Hypothalamic stimulation for trigeminal neuralgia in multiple sclerosis patients: Efficacy on the paroxysmal ophthalmic pain

R. Cordella, A. Franzini, L. La Mantia, C. Marras, A. Erbetta, G. Broggi

Research output: Contribution to journalArticle

Abstract

Trigeminal neuralgia is a disorder characterized by paroxysmal pain arising in one or more trigeminal branches; it is commonly reported in multiple sclerosis. In multiple sclerosis patients the ophthalmic branch may be frequently involved and the risks carried by neurosurgical ablative procedures are higher including major adverse effects such as corneal reflex impairment and keratitis. The objective of this works is to assess the role of posterior hypothalamus neuromodulation in the treatment of trigeminal neuralgia in multiple sclerosis patients. Five multiple sclerosis patients suffering from refractory recurrent trigeminal neuralgia involving all three trigeminal branches underwent deep brain stimulation of the posterior hypothalamus. The rationale of this intervention emerges from our earlier success in treating pain patients suffering from trigeminal autonomic cephalalgias. After follow-up periods that ranged from 1 to 4 years after treatment, the paroxysmal pain arising from the first trigeminal branch was controlled, whereas the recurrence of pain in the second and third trigeminal branches necessitated repeated thermorhizotomies to control in pain in two patients after 2 years of follow-up. In conclusion, deep brain stimulation may be considered as an adjunctive procedure for treating refractory paroxysmal pain within the first trigeminal division so as to avoid the complication of corneal reflex impairment that is known to follow ablative procedures.

Original languageEnglish
Pages (from-to)1322-1328
Number of pages7
JournalMultiple Sclerosis Journal
Volume15
Issue number11
DOIs
Publication statusPublished - 2009

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Keywords

  • Deep brain stimulation
  • Multiple sclerosis
  • Pain
  • Posterior hypothalamus
  • Trigeminal neuralgia

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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