Contributions
Abstract: P371
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - MS symptoms
Background: The prevalence of trigeminal neuralgia (TN) in Multiple Sclerosis (MS) patients is higher than in the general population. Patients whose pain is insufficiently relieved by medication require invasive treatment, although studies on outcomes of surgically treated MS-related TN patients suggest higher recurrence rates and lower pain-free responses compared to idiopathic TN.
Objective: Aim of this retrospective, multicenter study was to gather information on the characteristics of MS patients with TN and on their medical and surgical treatments.
Methods and Materials: Neurologists members of the RIREMS (Rising Researchers in MS) group, were asked to identify patients with TN from their available clinical records and to fill out a database comprising their clinical data, and information on medical and surgical treatments carried out in each patient.
Results: Patient population consisted of 298 patients (179F, 119M, mean age: 57 +/-11 years) with a mean age at TN onset of 48 +/-11 years, and a mean EDSS at onset of 4 +/-2. Pain was most frequently located in the territory of the third trigeminal branch and was bilateral in only 4% of cases. Carbamazepine was the most frequent preventive treatment, prescribed as a first choice in 52% of cases, followed by oxcarbazepine (20%), gabapentin (14%) and pregabalin (10%). The first-choice treatment was mostly discontinued due to inefficacy (48%) or adverse events/tolerability issues (40%), with only 12% of patients discontinuing it due to pain remission. A second, third or fourth preventive treatment was prescribed, either in combination or sequentially, in 43, 12 and 4% of patients, respectively. First-choice symptomatic treatments were intravenous steroids (44%), NSAIDs (20%) and opioids (17%). Surgery was performed in 81 (30%) patients, most commonly gamma knife stereotactic radiosurgery (37%), followed by microvascular decompression (22%) and radiofrequency thermocoagulation (21%). A second surgical procedure was carried out in 32% of these, and a third procedure in 10%. The majority of patients (77%) are currently being treated for TN; of these, 19% require a combination of at least two medications.
Conclusion: Long-lasting pain remission in MS-related TN was uncommon in our study population, with over one third of surgically treated patients undergoing a repeat surgical procedure and with 77% of all patients requiring at least one preventive medication after a mean period of 9 (+/-7) years from TN onset.
Disclosure: DF has served on advisory boards for Biogen, Roche and Novartis and has received travel grants and/or speaker honoraria from MerckSerono, Teva, Biogen, Sanofi-Genzyme and Novartis.PA has served on advisory boards and/or has received travel grants and/or speaker honoraria from MerckSerono, Roche, Teva Italia, Biogen, Mylan, Almirall, Sanofi-Genzyme and Novartis.MM has received research grants from MAGNIMS-ECTRIMS and MerckMC: honoraria for research or speaking from Sanofi-Genzyme, Merck-Serono, Biogen Idec, Bayer, Novartis Pharma and funds for travel from Sanofi-Genzyme, Merck-Serono, Biogen Idec, Teva, Novartis Pharma, Roche and Bayer.RF has nothing to discloseCC: advisory board and/or speaker honoraria from Novartis, TEVA, Biogen, Merck Serono, Genzyme.GDL has served on advisory boards and/or has received travel grants and/or speaker honoraria from MerckSerono, Roche, Teva Italia, Biogen, Almirall, Sanofi-Genzyme and NovartisDP has received honoraria for consultancy and/or speaking from Biogen Idec, Merck-Serono, Sanofi-Aventis, TEVA, Bayer-Schering, Novartis and GenzymePR has served on advisory boards for Biogen, Roche, TEVA, Sanophy-Genzyme, Merck, and Novartis and has received travel grants and/or speaker honoraria from Merck Serono, Teva, Biogen, Sanofi, Genzyme and Novartis.AlG has served on advisory boards for Merck. He has received travel support from Biogen and Merck. He has received research support from Merck, Novartis, and TevaLB has nothing to disclose.SLF attended advisory boards and/or has received travel grants and/or speaker honoraria from MerckSerono, Teva Italia, Biogen, Sanofi-Genzyme and NovartisPC has served on advisory boards and/or has received travel grants and/or speaker honoraria from Merck Serono, Teva Italia, Biogen, Almirall, Novartis, Sanofi-GenzymeCT has served on advisory boards and/or has received travel grants and/or speaker honoraria from Merck Serono, Roche, Teva Italia, Biogen, Almirall, Novartis, Sanofi-Genzyme.IP has nothing to discloseAn G: speaker and consulting fees from Biogen, Sanofi-Genzyme, Merck Serono and TevaFP has nothing to disclose.VC has nothing to disclose.MDF participated to advisory boards and received speaker/writing honoraria and funding for traveling from: Bayer, Biogen Idec, Genzyme, Merck, Novartis, Roche and Teva.GTM has served on advisory boards and/or received travel grants and speaker honoraria from Almirall, Biogen, Merck Serono, Novartis and TevaVN has served on advisory boards for Biogen, Teva, Sanofi-Genzyme and MerckSerono and has received travel grants and/or speaker honoraria from MerckSerono, Teva, Biogen, Sanofi-Genzyme Roche and Novartis.MR has served has received travel grants and/or speaker honoraria from Merck Serono, Teva Italia, Biogen, Novartis, Sanofi-GenzymeVT has nothing to discloseMCB served on advisory boards and/or has received travel grants and/or speaker honoraria from Merck, Roche, Teva Italia, Biogen, Almirall, Sanofi-Genzyme and Novartis.EC has served on advisory boards and/or has received travel grants and/or speaker honoraria from Bayer, Merck, Roche, Teva, Biogen, Almirall, Novartis, Genzyme.CG has served on advisory boards and/or has received travel grants and/or speaker honoraria from Merck Serono, Roche, Teva Italia, Biogen, Almirall, Novartis, Sanofi-Genzyme.CS has served on advisory boards and/or has received travel grants and/or speaker honoraria from Merck Serono, Roche, Teva Italia, Biogen, Almirall, Sanofi-Genzyme.FB has served on advisory boards for Teva and Roche and has received travel grants and/or speaker honoraria from Merck Serono, Teva, Biogen, Sanofi-Genzyme and Novartis.LL has received speaker fees from Teva and serves on scientific advisory boards for Biogen.
Abstract: P371
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - MS symptoms
Background: The prevalence of trigeminal neuralgia (TN) in Multiple Sclerosis (MS) patients is higher than in the general population. Patients whose pain is insufficiently relieved by medication require invasive treatment, although studies on outcomes of surgically treated MS-related TN patients suggest higher recurrence rates and lower pain-free responses compared to idiopathic TN.
Objective: Aim of this retrospective, multicenter study was to gather information on the characteristics of MS patients with TN and on their medical and surgical treatments.
Methods and Materials: Neurologists members of the RIREMS (Rising Researchers in MS) group, were asked to identify patients with TN from their available clinical records and to fill out a database comprising their clinical data, and information on medical and surgical treatments carried out in each patient.
Results: Patient population consisted of 298 patients (179F, 119M, mean age: 57 +/-11 years) with a mean age at TN onset of 48 +/-11 years, and a mean EDSS at onset of 4 +/-2. Pain was most frequently located in the territory of the third trigeminal branch and was bilateral in only 4% of cases. Carbamazepine was the most frequent preventive treatment, prescribed as a first choice in 52% of cases, followed by oxcarbazepine (20%), gabapentin (14%) and pregabalin (10%). The first-choice treatment was mostly discontinued due to inefficacy (48%) or adverse events/tolerability issues (40%), with only 12% of patients discontinuing it due to pain remission. A second, third or fourth preventive treatment was prescribed, either in combination or sequentially, in 43, 12 and 4% of patients, respectively. First-choice symptomatic treatments were intravenous steroids (44%), NSAIDs (20%) and opioids (17%). Surgery was performed in 81 (30%) patients, most commonly gamma knife stereotactic radiosurgery (37%), followed by microvascular decompression (22%) and radiofrequency thermocoagulation (21%). A second surgical procedure was carried out in 32% of these, and a third procedure in 10%. The majority of patients (77%) are currently being treated for TN; of these, 19% require a combination of at least two medications.
Conclusion: Long-lasting pain remission in MS-related TN was uncommon in our study population, with over one third of surgically treated patients undergoing a repeat surgical procedure and with 77% of all patients requiring at least one preventive medication after a mean period of 9 (+/-7) years from TN onset.
Disclosure: DF has served on advisory boards for Biogen, Roche and Novartis and has received travel grants and/or speaker honoraria from MerckSerono, Teva, Biogen, Sanofi-Genzyme and Novartis.PA has served on advisory boards and/or has received travel grants and/or speaker honoraria from MerckSerono, Roche, Teva Italia, Biogen, Mylan, Almirall, Sanofi-Genzyme and Novartis.MM has received research grants from MAGNIMS-ECTRIMS and MerckMC: honoraria for research or speaking from Sanofi-Genzyme, Merck-Serono, Biogen Idec, Bayer, Novartis Pharma and funds for travel from Sanofi-Genzyme, Merck-Serono, Biogen Idec, Teva, Novartis Pharma, Roche and Bayer.RF has nothing to discloseCC: advisory board and/or speaker honoraria from Novartis, TEVA, Biogen, Merck Serono, Genzyme.GDL has served on advisory boards and/or has received travel grants and/or speaker honoraria from MerckSerono, Roche, Teva Italia, Biogen, Almirall, Sanofi-Genzyme and NovartisDP has received honoraria for consultancy and/or speaking from Biogen Idec, Merck-Serono, Sanofi-Aventis, TEVA, Bayer-Schering, Novartis and GenzymePR has served on advisory boards for Biogen, Roche, TEVA, Sanophy-Genzyme, Merck, and Novartis and has received travel grants and/or speaker honoraria from Merck Serono, Teva, Biogen, Sanofi, Genzyme and Novartis.AlG has served on advisory boards for Merck. He has received travel support from Biogen and Merck. He has received research support from Merck, Novartis, and TevaLB has nothing to disclose.SLF attended advisory boards and/or has received travel grants and/or speaker honoraria from MerckSerono, Teva Italia, Biogen, Sanofi-Genzyme and NovartisPC has served on advisory boards and/or has received travel grants and/or speaker honoraria from Merck Serono, Teva Italia, Biogen, Almirall, Novartis, Sanofi-GenzymeCT has served on advisory boards and/or has received travel grants and/or speaker honoraria from Merck Serono, Roche, Teva Italia, Biogen, Almirall, Novartis, Sanofi-Genzyme.IP has nothing to discloseAn G: speaker and consulting fees from Biogen, Sanofi-Genzyme, Merck Serono and TevaFP has nothing to disclose.VC has nothing to disclose.MDF participated to advisory boards and received speaker/writing honoraria and funding for traveling from: Bayer, Biogen Idec, Genzyme, Merck, Novartis, Roche and Teva.GTM has served on advisory boards and/or received travel grants and speaker honoraria from Almirall, Biogen, Merck Serono, Novartis and TevaVN has served on advisory boards for Biogen, Teva, Sanofi-Genzyme and MerckSerono and has received travel grants and/or speaker honoraria from MerckSerono, Teva, Biogen, Sanofi-Genzyme Roche and Novartis.MR has served has received travel grants and/or speaker honoraria from Merck Serono, Teva Italia, Biogen, Novartis, Sanofi-GenzymeVT has nothing to discloseMCB served on advisory boards and/or has received travel grants and/or speaker honoraria from Merck, Roche, Teva Italia, Biogen, Almirall, Sanofi-Genzyme and Novartis.EC has served on advisory boards and/or has received travel grants and/or speaker honoraria from Bayer, Merck, Roche, Teva, Biogen, Almirall, Novartis, Genzyme.CG has served on advisory boards and/or has received travel grants and/or speaker honoraria from Merck Serono, Roche, Teva Italia, Biogen, Almirall, Novartis, Sanofi-Genzyme.CS has served on advisory boards and/or has received travel grants and/or speaker honoraria from Merck Serono, Roche, Teva Italia, Biogen, Almirall, Sanofi-Genzyme.FB has served on advisory boards for Teva and Roche and has received travel grants and/or speaker honoraria from Merck Serono, Teva, Biogen, Sanofi-Genzyme and Novartis.LL has received speaker fees from Teva and serves on scientific advisory boards for Biogen.