Contributions
Abstract: EP1363
Type: ePoster
Abstract Category: Clinical aspects of MS - 7 MS symptoms
Background and purpose: Neuropathic pain can be the presenting feature or occur during relapses of Multiple Sclerosis (MS). The association of trigeminal neuralgia with MS has been well documented and is typically related to a pontine lesion. Limited data exists regarding occipital neuralgia in patients with MS. We tested the hypothesis that occipital neuralgia in MS is associated with high cervical spinal cord lesions (C2-3).
Methods: We reviewed the records of 29 patients diagnosed with both occipital neuralgia and MS, clinically isolated syndrome or radiologically isolated syndrome (RIS) by a neurologist at our institution from January 2001 to December 2014. We collected data on demographics, disease course of MS, description of pain, sensory findings, comorbid headache disorders, history of trauma, presence of C2-3 demyelinating lesions, and treatment response.
Results: The patients with both occipital neuralgia and MS were typically female (76%) and had a later onset (age > 40) of occipital neuralgia (72%). Of those (28 patients) with available imaging for review, 18 patients (64%) had the presence of a C2-3 lesion. The majority of patients with a C2-3 lesion had unilateral symptoms (83%) and episodic pain (78%). All patients with documented sensory loss (3/3) had a C2-3 lesion. Six out of the 8 patients with progressive MS (PMS) (75%) had a C2-3 lesion with the remaining 2 patients having a potential alternative cause to their occipital distribution headache with moderate to severe cervical spondylotic changes on imaging. Of the 8 patients with a C2-3 lesion and imaging at onset of occipital neuralgia, 5 (62.5%) had evidence of active demyelination with enhancement on MRI. All of the 8 patients with long term follow-up that had either relapsing remitting MS (5/5), RIS (2/2) or transverse myelitis (1/1) had a good response (as defined by pain freedom for greater than 1 month) after treatment with occipital nerve blocks (ONB) and/or high dose intravenous (IV) steroids. None of the patients with PMS (3/3) responded to treatment with ONB or high dose IV steroids.
Conclusions: Predictors of an association between occipital neuralgia and presence of a C2-3 lesion were unilateral episodic symptoms, sensory loss, onset occurring later in life (age > 40), and PMS phenotype. Patients with PMS did not respond to ONB or high dose IV steroids, whereas other phenotypes responded to those treatments.
Disclosure:
Narayan R. Kissoon: nothing to disclose
James C. Watson: nothing to disclose
Orhun H. Kantarci: nothing to disclose
Abstract: EP1363
Type: ePoster
Abstract Category: Clinical aspects of MS - 7 MS symptoms
Background and purpose: Neuropathic pain can be the presenting feature or occur during relapses of Multiple Sclerosis (MS). The association of trigeminal neuralgia with MS has been well documented and is typically related to a pontine lesion. Limited data exists regarding occipital neuralgia in patients with MS. We tested the hypothesis that occipital neuralgia in MS is associated with high cervical spinal cord lesions (C2-3).
Methods: We reviewed the records of 29 patients diagnosed with both occipital neuralgia and MS, clinically isolated syndrome or radiologically isolated syndrome (RIS) by a neurologist at our institution from January 2001 to December 2014. We collected data on demographics, disease course of MS, description of pain, sensory findings, comorbid headache disorders, history of trauma, presence of C2-3 demyelinating lesions, and treatment response.
Results: The patients with both occipital neuralgia and MS were typically female (76%) and had a later onset (age > 40) of occipital neuralgia (72%). Of those (28 patients) with available imaging for review, 18 patients (64%) had the presence of a C2-3 lesion. The majority of patients with a C2-3 lesion had unilateral symptoms (83%) and episodic pain (78%). All patients with documented sensory loss (3/3) had a C2-3 lesion. Six out of the 8 patients with progressive MS (PMS) (75%) had a C2-3 lesion with the remaining 2 patients having a potential alternative cause to their occipital distribution headache with moderate to severe cervical spondylotic changes on imaging. Of the 8 patients with a C2-3 lesion and imaging at onset of occipital neuralgia, 5 (62.5%) had evidence of active demyelination with enhancement on MRI. All of the 8 patients with long term follow-up that had either relapsing remitting MS (5/5), RIS (2/2) or transverse myelitis (1/1) had a good response (as defined by pain freedom for greater than 1 month) after treatment with occipital nerve blocks (ONB) and/or high dose intravenous (IV) steroids. None of the patients with PMS (3/3) responded to treatment with ONB or high dose IV steroids.
Conclusions: Predictors of an association between occipital neuralgia and presence of a C2-3 lesion were unilateral episodic symptoms, sensory loss, onset occurring later in life (age > 40), and PMS phenotype. Patients with PMS did not respond to ONB or high dose IV steroids, whereas other phenotypes responded to those treatments.
Disclosure:
Narayan R. Kissoon: nothing to disclose
James C. Watson: nothing to disclose
Orhun H. Kantarci: nothing to disclose