Posted on 03-01-2018

Predicting treatment response in trigeminal neuralgia using diffusion tensor imaging

Trigeminal neuralgia (TN) is a chronic neuropathic facial pain disorder, characterized by excruciating, shock-like attacks of pain. When medications do not offer adequate relief for these patients, neurosurgical treatments are often considered. However, up to 20% of patients still do not experience relief even after surgical intervention. The ability to predict which patients are likely to respond to surgical intervention, and which would not would greatly optimize treatment planning and enable individual pain management.  In a recent paper, UTCSP members Peter Shih-Ping Hung, Dr. Karen Davis, Dr. Mojgan Hodaie, and colleagues investigate the use of diffusion tensor imaging to predict long-term pain relief in TN patients that undergo neurosurgical treatment.

Diffusion tensor imaging (DTI) is a structural neuroimaging technique used to illustrate brain white matter microstructure. Hung et al. used DTI to investigate diffusivity patterns in trigeminal nerve fibers before surgical treatment for TN and found pre-surgical DTI metrics that can accurately differentiate patients who will achieve long-lasting pain relief from those who will respond poorly to surgery. Specifically, the authors report microstructural abnormalities at the pontine segment of the affected trigeminal nerve that can predict non-responders. Overall, this study demonstrates DTI to be a promising objective, predictive tool that can be used in the clinic to develop personalized treatment plans for TN patients considering neurosurgical options. 

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Reference: Hung PS, Chen DQ, Davis KD, Zhong J, Hodaie M. (2017). Predicting pain relief: Use of pre-surgical trigeminal nerve diffusion metrics in trigeminal neuralgia. Neuroimage Clinical.