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MRI lesions can often precede trigeminal neuralgia symptoms by years in multiple sclerosis
  1. Sonam Dilwali1,
  2. Ian Mark2,
  3. Emmanuelle Waubant1
  1. 1 Department of Neuroimmunology, University of California System, San Francisco, California, USA
  2. 2 Department of Neuroradiology, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Sonam Dilwali, Department of Neuroimmunology, University of California System, San Francisco, CA 94158, USA; sonam.dilwali{at}


Background Understanding when multiple sclerosis (MS) lesions become clinically symptomatic may provide insight into disease pathophysiology. Our objective was to temporally associate lesion formation and trigeminal neuralgia (TN) symptom onset in MS.

Methods This is a retrospective case series of patients with MS, analysing time difference between TN symptom onset and oldest MRI showing a correlative lesion.

Results For the 26 patients with MS, a correlative lesion was noted on MRI on average 5±4 years prior to TN symptom onset; 57% had primary or secondary progressive MS.

Conclusions TN lesions can be present years prior to symptom onset, suggestive of alternative explanations than typical relapses. This phenomenon may hint at alternative pathophysiology of progressive MS in comparison to relapsing-remitting MS.

  • trigeminal neuralgia
  • MRI
  • multiple sclerosis

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  • Contributors SD, IM and EW contributed towards conception and design of the study, SD and IM contributed towards acquisition and analysis of data and SD and EW contributed towards drafting a significant portion of the manuscript or figures.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests IM has no disclosures to report. EW has participated in multicentre clinical trials funded by Genentech, Alexion and Biogen. She has current support from the NIH, NMSS, PCORI, CMSC and Race to Erase MS. No funding was required for this study. The spouse of author SD is an employee of Genentech.

  • Provenance and peer review Not commissioned; externally peer reviewed.