scholarly journals MVD for trigeminal neuralgia; neuralgia revisited with review of literature

2017 ◽  
Vol 3 (4) ◽  
pp. 849
Author(s):  
Renuka S. Melkundi ◽  
Sateesh Melkundi
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Age Of Onset ◽  
Demographic Data ◽  
Age Groups ◽  
Sudden Onset ◽  
Review Of Literature ◽  
Surgical Methods ◽  
Vascular Decompression

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Trigeminal neuralgia (TN) s an uncommon facial pain syndrome. It is commonly characterized by sudden onset of an attack of intense electric shock like facial pain localized along the sensory distribution of the ninth cranial nerve. Although many patients respond to the medical line of treatment but when PTS symptoms become intractable and could not tolerate the medications have to go for surgical decompression. Our study aims to review about micro vascular decompression for trigeminal neuralgia and its outcome along with the review of literature. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">It is a retrospective study conducted on 40 cases who were diagnosed with TN. between the period of July 2009 to July 2015. MVD has been performed on all the patients. Demographic data, clinical presentation, surgical findings, complications and long term follow-up were reviewed.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The median age of onset of TN is 50.4 years divided into five age groups ranging from 24 to 89 years with female preponderance showing 65.5% as compared to males. The distribution of location was in the ratio of right to left is 1.5:1. There was no mortality is seen in the study. 3 patients among them study population had complications 3 patients had facial hyposthesia, 1 patient had V3 paresis and 1 patient had CSF otorrhoea which got settled with drainage LP. All the patients had satisfactory improvement except one patient who had persistent pain. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">To conclude micro vascular decompression (MVD) is the surgical procedure of choice for the treatment of medically refractory TN who is fit for surgery. Of all the currently available surgical methods MVD provides the highest rate of long term satisfaction for the patients and offers the lowest rate of pain recurrence.</span></p>

Patterns of opioid use in patients with trigeminal neuralgia undergoing neurosurgery

2019 ◽  
Vol 131 (6) ◽  
pp. 1805-1811
Author(s):  
Andrew I. Yang ◽  
Brendan J. McShane ◽  
Frederick L. Hitti ◽  
Sukhmeet K. Sandhu ◽  
H. Isaac Chen ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Opioid Use ◽  
Exact Test ◽  
Fisher's Exact Test ◽  
Fisher’S Exact Test ◽  
Long Term Follow Up ◽  
Neurosurgical Intervention

OBJECTIVEFirst-line treatment for trigeminal neuralgia (TN) is pharmacological management using antiepileptic drugs (AEDs), e.g., carbamazepine (CBZ) and oxcarbazepine (OCBZ). Surgical intervention has been shown to be an effective and durable treatment for TN that is refractory to medical therapy. Despite the lack of evidence for efficacy in patients with TN, the authors hypothesized that patients with neuropathic facial pain are prescribed opioids at high rates, and that neurosurgical intervention may lead to a reduction in opioid use.METHODSThis is a retrospective study of patients with facial pain seen by a single neurosurgeon. All patients completed a survey on pain medications, medical comorbidities, prior interventions for facial pain, and a validated pain outcome tool (the Penn Facial Pain Scale). Patients subsequently undergoing neurosurgical intervention completed a survey at the 1-month follow-up in the office, in addition to telephone interviews using a standardized script between 1 and 6 years after intervention. Univariate and multivariate logistic regression were used to predict opioid use.RESULTSThe study cohort consisted of 309 patients (70% Burchiel type 1 TN [TN1], 18% Burchiel type 2 [TN2], 6% atypical facial pain [AFP], and 6% TN secondary to multiple sclerosis [TN-MS]). At initial presentation, 20% of patients were taking opioids. Of these patients, 55% were receiving concurrent opioid therapy with CBZ/OCBZ, and 84% were receiving concurrent therapy with at least one type of AED. Facial pain diagnosis (for diagnoses other than TN1, odds ratio [OR] 2.5, p = 0.01) and facial pain intensity at its worst (for each unit increase, OR 1.4, p = 0.005) were predictors of opioid use at baseline. Neurosurgical intervention led to a reduction in opioid use to 8% at long-term follow-up (p < 0.01, Fisher’s exact test; n = 154). Diagnosis (for diagnoses other than TN1, OR 4.7, p = 0.002) and postintervention reduction in pain at its worst (for each unit reduction, OR 0.8, p < 10−3) were predictors of opioid use at long-term follow-up. On subgroup analysis, patients with TN1 demonstrated a decrease in opioid use to 5% at long-term follow-up (p < 0.05, Fisher’s exact test), whereas patients with non-TN1 facial pain did not. In the nonsurgical group, there was no statistically significant decrease in opioid use at long-term follow-up (n = 81).CONCLUSIONSIn spite of its high potential for abuse, opioid use, mostly as an adjunct to AEDs, is prevalent in patients with facial pain. Opportunities to curb opioid use in TN1 include earlier neurosurgical intervention.

Trigeminal neuralgia associated with seizure and syncope

1984 ◽  
Vol 61 (3) ◽  
pp. 594-595 ◽  
Author(s):  
Wishwa N. Kapoor ◽  
Peter J. Jannetta
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Mechanical Stimulation ◽  
Microvascular Decompression ◽  
Facial Pain ◽  
Loss Of Consciousness ◽  
Content Type ◽  
Vascular Decompression ◽  
Fine Print ◽  
Stimulation Of

✓ A patient with trigeminal neuralgia experienced a generalized seizure and a prolonged syncopal episode. He was found to be asystolic during the syncopal episode. There was no recurrence of loss of consciousness after implantation of a pacemaker. Mechanical stimulation of the trigeminal nerve during craniotomy for microvascular decompression of the trigeminal nerve resulted in bradycardia. Since vascular decompression of the trigeminal nerve, there has been no recurrent facial pain, and no further syncope, seizures, or bradycardia. Syncope and seizures have not been previously reported in association with trigeminal neuralgia, although they are well described with glossopharyngeal neuralgia.

Abstract 16930: Despite Prior Results, Heart Transplant Recipients Over 70 Have Worse Survival Outcomes Based on the 2019 United Network for Organ Sharing Database

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jay Kanaparthi ◽  
Mohammed Kashem ◽  
Manish Suryapalam ◽  
Yoshiya Toyoda
Keyword(s):  
Demographic Data ◽  
Age Groups ◽  
Survival Outcomes ◽  
Ischemic Time ◽  
Kaplan Meier ◽  
Before And After ◽  
Chi Squared ◽  
Time Frames ◽  
United Network

Introduction: As the prevalence of heart failure increases by age, it is critical we understand the role of heart transplantation (HTx) in older patients. Recent long term studies have indicated no difference in HTx outcomes between recipients 70 years or older and those ages 60-69. But these studies included data from the 1980-90s, introducing significant variance due poorer outcomes across age groups in that era. We analyzed the most recent United Network for Organ Sharing (UNOS) database, stratified by time frames before and after 2000, to demonstrate this statistical discrepancy and derive a more representative comparison of modern survival by age group. Hypothesis: HTx recipients 70+ years old may not actually have comparable survival to those 60-69 years of age, when assessing more recent HTx data. Methods: All UNOS HTx recipients over 60 years of age (n=20,446) were divided into 2 cohorts: those 60-69 and those ≥70 years old, which were analyzed over two time frames: transplant date 1987-1999 and 2000-2019. Demographic data (gender, ethnicity, BMI) as well as peri-operative factors (ICU stay, ischemic time, and length of stay) were evaluated for significance using Chi-Squared and H-Tests as appropriate. Kaplan-Meier Curve with log-rank tests were used to assess 10 year survival outcomes. Results: 19,129 patients were 60-69 years old, and 1,317 were ≥70 years old, with mean ages of 64.0±2.7 and 71.3±1.6 years respectively. The distribution of demographic and peri-operative factors was significantly different between the cohorts, with p<0.05 for values. Survival analysis indicated no significance in the earlier timeframe (1987-1999) with p=0.341, but indicated significance in the later timeframe (2000-2019), with p=0.004. Conclusion: The results indicate that since 2000, recipients 60-69 years of age have better 10- year post transplant survival than older recipients, a relationship previously obscured by worse outcomes in early data.

scholarly journals Long-Term Retrospective Analysis of Microvascular Decompression in Patients With Recurrent Trigeminal Neuralgia

2020 ◽  
Vol 11 ◽  
Author(s):  
Jiayu Liu ◽  
Guangyong Wu ◽  
Hui Xiang ◽  
Ruen Liu ◽  
Fang Li ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Free Survival ◽  
Recurrent Group ◽  
Kaplan Meier ◽  
Vertebrobasilar Artery ◽  
Surgical Methods ◽  
First Onset

Objective: To explore the clinical characteristics of patients with recurrent trigeminal neuralgia (TN) and the experience of microvascular decompression (MVD) in the treatment of such patients.Methods: We retrospectively analyzed clinical data, imaging examination results, surgical methods, and treatment efficacies in 127 patients with recurrent typical TN from January 2005 to December 2014.Results: The age of the recurrent group was higher than that of the non-recurrent group (p &lt; 0.05). The duration of pain before the first MVD procedure was longer in the recurrent group than in the non-recurrent group (p &lt; 0.05). Patients in the recurrent group were more likely to have compression of the trigeminal nerve by the vertebrobasilar artery (VBA) or multiple vessels than patients in the non-recurrent group (p &lt; 0.05). A Kaplan–Meier curve showed a median pain-free survival of 12 months after the first MVD procedure. The severity of pain (preoperative visual analog scale [VAS] score) in patients with recurrence was lower than that in patients with first-onset TN (p &lt; 0.05). Vessel compression, Teflon compression or granuloma and arachnoid adhesion were considered the main causes of recurrence. Postoperative Barrow Neurological Institute (BNI) scores in the redo MVD group were excellent (T = 2) for 69 patients (53.33%) and good (T = 3) for 46 patients (36.22%). The postoperative follow-up was 63–167 months (105.92 ± 25.66). During the follow-up, no recurrence was noted. All complications were cured or improved.Conclusions: Microvascular decompression (MVD) is an effective surgical method for the treatment of TN. For recurrent patients, reoperation can achieve good results.

scholarly journals Radiosurgery for multiple sclerosis–related trigeminal neuralgia: retrospective review of long-term outcomes

2019 ◽  
Vol 131 (5) ◽  
pp. 1583-1590 ◽  
Author(s):  
Colin J. Przybylowski ◽  
Tyler S. Cole ◽  
Jacob F. Baranoski ◽  
Andrew S. Little ◽  
Kris A. Smith ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Retrospective Review ◽  
Pain Control ◽  
Facial Pain ◽  
Salvage Treatment ◽  
Long Term Outcomes ◽  
Facial Numbness

OBJECTIVEThe objective of this study was to assess long-term outcomes of facial pain and numbness after radiosurgery for multiple sclerosis (MS)–related trigeminal neuralgia (MS-TN).METHODSThe authors conducted a retrospective review of their Gamma Knife radiosurgeries (GKRSs) to identify all patients treated for MS-TN (1998–2014) with at least 3 years of follow-up. Treatment and clinical data were obtained via chart review and mailed or telephone surveys. Pain control was defined as a facial pain score of I–IIIb on the Barrow Neurological Institute (BNI) Facial Pain Intensity Scale. Kaplan-Meier analysis was performed to determine the rates of pain control after index and first salvage GKRS procedures. Patients could have had more than 1 salvage procedure. Pain control rates were based on the number of patients at risk during follow-up.RESULTSOf the 50 living patients who underwent GKRS, 42 responded to surveys (31 women [74%], median age 59 years, range 32–76 years). During the initial GKRS, the trigeminal nerve root entry zone was targeted with a single isocenter, using a 4-mm collimator with the 90% isodose line completely covering the trigeminal nerve and the 50% isodose line abutting the surface of the brainstem. The median maximum radiation dose was 85 Gy (range 50–85 Gy). The median follow-up period was 78 months (range 36–226 months). The rate of pain control after the index GKRS (n = 42) was 62%, 29%, 22%, and 13% at 1, 3, 5, and 7 years, respectively. Twenty-eight patients (67%) underwent salvage treatment, including 25 (60%) whose first salvage treatment was GKRS. The rate of pain control after the first salvage GKRS (n = 25) was 84%, 50%, 44%, and 17% at 1, 3, 5, and 7 years, respectively. The rate of pain control after the index GKRS with or without 1 salvage GKRS (n = 33) was 92%, 72%, 52%, 46%, and 17% at 1, 3, 5, 7, and 10 years, respectively. At last follow-up, 9 (21%) of the 42 patients had BNI grade I facial pain, 35 (83%) had achieved pain control, and 4 (10%) had BNI grade IV facial numbness (very bothersome in daily life).CONCLUSIONSIndex GKRS offers good short-term pain control for MS-TN, but long-term pain control is uncommon. If the index GKRS fails, salvage GKRS appears to offer beneficial pain control with low rates of bothersome facial numbness.

Cluster headache: Is age of onset important for clinical presentation?

Cephalalgia ◽  
2014 ◽  
Vol 34 (9) ◽  
pp. 664-670 ◽  
Author(s):  
Jasna Zidverc-Trajkovic ◽  
Kristina Markovic ◽  
Aleksandra Radojicic ◽  
Ana Podgorac ◽  
Nadezda Sternic
Keyword(s):  
Cluster Headache ◽  
Age Of Onset ◽  
Late Onset ◽  
Nasal Congestion ◽  
Demographic Data ◽  
Correct Diagnosis ◽  
Diagnostic Delay ◽  
Age Groups ◽  
Point Of View ◽  
Cross Sectional

Background The age of onset of cluster headache (CH) attacks most commonly is between 20 and 40 years old, although CH has been reported in all age groups. There is increasing evidence of CH with early or late onset and a different course of the disorder. The aim of the study was to analyze the influence of the age of onset on clinical features, disorder course, and therapy effectiveness in CH patients. Methods A retrospective and cross-sectional analysis was performed on 182 CH patients divided into three groups according to the age of onset. The first group consisted of patients with the first CH attack before 20 years of age, the second group was patients with age of onset between 20 and 40 years of age, and the third group was patients with age of onset after 40 years of age. Demographic data, features of CH periods and attacks, and the response to standardized treatment were compared among the groups. Results Patients with CH onset after 40 years of age reported a lower number of autonomic features and less frequently had conjunctival injection and nasal congestion/rhinorrhea phenomena during their attacks. Diagnostic delay was the longest in the patients with CH onset before 20 years of age. Conclusion The influence of the age of onset of CH is intriguing for further studies and could possibly extend the knowledge about CH pathophysiology. From a clinical point of view, the differences in CH presentation are insufficient to preclude a correct diagnosis and treatment because the same criteria could be applied regardless of patient age.

scholarly journals Persistent idiopathic facial pain – a prospective systematic study of clinical characteristics and neuroanatomical findings at 3.0 Tesla MRI

Cephalalgia ◽  
2016 ◽  
Vol 37 (13) ◽  
pp. 1231-1240 ◽  
Author(s):  
Stine Maarbjerg ◽  
Frauke Wolfram ◽  
Tone Bruvik Heinskou ◽  
Per Rochat ◽  
Aydin Gozalov ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Odds Ratio ◽  
Facial Pain ◽  
Clinical Characteristics ◽  
Age Of Onset ◽  
Persistent Idiopathic Facial Pain ◽  
High Prevalence ◽  
Chronic Orofacial Pain ◽  
Chronic Pain Conditions ◽  
Low Prevalence

Introduction Persistent idiopathic facial pain (PIFP) is a poorly understood chronic orofacial pain disorder and a differential diagnosis to trigeminal neuralgia. To address the lack of systematic studies in PIFP we here report clinical characteristics and neuroimaging findings in PIFP. Methods Data collection was prospective and standardized in consecutive PIFP patients. All patients underwent 3.0 MRI. Results In a cohort of 53 PIFP patients, the average age of onset was 44.1 years. PIFP was found in more women 40 (75%) than men 13 (25%), p < 0.001. There was a high prevalence of bilateral pain 7 (13%), hypoesthesia 23 (48%), depression 16 (30%) and other chronic pain conditions 17 (32%) and a low prevalence of stabbing pain 21 (40%), touch-evoked pain 14 (26%) and remission periods 10 (19%). The odds ratio between neurovascular contact and the painful side was 1.4 (95% Cl 0.4–4.4, p = 0.565) and the odds ratio between neurovascular contact with displacement of the trigeminal nerve and the painful side was 0.2 (95% Cl 0.0–2.1, p = 0.195). Conclusion PIFP is separated from trigeminal neuralgia both with respect to the clinical characteristics and neuroimaging findings, as NVC was not associated to PIFP.

scholarly journals Generational shift in the migratory common noctule bat: first-year males lead the way to hibernacula at higher latitudes

2020 ◽  
Vol 16 (9) ◽  
pp. 20200351
Author(s):  
K. A. Kravchenko ◽  
A. S. Vlaschenko ◽  
L. S. Lehnert ◽  
A. Courtiol ◽  
C.C. Voigt
Keyword(s):  
Demographic Data ◽  
Age Groups ◽  
First Year ◽  
Migratory Species ◽  
Long Distance ◽  
Generational Shift ◽  
Migratory Status ◽  
Underlying Mechanisms ◽  
Term Data

Many migratory species have shifted their geographic distribution in response to climate change, yet the underlying mechanisms are poorly understood, particularly for mammals. We hypothesized that generational shifts are underlying the observed colonization of hibernation sites further north in a migratory bat, the common noctule ( Nyctalus noctula) . To evaluate our hypothesis, we collected long-term data on the migratory status and demography of common noctules in a recently colonized hibernation area. Based on isotopic data of 413 individuals, we observed a significant decline in the proportion of long-distance migrants from 2004 to 2015 for both sexes and across all age groups. Demographic data collected between 2007 and 2016 from 3394 individuals demonstrated that subadult males were more abundant during the early colonization stage, followed by a gradual shift to a more balanced age and sex composition. Our results suggest that the colonization of hibernacula at higher latitudes is promoted by generational shifts, involving mostly first-year males. Generational shifts seem to be a likely mechanism for distribution changes in other bats and potentially also in other mammals.

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