BACKGROUND:
My wife, age 60, has active TN on the right side of her face. Classified at STN as she has Multiple Sclerosis (MS) that started over 35 years ago.

TN started in 1988 on the left side, long story made short, in 1994 she had successful surgery to severe 2/3 of her TN nerve on the left side. Surgery followed 6 years of increasing Tegretol etc., multiple peripheral nerve sections, one successful glycerol injection (10 mos relief) and one failed/disaster glycerol injection. Major surgery/nerve section followed multiple episodes of passing out from excruciating prolonged attacks. MVD is NOT an option with MS.

2004 tics started on RIGHT side. Similar lightning bolts as on the left but not excruciating. Tics controlled with Carbatrol + Gabapentin (Neurontin) app. 8 months. Late 2004 she was able to stop the meds with no pain. October 2006, the pain returned and controlled with 400 MG Carbatrol until Oct. 2010. Starting last Oct. meds increased multiple times as the pain broke-through. Currently taking 600 MG Carbatrol + 900 MG Neurontin. Tics stopped about 3 days ago. NOTE: Neurologist believes UTIs (urinary tract infections) may be exacerbating the TICS. Completed latest round of antibiotics yesterday. Neuro is with Jacobs Institute of Neurology in Buffalo NY - highly respected in the treatment of MS.

NOTE that her neuro and primary drs would prefer more Neurontin with less Carbatrol as the Carbatrol may be the cause of her low blood serum sodium levels. She is still adjusting to the increased meds with significant fatigue...........

Surgical Options:
With increased frequency of break-throughs, increased meds/side-effects and increased fear, it's time to consider surgical options.

One local (Buffalo NY) neurosurgeon in 2008 recommended balloon compression as his first choice, gama if the balloon failed, and last option partially cutting the nerve. As of 2008, he had performed app. 40-50 balloon compressions.

Based on my research it appears Balloon Compression is strong option. I'm NOT excited about the gama option. If successful, balloon compression might last a max of 5 years when associated with MS.

Partially cutting TN nerve root near brain stem (done in '94 left side) - need to weight potential benefits/risks. In addition to typical risks of brain surgery, AD seems to be the greatest concern. Does anyone has statistics on the risk of serve AD from such surgery?

MAJOR QUESTION - is nerve section surgery inevitable considering balloon compression is temporary and likelihood of TN continuing to progress? If so, why not do it now?

SURGEON RECOMMENDATIONS???
Any recommendation of neurosurgeons with successful experience treating TN in patients with MS.

Surgeon who performed 1994 surgery is in Wash. DC where we previously lived. I believe he is still practicing; however, he is NOT really a TN/MS guru. At least not recognized as such.

Sorry for the long post. Maybe I should break it into multiple topics?

Please don't shoot me for a duplicate post. I also posted this thread under Trigeminal Neuralgia; however, after 150 views, there have been NO replies/comments.