Grant: Project Grant

Trigeminal Neuralgia (TN) is a chronic facial pain condition in which patients experience excruciating attacks of shooting or stabbing pain in specific parts of the face supplied by the trigeminal nerve. TN patients live in constant fear of the next attack, and the pain can be so severe that it may push some patients to suicide; indeed, TN has historically been called the "suicide disease" in the neurosurgery literature. TN can be treated with medication, but >50% of TN patients eventually stop responding to medication or cannot tolerate medication side effects. For these patients, surgery targeting the trigeminal nerve is the final treatment option. However, even after technically successful surgery, about 20% of patients only have short-lasting pain relief, or no pain relief at all. Over time, an even larger proportion of patients experience a relapse of their pain, requiring repeat surgery, which is usually less successful and has a higher risk of complications. The main question of this study is: why do some TN patients respond well to surgical treatment, while others either do not or experience early pain relapse? We believe that differences in the structure and function of the brain and trigeminal nerve can explain differences in pain outcome after surgery. We will answer our central question by analyzing Magnetic Resonance Imaging (MRI) brain scans obtained immediately before and at many time points after surgery in TN patients. We will also test facial sensation and specific reflexes involving the trigeminal nerve at all time points. Using different statistical methods, we will then come up with a method of predicting how well any individual patient is likely to respond to surgery, based on their brain MRI, facial sensations/reflexes, and other clinical features. This study will improve how patients undergoing TN surgery are counseled, and help us to better understand TN and how to personalize its treatment in each patient.