Predicting the efficacy of medical therapy in patients with trigeminal neuralgia

While MRI has proven valuable in predicting the surgical outcomes of trigeminal neuralgia (TN), studies on predicting the efficacy of medical therapy remain limited. The goal of this study was to identify MRI and clinical characteristics that could predict the efficacy of medical therapy for TN.

We conducted a blinded evaluation of MRI characteristics in TN patients. Clinical data were obtained from medical records or follow-up phone calls. The relationship between MRI findings and clinical characteristics with the efficacy of medical therapy was then analyzed.

A total of 112 patients, including 44 men and 68 women, were enrolled in the study. After six months of follow-up, 35 patients (31.3 %) reported treatment failure, 30 patients (26.8 %) reported poor results, 19 patients (17.0 %) reported good results, and 28 patients (25.0 %) reported excellent results. Logistic regression analysis revealed that patients with the vertebral artery as the offending vessel were 5.625 times more likely to experience poor medical therapy efficacy (95 % confidence interval: 1.084-30.530, p = 0.040). In contrast, patients with involvement of the ophthalmic division (V1) of the trigeminal nerve were 0.416 times less likely to experience poor medical therapy efficacy (95 % CI: 0.178-0.974, p = 0.043).

Our study demonstrates that the vertebral artery as the offending vessel and involvement of the ophthalmic division of the TN are correlated with medical therapy efficacy. These findings may assist clinicians in providing more informed guidance when deciding between surgical and medical treatment options for TN patients.