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Earlier radiosurgery leads to better pain relief and less medication usage for trigeminal neuralgia patients: an international multicenter study.
J Neurosurg. 2020 Jul 03 [Online ahead of print]JN

Abstract

OBJECTIVE

Trigeminal neuralgia (TN) is a chronic pain condition that is difficult to control with conservative management. Furthermore, disabling medication-related side effects are common. This study examined how stereotactic radiosurgery (SRS) affects pain outcomes and medication dependence based on the latency period between diagnosis and radiosurgery.

METHODS

The authors conducted a retrospective analysis of patients with type I TN at 12 Gamma Knife treatment centers. SRS was the primary surgical intervention in all patients. Patient demographics, disease characteristics, treatment plans, medication histories, and outcomes were reviewed.

RESULTS

Overall, 404 patients were included. The mean patient age at SRS was 70 years, and 60% of the population was female. The most common indication for SRS was pain refractory to medications (81%). The median maximum radiation dose was 80 Gy (range 50-95 Gy), and the mean follow-up duration was 32 months. The mean number of medications between baseline (pre-SRS) and the last follow-up decreased from 1.98 to 0.90 (p < 0.0001), respectively, and this significant reduction was observed across all medication categories. Patients who received SRS within 4 years of their initial diagnosis achieved significantly faster pain relief than those who underwent treatment after 4 years (median 21 vs 30 days, p = 0.041). The 90-day pain relief rate for those who received SRS ≤ 4 years after their diagnosis was 83.8% compared with 73.7% in patients who received SRS > 4 years after their diagnosis. The maximum radiation dose was the strongest predictor of a durable pain response (OR 1.091, p = 0.003). Early intervention (OR 1.785, p = 0.007) and higher maximum radiation dose (OR 1.150, p < 0.0001) were also significant predictors of being pain free (a Barrow Neurological Institute pain intensity score of I-IIIA) at the last follow-up visit. New sensory symptoms of any kind were seen in 98 patients (24.3%) after SRS. Higher maximum radiation dose trended toward predicting new sensory deficits but was nonsignificant (p = 0.075).

CONCLUSIONS

TN patients managed with SRS within 4 years of diagnosis experienced a shorter interval to pain relief with low risk. SRS also yielded significant decreases in adjunct medication utilization. Radiosurgery should be considered earlier in the course of treatment for TN.

Authors+Show Affiliations

1Department of Neurosurgery, New York University Langone Medical Center, New York, New York.1Department of Neurosurgery, New York University Langone Medical Center, New York, New York.1Department of Neurosurgery, New York University Langone Medical Center, New York, New York.1Department of Neurosurgery, New York University Langone Medical Center, New York, New York.Departments of2Neurosurgery and.Departments of2Neurosurgery and.3Radiation Oncology, University of Southern California, Los Angeles, California.4Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.4Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.5Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio.6Centro Gamma Knife Dominicano, CEDIMAT, Santo Domingo, Dominican Republic.7Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada.7Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada.8Department of Oncology, Division of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada.9Department of Neurosurgery, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico.10Administración de Servicios Médicos de Puerto Rico, Centro Gamma Knife de Puerto Rico y El Caribe, San Juan, Puerto Rico.11Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada.No affiliation info available11Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada.12Center for Neuro-Restoration, Cleveland Clinic, Cleveland, Ohio.12Center for Neuro-Restoration, Cleveland Clinic, Cleveland, Ohio.13Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and.14Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.14Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.14Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.14Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.13Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and.1Department of Neurosurgery, New York University Langone Medical Center, New York, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32619989

Citation

Mureb, Monica, et al. "Earlier Radiosurgery Leads to Better Pain Relief and Less Medication Usage for Trigeminal Neuralgia Patients: an International Multicenter Study." Journal of Neurosurgery, 2020, pp. 1-8.
Mureb M, Golub D, Benjamin C, et al. Earlier radiosurgery leads to better pain relief and less medication usage for trigeminal neuralgia patients: an international multicenter study. J Neurosurg. 2020.
Mureb, M., Golub, D., Benjamin, C., Gurewitz, J., Strickland, B. A., Zada, G., Chang, E., Urgošík, D., Liščák, R., Warnick, R. E., Speckter, H., Eastman, S., Kaufmann, A. M., Patel, S., Feliciano, C. E., Carbini, C. H., Mathieu, D., Leduc, W., Nagel, S. J., ... Kondziolka, D. (2020). Earlier radiosurgery leads to better pain relief and less medication usage for trigeminal neuralgia patients: an international multicenter study. Journal of Neurosurgery, 1-8. https://doi.org/10.3171/2020.4.JNS192780
Mureb M, et al. Earlier Radiosurgery Leads to Better Pain Relief and Less Medication Usage for Trigeminal Neuralgia Patients: an International Multicenter Study. J Neurosurg. 2020 Jul 3;1-8. PubMed PMID: 32619989.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Earlier radiosurgery leads to better pain relief and less medication usage for trigeminal neuralgia patients: an international multicenter study. AU - Mureb,Monica, AU - Golub,Danielle, AU - Benjamin,Carolina, AU - Gurewitz,Jason, AU - Strickland,Ben A, AU - Zada,Gabriel, AU - Chang,Eric, AU - Urgošík,Dušan, AU - Liščák,Roman, AU - Warnick,Ronald E, AU - Speckter,Herwin, AU - Eastman,Skyler, AU - Kaufmann,Anthony M, AU - Patel,Samir, AU - Feliciano,Caleb E, AU - Carbini,Carlos H, AU - Mathieu,David, AU - Leduc,William, AU - ,, AU - Nagel,Sean J, AU - Hori,Yusuke S, AU - Hung,Yi-Chieh, AU - Ogino,Akiyoshi, AU - Faramand,Andrew, AU - Kano,Hideyuki, AU - Lunsford,L Dade, AU - Sheehan,Jason, AU - Kondziolka,Douglas, Y1 - 2020/07/03/ PY - 2019/10/12/received PY - 2020/04/15/accepted PY - 2020/7/4/entrez PY - 2020/7/4/pubmed PY - 2020/7/4/medline KW - BNI = Barrow Neurological Institute KW - Gamma Knife radiosurgery KW - MVD = microvascular decompression KW - SRS = stereotactic radiosurgery KW - TN = trigeminal neuralgia KW - carbamazepine KW - pain KW - stereotactic radiosurgery KW - trigeminal neuralgia SP - 1 EP - 8 JF - Journal of neurosurgery JO - J. Neurosurg. N2 - OBJECTIVE: Trigeminal neuralgia (TN) is a chronic pain condition that is difficult to control with conservative management. Furthermore, disabling medication-related side effects are common. This study examined how stereotactic radiosurgery (SRS) affects pain outcomes and medication dependence based on the latency period between diagnosis and radiosurgery. METHODS: The authors conducted a retrospective analysis of patients with type I TN at 12 Gamma Knife treatment centers. SRS was the primary surgical intervention in all patients. Patient demographics, disease characteristics, treatment plans, medication histories, and outcomes were reviewed. RESULTS: Overall, 404 patients were included. The mean patient age at SRS was 70 years, and 60% of the population was female. The most common indication for SRS was pain refractory to medications (81%). The median maximum radiation dose was 80 Gy (range 50-95 Gy), and the mean follow-up duration was 32 months. The mean number of medications between baseline (pre-SRS) and the last follow-up decreased from 1.98 to 0.90 (p < 0.0001), respectively, and this significant reduction was observed across all medication categories. Patients who received SRS within 4 years of their initial diagnosis achieved significantly faster pain relief than those who underwent treatment after 4 years (median 21 vs 30 days, p = 0.041). The 90-day pain relief rate for those who received SRS ≤ 4 years after their diagnosis was 83.8% compared with 73.7% in patients who received SRS > 4 years after their diagnosis. The maximum radiation dose was the strongest predictor of a durable pain response (OR 1.091, p = 0.003). Early intervention (OR 1.785, p = 0.007) and higher maximum radiation dose (OR 1.150, p < 0.0001) were also significant predictors of being pain free (a Barrow Neurological Institute pain intensity score of I-IIIA) at the last follow-up visit. New sensory symptoms of any kind were seen in 98 patients (24.3%) after SRS. Higher maximum radiation dose trended toward predicting new sensory deficits but was nonsignificant (p = 0.075). CONCLUSIONS: TN patients managed with SRS within 4 years of diagnosis experienced a shorter interval to pain relief with low risk. SRS also yielded significant decreases in adjunct medication utilization. Radiosurgery should be considered earlier in the course of treatment for TN. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/32619989/Earlier_radiosurgery_leads_to_better_pain_relief_and_less_medication_usage_for_trigeminal_neuralgia_patients:_an_international_multicenter_study L2 - https://thejns.org/doi/10.3171/2020.4.JNS192780 DB - PRIME DP - Unbound Medicine ER -
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