gms | German Medical Science

Objective: Trigeminal neuropathy attributed to Multiple Sclerosis can be a major therapeutical challenge. Peripheral nerve field stimulation (PNFS) is a promising modality for treatment of intractable facial pain. However, evidence is sparse. We are therefore presenting our results in a small series with successful treatment of trigeminal neuropathy in Multiple Sclerosis patients.

Method: We analyzed the outcome of five Multiple Sclerosis patients with trigeminal neuropathy who underwent implantation of one or several subcutaneous electrodes for trigeminal nerve field stimulation (Medtronic Pisces Quad Plus, IPG: PrimeAdvanced). All patients were followed up in our outpatient department.

Results: The average patient age was 60.4 years (range 36-76). In four patients (three male), a stimulation system was implanted after successful trial stimulation. One male patient was successfully tested, but died due to progressive multifocal leucoencephalopathy before the implantation. All patients suffered from regular pain attacks despite high-dosage pharmacological treatment which resulted in severe neurological side effects like ataxia, drowsiness, and blurred vision. The average follow-up after implantation was 11 months (range 1-25). All four patients reported major improvement with reduced frequency and intensity of pain attacks with stimulation and all reduced their medication. In one patient, an electrode infection required a system explantation with subsequent re-implantation.

Conclusions: According to our experience, severe trigeminal neuropathy in Multiple Sclerosis emerges as an important indication for PNFS when established therapies have failed. In our small cohort, all patients had a marked symptom improvement upon stimulation, which causes much less adverse effects than high-dosage therapy with anticonvulsants and second-line drugs.