Structural neuroimaging reveals the peripheral and central contributions to trigeminal neuralgia pain
Trigeminal neuralgia (TN) is a chronic neuropathic facial pain disorder, considered as one of the most painful conditions known to medicine. The characteristic feature of TN involves severe episodes of electric shock-like unilateral facial pain. Since a viable animal model of TN has not been established, the etiology and pathophysiological mechanisms of TN remains elusive. In a recent review article, UTCSP members Drs. Danielle DeSouza, Mojgan Hodaie, and Karen Davis discuss their body of work on how structural magnetic resonance imaging (MRI), including diffusion tensor imaging (DTI), can reveal peripheral and CNS abnormalities of TN.
TN is thought to arise from a peripheral injury, specifically, compression of the trigeminal nerve at the root entry zone (REZ) by blood vessels. The authors showed that at the REZ, the nerve is disrupted due to demyelination, neuroinflammatory processes, and/or edema. In addition to nerve related abnormalities, the authors also found CNS related alterations in TN patients. Specifically, the authors report abnormal gray and white matter in brain regions involved in the sensory and cognitive experience of pain, pain modulation, and motor function.
The studies presented in this review establish that structural MRI serves as a valuable technique to identify both peripheral and CNS abnormalities in TN patients. Furthermore, as the authors conclude, structural MRI may offer a means to examine TN treatment effects and also help predict TN treatment outcomes.
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Reference: DeSouza, Hodaie, and Davis. (2016). Structural Magnetic Resonance Imaging Can Identify Trigeminal System Abnormalities in Classical Trigeminal Neuralgia. Frontiers in Neuroanatomy.