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Randomized Controlled Trial
. 2020 Feb;24(2):338-345.
doi: 10.1002/ejp.1489. Epub 2019 Oct 16.

Combined pulsed and thermal radiofrequency versus thermal radiofrequency alone in the treatment of recurrent trigeminal neuralgia after microvascular decompression: A double blinded comparative study

Khaled A Abdel-Rahman  1 , Abdelraheem M Elawamy  1 , Mohamed F Mostafa  1 , Waleed S Hasan  1 , Ragaa Herdan  1 , Nagwa M Osman  1 , Abdelrady S Ibrahim  1 , Mohamed G Aly  1 , Abdelhady S Ali  1 , Gamal M Abodahab  2
Affiliations
Randomized Controlled Trial

Combined pulsed and thermal radiofrequency versus thermal radiofrequency alone in the treatment of recurrent trigeminal neuralgia after microvascular decompression: A double blinded comparative study

Khaled A Abdel-Rahman et al. Eur J Pain. 2020 Feb.

Abstract

Background: Recurrent trigeminal neuralgia (RTN) is a common clinical problem and pain recurs in many patients after microvascular decompression (MVD). We evaluated the effect of adding pulsed radiofrequency to radiofrequency thermocoagulation at 60°C compared to radiofrequency thermocoagulation at 70°C alone in the treatment of recurrent trigeminal neuralgia after microvascular decompression.

Methods: 40 patients with recurrent trigeminal neuralgia after microvascular decompression were randomly divided into two equal groups. Group A: received prolonged duration of pulsed radiofrequency followed by less destructive thermocoagulation, while group B: received sole thermocoagulation. Then patients followed up for 2 years to evaluate the success rate by the Barrow Neurological Institute Pain Intensity (BNI) Scale, complications, and the need to medical treatment.

Results: The success rate was 100% in both groups at discharge (BNI < III). It was 83.3% and 78.7% after 6 months, 77.8% and 68.4% after 12 month, 72.2% and 68.4% after 18 months and 66.7% and 63.1% after 24 months in group A and B, respectively (p > .05). In group A 88.9% of patients stopped tegretol treatment after the procedure compared to 84.2% in group B (p = .32). 88.9% compared to 89.5% % in group A and B, respectively, did not use tricyclic antidepressant (p = .61). The overall complications in group A was 5.61%, while it was 36.8% in group B (p = .025).

Conclusion: Combined pulsed and thermal radiofrequency can significantly reduce the incidence of the side effects/complications with similar success rate than using thermal radiofrequency alone in treatment of recurrent trigeminal neuralgia after microvascular decompression.

Trial registration: ClinicalTrials.gov NCT03396406.

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References

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