Trigeminal neuralgia (TN) is commonly associated with multiple sclerosis (MS). Whether TN should be considered a clinical relapse or evidence of active disease lacks consensus. TN was diagnosed in 0.9%–1.9% (n = 171) of people with multiple sclerosis (pwMS) at three international sites. In 9.9%, TN was their first potential demyelinating symptom. In 86%, TN onset occurred a median of 13–16 years after MS diagnosis. A clinical relapse occurred within 6 months of TN onset in 20% of pwMS. These data suggest TN onset should be evaluated as active disease and incorporated in diagnostic and therapeutic decisions in MS.
BurkholderDBKoehlerPJBoesCJ. Trigeminal neuralgia and multiple sclerosis: A historical perspective. Can J Neurol Sci2017; 44(5): 589–593.
2.
HoushiSTavallaeiMJBarzegarM, et al. Prevalence of trigeminal neuralgia in multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord2022; 57: 103472.
3.
HewardKDRoy-HewitsonCSolomonAJ. Multiple sclerosis presenting with paroxysmal symptoms: Patients at the limitations of current diagnostic criteria. Mult Scler2024; 30(11–12): 1566–1570.
4.
FallataASalterATyryT, et al. Trigeminal neuralgia commonly precedes the diagnosis of multiple sclerosis. Int J MS Care2017; 19(5): 240–246.
5.
SolomonAJAscherioA. Early diagnosis of multiple sclerosis: Further evidence for missed opportunity. Neurology2021; 96: 1111–1112.
6.
Cobo-CalvoATurCOtero-RomeroS, et al. Association of very early treatment initiation with the risk of long-term disability in patients with a first demyelinating event. Neurology2023; 101: e1280–e1292.
7.
BrownleeWJHardyTAFazekasF, et al. Diagnosis of multiple sclerosis: Progress and challenges. Lancet2017; 389: 1336–1346.
8.
BeckmannYÖzakbaşSBülbülNG, et al. Reassessment of Lhermitte’s sign in multiple sclerosis. Acta Neurol Belg2015; 115(4): 605–608.
9.
RabadiMH. Multiple sclerosis relapse presenting as trigeminal neuralgia. Radiol Case Rep2024; 19(8): 3545–3547.
10.
MontanoNRapisardaAIoannoniE, et al. Microvascular decompression in patients with trigeminal neuralgia and multiple sclerosis: Results and analysis of possible prognostic factors. Acta Neurol Belg2020; 120(2): 329–334.
11.
TohyamaSOhJTimmM, et al. Should trigeminal neuralgia be considered a clinically isolated syndrome. Mult Scler2023; 29(4–5): 637–641.
