title: Gamma knife radiosurgery for treatment of trigeminal neuralgia in multiple sclerosis patients.
abstract: BACKGROUND
  Trigeminal neuralgia is a paroxysmal pain syndrome commonly associated with multiple sclerosis. While gamma knife radiosurgery has been shown to be an effective treatment for most cases of trigeminal neuralgia, it is considered to be less efficacious in patients with multiple sclerosis and less viable as a treatment option.
  
  
  METHODS
  Seven patients with multiple-sclerosis-associated trigeminal neuralgia were identified from 50 consecutive patients treated for trigeminal neuralgia at the Memorial-Hermann Gamma Knife Radiosurgery Center. A Leksell gamma knife was used to deliver 80 or 90 Gy to a single 4-mm isocenter targeting the fifth nerve root entry zone into the pons. The patients were followed for a median period of 28 months and graded on a scale of 1 to 5, adopted from the Barrow Neurological Institute.
  
  
  RESULTS
  All 7 patients showed excellent responses to radiosurgery with complete resolution of their pain and cessation of pain medications. The time to maximal response varied from 1 day to 8 months after treatment. The only complication was persistent facial numbness over the distribution of V2 and V3 which occurred in 4 patients. One patient experienced a recurrence of pain (grade 3) 24 months after radiation treatment, and she is currently being treated with carbamazepine.
  
  
  CONCLUSIONS
  Gamma knife radiosurgery is an effective treatment option for trigeminal neuralgia patients with multiple sclerosis. These patients should be informed that there appears to be a higher incidence of facial numbness and that a longer period of several months should be allowed before the full effects of treatment may be observed as compared to the general population.
authors.affiliation: Baylor College of Medicine, Houston, Tex 77030, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Huang
authors.forename: Bin S
authors.initials: BS
authors.lastname: Teh
authors.forename: Otto
authors.initials: O
authors.lastname: Zeck
authors.forename: Shiao Y
authors.initials: SY
authors.lastname: Woo
authors.forename: Hsin H
authors.initials: HH
authors.lastname: Lu
authors.forename: J Kam
authors.initials: JK
authors.lastname: Chiu
authors.forename: E Brian
authors.initials: EB
authors.lastname: Butler
authors.forename: William B
authors.initials: WB
authors.lastname: Gormley
authors.forename: L Steven
authors.initials: LS
authors.lastname: Carpenter
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods* / Q000706:statistics & numerical data; D014277:Trigeminal Neuralgia / Q000150:complications / Q000473:pathology / Q000601:surgery*