Roger Collet Vidiella (Barcelona/ ES), Joan Miquel Fernández Vidal (Barcelona/ ES), Gonzalo Olmedo Saura (Barcelona/ ES), Ana Martínez Viguera (Barcelona/ ES), Clara Toscano Prat (Barcelona/ ES), Maria Borrell Pichot (Barcelona/ ES), Raquel Sainz-Torres (Barcelona/ ES), Tania Isabel Mederer Fernandez (Barcelona/ ES), Blanca Albertí Vall (Barcelona/ ES), Rodrigo Rodríguez Rodríguez (Barcelona/ ES), Juan Angel Aibar Duran (Barcelona/ ES), Robert Belvís Nieto (Barcelona/ ES), Noemí Morollón Sánchez-Mateo (Barcelona/ ES)
Abstract text (incl. figure legends and references)
Question
The proportion of patients that respond to medical and surgical treatment in trigeminal neuralgia (TN) is variable. We aimed to identify potential predictors of response to medical and surgical treatment in classical and idiopathic trigeminal neuralgia.
Methods
We conducted an observational, retrospective, and unicenter study in adults with classical or idiopathic TN. We analyzed the relationship between several epidemiologic, anatomic, and clinical characteristics and outcomes with the use of the chi-square or Fisher's exact test for categorical variables and with ANOVA for continuous variables. P-value ≤0.05 was considered significant. All reported P-values are two-sided.
Results
A total of 193 patients (67% women) were included, with a median age at the first visit of 64 [22-93] years.
Medical treatment response for ≥2 years was present in 59% of patients. Older age at the first visit (66 vs 58, p<0.01) and the presence of hypertension (47% vs 26%, p=0.03) were associated with response to medical treatment. No significant differences were found in terms of gender, affected branch, type of TN, or other comorbidities.
The effectiveness of microvascular decompression was 87%. A more significant number of previous drugs (3.7 vs 6.7, p=0.03) was associated with no response. No differences were found regarding other variables.
The effectiveness with thermocoagulation was 60%. V2 involvement (75% vs 17%, p=0.01) and pain in V2-V3 branches (91% vs 40%, p=0.01) were associated with effectiveness, while single branch involvement (27% vs 87%, p<0.01) to no response.
The effectiveness of mechanical compression was 84%. No response predictors were found.
Conclusions
Advanced age and hypertension were associated with a sustained response to medical treatment. A greater number of drugs before microvascular decompression was associated with a worse response. The involvement of branches V2 and V2-V3 was associated with effectiveness with thermocoagulation.