A systematic review of the management of trigeminal neuralgia in patients with multiple sclerosis.

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A systematic review of the management of trigeminal neuralgia in patients with multiple sclerosis.

World Neurosurg. 2017 Dec 30;:

Authors: Zakrzewska JM, Wu J, S-L Brathwaite T

Abstract
BACKGROUND AND OBJECTIVE: Patients with trigeminal neuralgia (TN) and multiple sclerosis (MS) are often treated with medications or a surgical procedure. However, there is little evidence that such treatments result in 50% pain reduction and improvement in quality of life. The aim of this systematic review is to evaluate the clinical effectiveness of treatments in patients with MS and trigeminal neuralgia DATABASES AND DATA TREATMENT: We searched Medline, EMBASE, and the Cochrane Collaboration database from inception until October 2016. Two authors independently selected studies for inclusions, data extraction and bias assessment.
RESULTS: All studies were of low quality using the GRADE system. For medical management, ten studies were included of which one was a randomised control trials. Two studies were on the use of misopropol, unique to patients with MS. For surgical therapy, 26 studies with at least 10 patients and a minimum of two-year follow-up were included. All types of surgical procedures are reported and the results are poorer than for TN without MS with 50% having a recurrence by two years. The main complications were sensory loss. Many patients had to undergo further procedures to become pain free and there were no agreed prognostic factors.
CONCLUSIONS: There was insufficient evidence to support any one medical therapy and so earlier surgery may be preferable. A patient with TN and MS has therefore to make a decision based on low level evidence beginning with standard drug therapy and then choosing a surgical procedure.

PMID: 29294398 [PubMed - as supplied by publisher]

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