Journal article
Impact of Multiple Sclerosis Subtypes on Pain Management in Patients With Trigeminal Neuralgia After Stereotactic Radiosurgery: An International Multicenter Analysis
Neurosurgery, v 94(4), pp 838-846
01 Apr 2024
PMID: 38051068
Abstract
BACKGROUND AND OBJECTIVES: Trigeminal neuralgia affects approximately 2% of patients with multiple sclerosis (MS) and often shows higher rates of pain recurrence after treatment. Previous studies on the effectiveness of stereotactic radiosurgery (SRS) for trigeminal neuralgia did not consider the different MS subtypes, including remitting relapsing (RRMS), primary progressive (PPMS), and secondary progressive (SPMS). Our objective was to investigate how MS subtypes are related to pain control (PC) rates after SRS. METHODS: We conducted a retrospective multicenter analysis of prospectively collected databases. Pain status was assessed using the Barrow National Institute Pain Intensity Scales. Time to recurrence was estimated through the Kaplan-Meier method and compared groups using log-rank tests. Logistic regression was used to calculate the odds ratio (OR). RESULTS: Two hundred and fifty-eight patients, 135 (52.4%) RRMS, 30 (11.6%) PPMS, and 93 (36%) SPMS, were included from 14 institutions. In total, 84.6% of patients achieved initial pain relief, with a median time of 1 month; 78.7% had some degree of pain recurrence with a median time of 10.2 months for RRMS, 8 months for PPMS, 8.1 months for SPMS (P = .424). Achieving Barrow National Institute-I after SRS was a predictor for longer periods without recurrence (P = .028). Analyzing PC at the last available follow-up and comparing with RRMS, PPMS was less likely to have PC (OR = 0.389; 95% CI 0.153-0.986; P = .047) and SPMS was more likely (OR = 2.0; 95% CI 0.967-4.136; P = .062). A subgroup of 149 patients did not have other procedures apart from SRS. The median times to recurrence in this group were 11.1, 9.8, and 19.6 months for RRMS, PPMS, and SPMS, respectively (log-rank, P = .045). CONCLUSION: This study is the first to investigate the relationship between MS subtypes and PC after SRS, and our results provide preliminary evidence that subtypes may influence pain outcomes, with PPMS posing the greatest challenge to pain management.
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Details
- Title
- Impact of Multiple Sclerosis Subtypes on Pain Management in Patients With Trigeminal Neuralgia After Stereotactic Radiosurgery: An International Multicenter Analysis
- Creators
- Fernando De Nigris Vasconcellos - NYU, Dept Neurol Surg, NYU Langone Hlth, New York, NY 10016 USAElad Mashiach - New York UniversityJuan Diego Alzate - New York UniversityKenneth Bernstein - NYU Langone HealthLauren Rotman - New York UniversitySarah Levy - Mount Sinai HospitalTanxia Qu - NYU Langone HealthRodney E. Wegner - Allegheny Health NetworkMatthew J. Shepard - Allegheny Health NetworkSamir Patel - University of AlbertaRonald E. Warnick - Jewish HospitalNuria Martinez Moreno - Hospital Ruber InternacionalRoberto Martinez Alvarez - Hospital Ruber InternacionalPiero Picozzi - IRCCS Humanitas Research HospitalAndrea Franzini - IRCCS Humanitas Research HospitalSelcuk Peker - Koç UniversityYavuz Samanci - Koç UniversityAhmed N. Elguindy - The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteJoshua D. Palmer - The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteL. Dade Lunsford - Neurological SurgeryShalini G. Jose - Neurological SurgeryZhishuo Wei - Neurological SurgeryAjay Niranjan - Neurological SurgerySarra Blagui - Université de SherbrookeChristian Iorio-Morin - Université de SherbrookeDavid Mathieu - Université de SherbrookeRobert G. Briggs - University of Southern CaliforniaCheng Yu - University of Southern CaliforniaGabriel Zada - University of Southern CaliforniaSamantha Dayawansa - University of AmsterdamJason Sheehan - Urology of VirginiaMichael Schulder - North Shore University HospitalAnuj Goenka - North Shore University HospitalSabrina Begley - North Shore University HospitalHamza Khilji - SUNY Downstate Health Sciences UniversityDusan Urgosik - Na Homolce HospitalRoman Liscak - Na Homolce HospitalDouglas Kondziolka - Neurological Surgery
- Publication Details
- Neurosurgery, v 94(4), pp 838-846
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology
- Web of Science ID
- WOS:001234183400012
- Scopus ID
- 2-s2.0-85188202292
- Other Identifier
- 991022155293304721