Hello, I have Multiple Sclerosis. But I also have a history of recurrent sinus infections. I have had TN on the left side of my face for close to four years. Today, I am having very similar pain in an area I know could be my trigeminal nerve- though on the right side. I don't know which doctor to see: my GP or my neurologist. Any thoughts?
An increased incidence of TN was reported more than one hundred years ago and reconfirmed since. The following article from the Mayo Clinic in Rochester, Minnesota that could be accessed online or in the nearest medical library by your doctor speaks to this association and the outcomes of surgery: Neurosurgery Issue: Volume 71(3), September 2012, p 581–586
Outcomes After Percutaneous Surgery for Patients With Multiple Sclerosis-Related Trigeminal Neuralgia Mallory, Grant W. MD*; Atkinson, John L. MD*; Stien, Kathy J. RN*; Keegan, B. Mark MD‡; Pollock, Bruce E. MD*,§
CONCLUSION: Percutaneous surgery for patients with MS-TN is less likely to provide pain relief than similar operations performed for patients with idiopathic TN. New trigeminal deficits did not correlate with better facial pain outcomes, supporting the concept that many patients with MS-TN have centrally mediated pain.
ABBREVIATIONS: BMC, balloon microcompression
MS, multiple sclerosis
MS-TN, multiple sclerosis-related trigeminal neuralgia
PRGR, percutaneous glycerol rhizotomy
RFL, radiofrequency ablation
TN, trigeminal neuralgia
An association between trigeminal neuralgia (TN) and multiple sclerosis (MS) was first appreciated on autopsy by Oppenheim in 1894.1 Subsequent studies have shown that approximately 1% to 2% of MS patients will develop TN.2,3 In patients with MS-related TN (MS-TN), pain is often bilateral and starts at a younger age compared with patients with idiopathic TN. Medical therapy effectively relieves the pain in many patients. However, not all patients with MS-TN achieve pain relief with medications alone, and surgical treatment is often necessary. For patients with MS-TN, the optimal surgical management is not well defined. Microvascular decompression is generally not recommended because MS-TN pain is thought to result from an inflammatory process causing demyelination along the proximal nerve and within the pons rather than vascular compression.4,5 However, some patients with MS and TN are shown to have a neurovascular compression and may benefit from microvascular decompression.6,7 Percutaneous operations such as radiofrequency rhizotomy (RFL), glycerol rhizotomy (PRGR), and balloon microcompression (BMC) are the most commonly performed procedures for patients with medically refractory MS-TN. They have become the first-line surgical approach for patients with MS-TN because they are minimally invasive and can be repeated if pain recurs. Although technically different, these operations share the common goal of damaging the retrogasserian trigeminal fibers to provide pain relief with an acceptable degree of facial numbness. Stereotactic radiosurgery has been used for patients with MS-TN,8 but the results to date appear poor compared with results in patients with idiopathic TN, and there are concerns that radiation exposure may trigger a demyelinating episode.9
I suggest that you see your Neurologist, who can bring his/her experience with TN to bear on your current situation
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