The Effect of Microvascular Decompression in Patients With Multiple Sclerosis and TN
 

This is surprising with the Canadian MS Society's usual stance.

The Effect of Microvascular Decompression in Patients With Multiple Sclerosis and Trigeminal Neuralgia

Medical Update Memo
August 5, 2010

Summary
Trigeminal neuralgia (TN) in patients with multiple sclerosis (MS) is thought to be caused by demyelinating plaques within the nerve root entry zone, the trigeminal nucleus, or the trigeminal tracts.

Authors review their experience of microvascular decompression (MVD) in patients with MS and symptomatic TN. Sandell T, Eide PK., Neurosurgery. 2010 Jul 21. [Epub ahead of print]

http://www.ncbi.nlm.nih.gov/pubmed/20651626

Details
All first-time MVDs for symptomatic trigeminal neuralgia in patients with MS performed by the senior author during an 8-year period (1999-2007) in this department were reviewed.

The preoperative pain components were differentiated as being 100% episodic pain, > 50% episodic pain, or > 50% constant pain. At follow-up, pain relief was assessed with a standard mail questionnaire; those still having residual pain were further examined in the outpatient clinic or interviewed by phone.

Of the 19 MS patients, 15 were available for follow-up. The median observation period was 55 months (range, 17-99 months). At follow-up, 7 of 15 patients (47%) were completely free of their episodic pain, and an additional 4 (27%) had significant relief of episodic pain (ie, worst pain marked as 0 to 3 cm on a 10-cm visual analog scale).

Among the subgroup of 8 patients with a constant pain component, all were free of their constant pain, and 4 (50%) were free of their episodic pain.

CONCLUSION:
In an 8-year experience of doing MVD in MS patients with TN, authors found complete and significant relief of episodic TN in a large proportion of patients.
Even those with a constant pain component before MVD were completely relieved of their constant pain. Thus, in patients with TN (with or without a constant pain component), the presence of MS should not prevent patients from being offered MVD

My note: This is like CCSVI neck clearing of the jugular veins. Then no more T.N.

Is this an older procedure or something new? A friend of mine has severe MS and severe TN at times. I know she had surgery many years ago for the TN and it worked to help her but the effects of the surgery wore off. I wonder if it was this or something different?

19 patients, sounds like an extremely early study. May not mean much, but then it might.

Good news, Lady. Thanks..:)

I have both MS & TN, had MVD done May 09. MVD stopped the stabbing pain, still have incredible pain, though. Seems to be getting worse.

I am sorry to hear that you still have pain. Have you though of getting the laser Cyberknife treatment by a Neurosurgeon? Cut the nerve bloodlessly.

I have MS and TN as well (TN probably was my 'onset' symptom, it was actually diagnosed long before the MS was, confirmed by various docs since).

My medications seem to keep it mostly in check, and I know my main triggers, but I still occasionally get the 'take my breath away' ice pick stabbing, shooting pain throbbing in my head/face (left side mostly, but I've had it occur bi-laterally).

Going under the knife for it, I probably wouldn't myself, but that's just my own personal experience with it. I know how to 'calm' the beast for me now, and that includes therapeutic hot bathtub soaks (I know, hot bath, MS nightmare, actually helps my TN big time!).

Thanks for the info Lady! :hug:

"Microvascular" sounds familiar to me. I have another painful condition caused in some
way by microvascular problems, in my toes and forefeet. Because I have Polycythema Vera, I have thick blood, i.e. high red cells and platelets, which must clog the little vessels in my toes. The result, a painful condition called Erythromelalgia, with stabbing pain, burning pain and numbness. The numbness contributed to my fall in May, which broke my kneecap, which I have been recovering from for several months, now in an
Assisted Living for a month more. Now walking without a cane a little bit.

Since I also have MS and Porphyria dxs, I am used to having neuropathic problems, but never realized that they could be caused by vascular problems. This has become more familiar to me since my PV dx 5 years or so. I may need to take Interferon to lower the
counts.

The idea that neuropathy can be caused by vascular problems is now VERY familiar.

For years, I have taken a small amount of niacin (non flush) to control the paresthesias
in my temples and the fogginess in the eyes, which come on if I do not have niacin.

I don't know if niacin helps the erythromelalgia in my toes (numbness, pain). Not much,
it seems, but possibly this would be worse if I did not take the 250 mg of niacin a day.

I can't take the drugs which "control" neuropathy such as Lyrica. Sensitive to all of those.

I know of no means of operating on the microvascular structure in the toes--probably too small?

Mariel you could have CCSVI. Did you consider that? :)

Lady, I just googled this, and I can't tell from first reading if it would have anything to do with me. For one things, I don't think I have any occulusion of jugular veins. Mine are always
very clear. On the other hand, I had a PET scan many many years ago, one of the first, which showed low blood flow to the brain, within the brain, not in the vein leading up to it. I believe the PET scan was pre every dx, and no one dx'd anything from it except Chronic Fatigue, which
was about all anyone could come up with in those days for me....but soon afterwards the
eye problems brought an MS dx (blind spot, double vision, narrowed visual fields). I just don't know if I could have this.

What is more easily clear is that I have Polycythemia Vera, which can cause mini-strokes, and that could account for occasional dimming of eyes, which is helped by the niacin which opens the vessels. I am JAK2 Positive, so that is a definite dx, much easier to get than MS or Porphyria.