Introduction: Trigeminal neuralgia (TN) is a neuropathic pain syndrome characterized by sudden, severe, and short-lived pain attacks in the facial region. When TN is associated with multiple sclerosis (MS), it may present distinct clinical features. The frequency of refractory TN and treatment responses in MS patients remain controversial in the literature. This study aims to investigate the clinical characteristics of MS-associated TN and assess whether TN is more treatment-resistant in MS patients.
Methods: This retrospective observational study analyzed the clinical and demographic data of patients diagnosed with TN and MS who presented to the Neurology Outpatient Clinic of Ankara Bilkent City Hospital between 2019 and 2025. The study included 36 MS patients with TN and 36 TN patients without MS, matched for age and sex. Variables such as age, sex, disease duration, MS type, Expanded Disability Status Scale (EDSS) score, TN onset age, TN treatment history, and magnetic resonance (MR) imaging findings were recorded. Refractory TN was defined as TN that did not respond to first- and second-line pharmacological treatments and required interventional procedures.
Results: The mean age of MS patients with TN was 51.19±10.78, similar to that of non-MS TN patients (p=0.97). While no significant differences were found in TN clinical characteristics between groups, MRI revealed a higher frequency of TN-associated brainstem lesions in MS patients (p=0.04). The rates of local anesthetic ganglion block and radiofrequency ablation were significantly higher in MS patients (p=0.01, p=0.02). Barrow Neurological Institute Pain Scale (BNI-PS) scores were significantly higher in MS patients (p=0.001), and the prevalence of refractory TN was markedly greater in the MS group (p=0.01). A positive correlation was observed between refractory TN and EDSS scores in MS patients (p=0.002, r=0.482).
Conclusion: This study demonstrates that TN is more resistant to treatment in MS patients, with a higher prevalence of refractory TN. Furthermore, the increased pain severity and greater need for interventional treatments in MS patients suggest that alternative management strategies are required for MS-associated TN. Larger-scale prospective studies are needed to evaluate treatment responses and long-term outcomes in this population.
Keywords: Multiple sclerosis; refractory trigeminal neuralgia; treatment-