
- Department of Neuroscience, Cell Biology, and Anatomy, University of Texas Medical Branch, Galveston, TX, USA
| | - Mark F. Sabbagh
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Y. Shin
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adele M. Snowman
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren K. Albacarys
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Mark Luciano
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xinzhong Dong
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Solomon H. Snyder
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Xiong F, Zhang T, Wang Q, Li C, Geng X, Wei Q, Yuan Z, Li Z. Xper-CT combined with laser-assisted navigation radiofrequency thermocoagulation in the treatment of trigeminal neuralgia. Front Neurol 2022; 13:930902. [PMID: 35983433 PMCID: PMC9378955 DOI: 10.3389/fneur.2022.930902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Our objective was to study the clinical feasibility of Xper-CT combined with laser-assisted radiofrequency thermocoagulation in the treatment of trigeminal neuralgia. Materials and methods A retrospective analysis was made of 60 patients with trigeminal neuralgia who visited the Affiliated Hospital of Binzhou Medical University from January 2019 to May 2021. According to the different surgical methods, we were divided into C-arm X-ray group and laser navigation group. The operation time, operative complications, post-operative 24 h, post-operative 3 and 6 months Barrow Neurotics Institute (BNI) score were recorded and compared. Results Compared with the C-arm X-ray-guided puncture group, Xper-CT combined with laser-assisted navigation has the obvious advantages of shorter total puncture time, shorter surgical time, higher success rate of first puncture, and better surgical effect. Conclusion Radiofrequency therapy of trigeminal neuralgia with Xper-CT combined with laser-assisted navigation has a good clinical effect and can be promoted and applied.
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Lovette BC, Bannon SM, Spyropoulos DC, Vranceanu AM, Greenberg J. “I Still Suffer Every Second of Every Day”: A Qualitative Analysis of the Challenges of Living with Chronic Orofacial Pain. J Pain Res 2022; 15:2139-2148. [PMID: 35935679 PMCID: PMC9346146 DOI: 10.2147/jpr.s372469] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Chronic orofacial pain is prevalent and debilitating. Psychological and social factors place a heavy burden on this population but are often overlooked. Here, we offer the first comprehensive qualitative conceptualization of the challenges of living with chronic orofacial pain through a biopsychosocial perspective to inform multifaceted care for this population. Design We employed a qualitative thematic analysis of open text responses using a hybrid inductive-deductive approach and a biopsychosocial framework. Methods Two hundred and sixty participants with chronic orofacial pain responded to an open-ended question: “What is the biggest challenge you face in managing your condition?” by typing their responses into a text box as part of an online survey. We mapped responses onto biomedical, psychological, and social themes (deductive) and concurrently identified findings within each theme that emerged directly from the data (inductive). Results Subthemes within the biomedical theme included challenges with biomedical pain management, medication side effects, sensory triggers, physical symptoms of stress/tension, and biological functions and related activities of daily living. Subthemes within the psychological theme included anxiety, depression, emotional symptoms of stress, unpredictability/uncertainty of pain, and psychological and cognitive aspects of medication management. Subthemes within the social theme included social relational, experience with providers, socioeconomics and access to care, and roles and responsibilities. Conclusion Chronic orofacial pain is associated with multifaceted challenges. Consideration of individuals’ experiences of biomedical, psychological, and social challenges in the assessment, referral, and treatment of chronic orofacial pain holds the potential to promote more comprehensive, patient-centered care for this population.
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Affiliation(s)
- Brenda C Lovette
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah M Bannon
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Correspondence: Jonathan Greenberg, Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA, Email
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