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How is trigeminal neuralgia in multiple sclerosis (MS) treated?

Pharmacologic treatment for trigeminal neuralgia (TN; also called tic douloureux), a multiple sclerosis (MS) symptom which causes severe shock-like or burning facial pain, includes oral medications such as gabapentin (Neurontin), carbamazepine (Tegretol), phenytoin (Dilantin), and baclofen (Lioresal). If TN is unresponsive to these medications, a non-invasive procedure called gamma knife radiation allows intense doses of radiation to treat the targeted area while largely sparing surrounding tissues. Another option is percutaneous rhizotomy, a surgical procedure that severs the trigeminal sensory nerve.
Multiple sclerosis is a demyelinating disease. By definition, the insulation on the nerve fibers is degraded in multiple sclerosis. It’s an autoimmune disease, so the body attacks the myelin, which is the insulating material for nerve fibers. The nerve fibers become exposed, they cross-circuit, and one can get the pain just as one does with trigeminal neuralgia, where the factor that eliminates the appropriate insulation is the pressure from the pulsating of an artery directly next to the nerve.

Obviously, microvascular decompression is not going to have any effect on multiple sclerosis, because the problem is not pressure. It’s a disease of the insulation of nerve fibers. Trigeminal neuralgia with multiple sclerosis can be problematic. Multiple sclerosis sometimes resolves on its own, temporarily or permanently. Tidling a person over with appropriate pain relief, trying the standard kinds of trigeminal neuralgia medications, is something that can be done in a patient with multiple sclerosis. If the damage to the nerve is permanent, then there is some hope that stereotactic radiosurgery may have an effect on the nerve and may provide some relief in trigeminal neuralgia due to multiple sclerosis. This is a more difficult problem because it’s an intrinsic disorder of the nerve and the nerve fibers and the insulation of the nerve fibers rather than some sort of extrinsic pressure that one can remove surgically.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.