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$Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain$

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Multiple sclerosis relapse presenting as trigeminal neuralgia.

Meheroz H Rabadi^1,2

¹Oklahoma City VA Medical Center, OK, USA.

Radiology Case Reports

|July 1, 2024

Summary

Trigeminal neuralgia (TGN) is a painful condition affecting people with multiple sclerosis (MS). Early MRI diagnosis and carbamazepine treatment effectively managed facial pain in an MS patient.

Keywords:

Carbamazepine Magnetic resonance imaging Multiple sclerosis Trigeminal neuralgia

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Area of Science:

Neurology
Neuroimmunology

Background:

Trigeminal neuralgia (TGN) is a debilitating facial pain disorder, affecting approximately 2% of individuals with multiple sclerosis (MS).
Disease-modifying therapies (DMTs) are crucial for managing MS and preventing relapses.

Observation:

A 54-year-old woman with a history of MS experienced severe right-sided facial pain after discontinuing her DMT.
Brain MRI with gadolinium revealed an enhancing plaque on the right trigeminal nerve.

Findings:

The patient was diagnosed with TGN secondary to MS.
Initiation of carbamazepine 300 mg four times daily led to pain relief.

Implications:

This case underscores the importance of early diagnosis of TGN in MS patients using MRI with gadolinium enhancement.
Prompt treatment with carbamazepine and restarting DMT can effectively manage symptoms and prevent disease progression.