Document Detail

Trigeminal neuralgia due to multiple sclerosis: ultrastructural findings in trigeminal rhizotomy specimens.
MedLine Citation:
PMID:  11489143     Owner:  NLM     Status:  MEDLINE    
Trigeminal neuralgia is a well-recognized complication of multiple sclerosis. In patients with neuralgia not responding to medical treatment or transcutaneous ablative procedures, the pain can often be treated successfully by partial rhizotomy of the trigeminal sensory root. We have examined partial trigeminal rhizotomy specimens from six multiple sclerosis patients, aged between 34 and 77 years, with intractable trigeminal neuralgia lasting between 18 months and 11 years. The rhizotomy specimens were placed in buffered glutaraldehyde immediately after resection, and subsequently processed for electron microscopy. In all cases, this revealed demyelination in the proximal (CNS) part of the nerve root, with associated gliosis and variable inflammation. A consistent feature was the presence of clusters of juxtaposed axons without intervening glial processes. Similar juxtaposition of axons was previously observed in trigeminal neuralgia due to vascular compression of the nerve root. Experimental studies indicate that this arrangement of demyelinated axons is conducive to both spontaneous impulse activity and ephaptic spread of excitation. The demyelination and associated juxtaposition of axons may therefore account for key aspects of the pathogenesis of trigeminal neuralgia.
S Love; T Gradidge; H B Coakham
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neuropathology and applied neurobiology     Volume:  27     ISSN:  0305-1846     ISO Abbreviation:  Neuropathol. Appl. Neurobiol.     Publication Date:  2001 Jun 
Date Detail:
Created Date:  2001-08-07     Completed Date:  2001-09-20     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7609829     Medline TA:  Neuropathol Appl Neurobiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  238-44     Citation Subset:  IM    
Department of Neuropathology, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol BS16 1LE, UK.
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MeSH Terms
Gliosis / etiology,  pathology
Microscopy, Electron
Middle Aged
Multiple Sclerosis / complications*
Myelin Sheath / pathology
Neuritis / etiology,  pathology
Trigeminal Nerve / surgery*,  ultrastructure*
Trigeminal Neuralgia / etiology*,  pathology*,  surgery

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