Robert A. Mericle, M.D.
Department of Neurological Surgery
Vanderbilt University Medical Center
B-1053 Preston Research Bldg.
Nashville, TN 37232-5345
615-322-7417
http://www.mc.vanderbilt.edu/surgery/neurosrg/Staff/Mericle/mericlebio.htm
Transcript: Multiple Sclerosis and trigeminal neuralgia
What about patients that have Multiple Sclerosis? Multiple Sclerosis is one of the causes of trigeminal neuralgia in my experience. And Multiple Sclerosis can cause trigeminal neuralgia by forming a plaque on the trigeminal nerve at it’s weak spot in the myelin. And the reason why I think patients with Multiple Sclerosis are unique is because there’s not a blood vessel pushing on the nerve. So if you go in to do the surgery, to do a microvascular decompression, you generally won’t find a blood vessel pushing on the nerve there because it was a myelin plaque that was pushing on the nerve. Now of course it’s always possible to have both, to have Multiple Sclerosis and a blood vessel pushing on the nerve, and it could be the blood vessel pushing on the nerve that’s causing the pain but generally if somebody has Multiple Sclerosis I think it’s safest and best to assume that it’s the Multiple Sclerosis causing the trigeminal neuralgia. Generally the best treatment for that is a percutaneous which means through the skin with no incision, radiofrequency lesion or RFL, some people call it a PSR. And that procedure is very effective for patients with Multiple Sclerosis. You do sometimes have to repeat it over the years if the pain returns but it’s a very effective with Multiple Sclerosis. Another option for that is Radiosurgery such as Gamma Knife or computerized photon eye for that sort of thing and we also offer that option at my institution but it’s generally not the first choice for patients because it takes a lot longer for it to become effective. Sometimes you know a month or two or sometimes three months before the pain goes away and the RFL procedure, the pain goes away immediately. And also in my experience the Radiosurgery procedures are probably more likely to cause anesthesia dolorosa which we had talked about previously.