BACKGROUND AND OBJECTIVES: Trigeminal neuralgia affects approximately 2% of patients with multiple sclerosis (MS) and often shows higher rates of pain recurrence after treatment. Previous studies on the effectiveness of stereotactic radiosurgery (SRS) for trigeminal neuralgia did not consider the different MS subtypes, including remitting relapsing (RRMS), primary progressive (PPMS), and secondary progressive (SPMS). Our objective was to investigate how MS subtypes are related to pain control (PC) rates after SRS. METHODS: We conducted a retrospective multicenter analysis of prospectively collected databases. Pain status was assessed using the Barrow National Institute Pain Intensity Scales. Time to recurrence was estimated through the Kaplan-Meier method and compared groups using log-rank tests. Logistic regression was used to calculate the odds ratio (OR). RESULTS: Two hundred and fifty-eight patients, 135 (52.4%) RRMS, 30 (11.6%) PPMS, and 93 (36%) SPMS, were included from 14 institutions. In total, 84.6% of patients achieved initial pain relief, with a median time of 1 month; 78.7% had some degree of pain recurrence with a median time of 10.2 months for RRMS, 8 months for PPMS, 8.1 months for SPMS ( P = .424). Achieving Barrow National Institute-I after SRS was a predictor for longer periods without recurrence ( P = .028). Analyzing PC at the last available follow-up and comparing with RRMS, PPMS was less likely to have PC (OR = 0.389; 95% CI 0.153-0.986; P = .047) and SPMS was more likely (OR = 2.0; 95% CI 0.967-4.136; P = .062). A subgroup of 149 patients did not have other procedures apart from SRS. The median times to recurrence in this group were 11.1, 9.8, and 19.6 months for RRMS, PPMS, and SPMS, respectively (log-rank, P = .045). CONCLUSION: This study is the first to investigate the relationship between MS subtypes and PC after SRS, and our results provide preliminary evidence that subtypes may influence pain outcomes, with PPMS posing the greatest challenge to pain management.

Department of Neurological Surgery NYU Langone Health New York University New York New York USA

Department of Neurological Surgery UPMC Pittsburgh Pennsylvania USA

Department of Neurology Mount Sinai Corinne Goldsmith Dickinson Center for MS Mount Sinai New York USA

Department of Neurosurgery Allegheny Health Network Pittsburgh Pennsylvania USA

Department of Neurosurgery Centre de recherche du CHUS Université de Sherbrooke Sherbrooke Canada

Department of Neurosurgery Gamma Knife Center Jewish Hospital Mayfield Clinic Cincinnati Ohio USA

Department of Neurosurgery IRCCS Humanitas Research Hospital Rozzano Italy

Department of Neurosurgery Koc University School of Medicine Istanbul Turkey

Department of Neurosurgery North Shore University Hospital Hempstead New York USA

Department of Neurosurgery North Shore University Hospital Manhasset New York USA

Department of Neurosurgery North Shore University Hospital SUNY Downstate College of Medicine Brooklyn New York USA

Department of Neurosurgery University of Southern California Los Angeles California USA

Department of Neurosurgery UVA Charlottesville Virginia USA

Department of Radiation Oncology NYU Langone Health New York University New York New York USA

Department of Radiation Oncology The James Cancer Hospital at The Ohio State University Columbus Ohio USA

Division of Radiation Oncology Allegheny Health Network Cancer Institute Allegheny Health Network Pittsburgh Pennsylvania USA

Division of Radiation Oncology Department of Oncology University of Alberta Edmonton Canada

Radiosurgery Unit Hospital Ruber Internacional Madrid Spain

Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czechia

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