13.1.2.4 Painful trigeminal neuropathy attributed to multiple sclerosis (MS) plaque

Description:
Unilateral head and/or facial pain in the distribution of a trigeminal nerve and with the characteristics of classical trigeminal neuralgia, induced by a multiple sclerosis plaque affecting the trigeminal nerve root and associated with other symptoms and/or clinical signs of multiple sclerosis.

Diagnostic criteria:
A. Head and/or facial pain with the characteristics of 13.1.1 Classical trigeminal neuralgia with or without concomitant persistent facial pain, but not necessarily unilateral
B. Multiple sclerosis (MS) has been diagnosed
C. An MS plaque affecting the trigeminal nerve root has been demonstrated by MRI or by routine electrophysiological studies (blink reflex or trigeminal evoked potentials) indicating impairment of the affected trigeminal nerve(s)
D. Not better accounted for by another ICHD-3 diagnosis.

Comments:
Current studies indicate that about 7% of MS patients have a syndrome that is similar to 13.1.1 Classical trigeminal neuralgia. However, symptoms of trigeminal neuralgia are very rarely a presenting feature of MS.

Symptoms of 13.1.2.4 Painful trigeminal neuropathy attributed to multiple sclerosis (MS) plaque are more likely to be bilateral than those of 13.1.1 Classical trigeminal neuralgia.

Patients with 13.1.2.4 Painful trigeminal neuropathy attributed to multiple sclerosis (MS) plaque benefit less from pharmacological interventions than those with 13.1.1 Classical trigeminal neuralgia.