Sequential onset of bilateral trigeminal neuralgia: clinical presentation and outcomes

Purpose: Sequential onset of bilateral trigeminal neuralgia (TN) is rare and not well-described in the literature. The objective of this study was to characterize demographic, clinical, and procedural characteristics of patients with sequential onset bilateral TN. Methods: We retrospectively reviewed patients presenting with sequential onset bilateral TN at our institution from 2007 to 2020. Patient demographics, clinical diagnoses, pain outcomes, and procedural characteristics were recorded and compared. Factors associated with pain recurrence were assessed using survival analyses and multivariate regressions. Results: We identified 34 patients who presented with sequential onset bilateral TN. The average age of onset for the index case was 49.9 ± 15.5 years, and 58.0 ± 16.8 years for the contralateral case. In total for our cohort, 91 surgical procedures were performed for the index case, and 70 for the contralateral case. With each additional surgical intervention, pain-free survival was more likely to decrease, p = 0.05. When controlled for order of intervention, glycerin rhizotomy (p = 0.01) and glycerin-radiofrequency rhizotomy (p = 0.05) were more likely associated with pain recurrence compared to microvascular decompression. While pain outcomes were significantly decreased in our cohort at final follow-up, 82.4% of patients were still dependent on medication for pain management after an average of 5.03 ± 7.74 years. Conclusion: Our results represent one of the largest series of sequential onset bilateral TN in North America. Our study demonstrates the high treatment burden and chronicity of pain encountered in this population.