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Updated: Aug 20, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
MRI lesions can often precede trigeminal neuralgia symptoms by years in multiple sclerosis
Sonam Dilwali1, Ian Mark2, Emmanuelle Waubant3
1Department of Neuroimmunology, University of California System, San Francisco, California, USA sonam.dilwali@ucsf.edu.
Background:
Understanding when multiple sclerosis (MS) lesions become clinically symptomatic may provide insight into disease pathophysiology. Our objective was to temporally associate lesion formation and trigeminal neuralgia (TN) symptom onset in MS.
Methods:
This is a retrospective case series of patients with MS, analysing time difference between TN symptom onset and oldest MRI showing a correlative lesion.
Results:
For the 26 patients with MS, a correlative lesion was noted on MRI on average 5±4 years prior to TN symptom onset; 57% had primary or secondary progressive MS.
Conclusions:
TN lesions can be present years prior to symptom onset, suggestive of alternative explanations than typical relapses. This phenomenon may hint at alternative pathophysiology of progressive MS in comparison to relapsing-remitting MS.
Insights
Multiple sclerosis (MS) lesions linked to trigeminal neuralgia (TN) symptoms can appear years before onset. This finding suggests different disease mechanisms in progressive MS compared to relapsing-remitting MS.
Area of Science:
- Neurology
- Neuroimmunology
- Neuroscience
Background:
- Understanding the clinical manifestation of multiple sclerosis (MS) lesions is crucial for elucidating disease pathophysiology.
- Investigating the temporal relationship between lesion development and the onset of trigeminal neuralgia (TN) symptoms in MS patients offers valuable insights.
Purpose of the Study:
- To temporally associate the formation of MS lesions with the onset of TN symptoms.
- To explore potential differences in pathophysiology between progressive MS and relapsing-remitting MS based on lesion-symptom timing.
Main Methods:
- Retrospective case series analysis of patients diagnosed with MS.
- Evaluation of the time difference between the onset of TN symptoms and the earliest MRI evidence of a corresponding lesion.
Main Results:
- In 26 MS patients, correlative lesions were observed on MRI an average of 5±4 years before TN symptom onset.
- A significant proportion (57%) of patients had either primary or secondary progressive MS.
Conclusions:
- Trigeminal neuralgia lesions in MS can predate symptom onset by several years, indicating mechanisms beyond typical relapses.
- This temporal dissociation may suggest distinct pathophysiological pathways in progressive MS compared to relapsing-remitting MS.
