Zakrzewska, JM, Wu, J orcid.org/0000-0001-6093-599X and Brathwaite, TS-L (2018) A Systematic Review of the Management of Trigeminal Neuralgia in Patients with Multiple Sclerosis. World Neurosurgery, 111. pp. 291-306. ISSN 1878-8750
Abstract
Background and Objective; Patients with trigeminal neuralgia (TN) and multiple sclerosis (MS) are often treated with medications or a surgical procedure. However, there is little evidence that such treatments result in 50% pain reduction and improvement in quality of life. The aim of this systematic review is to evaluate the clinical effectiveness of treatments in patients with MS and trigeminal neuralgia. Methods; We searched Medline, EMBASE, and the Cochrane Collaboration database from inception until October 2016. Two authors independently selected studies for inclusions, data extraction, and bias assessment. Results; All studies were of low quality using the GRADE (Grading of recommendations Assessment, Development and Evaluation) system. For medical management, 10 studies were included, of which one was a randomized controlled trial. Two studies were on the use of misopropol, unique to patients with MS. For surgical therapy, 26 studies with at least 10 patients and a minimum of 2 years follow-up were included. All types of surgical procedures are reported and the results are poorer for TN with MS, with 50% having a recurrence by 2 years. The main complication was sensory loss. Many patients had to undergo further procedures to become pain free and there were no agreed prognostic factors. Conclusions; There was insufficient evidence to support any 1 medical therapy and so earlier surgery may be preferable. A patient with TN and MS has therefore to make a decision based on low-level evidence, beginning with standard drug therapy and then choosing a surgical procedure.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2017 Elsevier Inc. All rights reserved. This is an author produced version of a paper published in World Neurosurgery. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | antiepileptic drugs; multiple sclerosis; neurosurgery; systematic review; trigeminal neuralgia |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Dentistry (Leeds) > Applied Health and Clinical Translation (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 11 Jan 2018 11:35 |
Last Modified: | 30 Dec 2018 01:38 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.wneu.2017.12.147 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:126140 |