Association of trigeminal neuralgia with multiple sclerosis: clinical and pathological features

The clinical characteristics of facial pain in patients with trigeminal neuralgia (TN) and associated multiple sclerosis (MS) were studied. Among 900 patients with TN 22 (2.4%) had associated MS. Sixteen patients had typical TN, while six had atypical TN. Facial pain commenced at a younger age (P less than 0.005) and a significantly higher proportion had bilateral facial pain (P less than 0.01) in the group with MS compared to TN patients without MS. In three patients TN was the first manifestation of MS, in the remainder facial pain occurred on an average of 12 years after onset of MS. Seventeen patients had associated signs of brain-stem involvement. The facial pain was, however, indistinguishable from the pain in patients without brain-stem deficits. While sclerotic plaques in the central nervous system probably are of etiological significance for development of TN neither clinical nor neuropathological findings suggest that this is due to affection of trigeminal nuclei complex in the brain-stem.