Radiofrequency thermocoagulation for the treatment of trigeminal neuralgia associated with a focal pontine lesion: illustrative case.

BACKGROUND: Trigeminal neuralgia (TN) associated with a focal pontine lesion is a rare but challenging condition. The origin of the lesion, which does not fulfill the diagnostic criteria for multiple sclerosis, remains disputable. Pain in such conditions is often refractory to treatment, including microvascular decompression. OBSERVATIONS: A 36-year-old female presented with a 3.5-year history of shooting pain in the right V2 distribution triggered by talking and chewing. She became less responsive to high-dose carbamazepine over time. Magnetic resonance imaging (MRI) revealed no neurovascular compression but an elongated lesion hyperintense on T2-weighted imaging and T2- fluid-attenuated inversion recovery and hypointense and nonenhancing on T1-magnetization prepared rapid gradient-echo imaging without restricted diffusion, hemorrhage, or supposed malformation along the right pontine trigeminal pathway (PTP). Two other similar lesions were found in the corpus callosum and left thalamus. All lesions were stable compared to MRI data obtained 2 years before. Cerebrospinal fluid contained no oligoclonal bands. Pain attacks ceased with right-sided gasserian radiofrequency thermocoagulation (RFTC), and at the 6-month follow-up, there was no recurrence. LESSONS: In patients with TN, preoperative neuroimaging should assess for brainstem lesions along the PTP. RFTC can be considered a treatment option in medication-refractory TN associated with a focal pontine lesion.

Noninvasive Neuromodulation in Headache: An Update.

Background: Migraine is a common disabling primary headache condition. Although strives have been made in treatment, there remains an unmet need for safe, effective acute, and preventative treatments. The promising concept of neuromodulation of relevant neuronal targets in a noninvasive fashion for the treatment of primary headache disorders has led to the trial of numerous devices over the years. Objective: We aimed to review the evidence on current neuromodulation treatments available for the management of primary headache disorders. Methods: Randomized controlled trial as well as open-label and real-world studies on central and peripheral cephalic and noncephalic neuromodulation modalities in primary headaches were critically reviewed. Results: The current evidence suggests a role of single-pulse transcranial magnetic stimulation, supraorbital nerve stimulation, and remote noncephalic electrical stimulation as migraine abortive treatments, with stronger evidence in episodic rather than in chronic migraine. Single-pulse transcranial magnetic stimulation and supraorbital nerve stimulation also hold promising evidence in episodic migraine prevention and initial positive evidence in chronic migraine prevention. More evidence should clarify the therapeutic role of the external vagus nerve stimulation and transcranial direct current stimulation in migraine. However, external vagus nerve stimulation may be effective in the acute treatment of episodic but not chronic cluster headache, in the prevention of hemicrania continua and paroxysmal hemicrania but not of short-lasting neuralgiform headache attacks. The difficulty in setting up sham-controlled studies has thus far prevented the publication of robust trials. This limitation along with the cost of these therapies has meant that their use is limited in most countries. Conclusion: Neuromodulation is a promising nonpharmacological treatment approach for primary headaches. More studies with appropriate blinding strategies and reduction of device cost may allow more widespread approval of these treatments and in turn increase clinician's experience in neuromodulation.

[Experimental evaluation of the therapeutic potential of liposome-mediated apoe3 gene transfection for cerebral atherosclerosis].

OBJECTIVE: Introduction: In recent years, a stroke has been the cause of high lethality, long-term and sustained disability, the problem of which is still far from being resolved. The root cause of stroke is atherosclerosis. The aim: Study of neurotrophic and neuroprotective functions of apoE in rat brain tissue in experimental atherosclerosis. PATIENTS AND METHODS: Materials and methods: The study included 60 sexually mature rats. The model of experimental atherosclerosis was created by Anichkov method. The experimental animals were divided into 3 groups: control, experimental and a group of animals with experimental atherosclerosis with intrapoly gene apolipoprotein E (apoE) 50 µg of DNA per animal injected on the 1st day of atherosclerosis modeling. RESULTS: Results: Morphological study of cortex in III and V layers in animals with experimental atherosclerosis showed a quantitative and qualitative changes in cellular composition. Neurons had atrophic and destructive changes as well as karyopicnose and carriolysis, nucleoli often were not imagined. Reduced number of normochromic cells (up to 50%), hypochromic cells (up to 4%), double increased number of hyperchromic neurons (up to 10%), prominently hyperchromic neurocytes (up to 20%) and prominently hypochromic neurocytes (up to 10%), non-nucleated cells, so called «shadow cells¼ were observed. Experimental atherosclerosis led to a significant increase in neuroglial layers, an increase in the diameter of vascular lumen due to thickening of the inner and middle layers. Gene therapy had a pronounced neuroprotective effect, led to the restoration of the quantitative and qualitative composition of the neurons, reduction of vessels diameter. CONCLUSION: Conclusions: Experimental cholesterol loading leads to pronounced dystrophy of cells of the sensorimotor layer in rat cerebral cortex. The obtained data confirm the positive preventive effect of gene transfection on the qualitative and quantitative cellular composition and the state of the vascular bed of rat cerebral cortex. The further prospective study is needed.