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. 2023 Dec;44(12):4465-4472.
doi: 10.1007/s10072-023-06923-5. Epub 2023 Jul 12.

Sex differences in trigeminal neuralgia: a focus on radiological and clinical characteristics

Gianfranco De Stefano  1 , Daniel Litewczuk  1 , Cristina Mollica  2 , Giuseppe Di Pietro  1 , Eleonora Galosi  1 , Caterina Leone  1 , Pietro Falco  1 , Maria Giulia Tullo  3 , Francesca Caramia  1 , Andrea Truini  1 , Giulia Di Stefano  1
Affiliations

Sex differences in trigeminal neuralgia: a focus on radiological and clinical characteristics

Gianfranco De Stefano et al. Neurol Sci. 2023 Dec.

Abstract

Background: It is well established that trigeminal neuralgia is more prevalent in females than in males. Neurovascular compression with morphological changes of the trigeminal root represents the most recognized etiological factor. However, other factors may play a role in the framework of a multi-hit model. The primary aim of this study was to investigate sex differences in radiological and clinical characteristics of trigeminal neuralgia to better understand the multifactorial origin of this peculiar neuropathic pain condition.

Methods: In this cross-sectional study patients with a definite diagnosis of primary trigeminal neuralgia were consecutively enrolled. Each patient underwent 3T MRI with sequences dedicated to the study of neurovascular compression. Major morphological changes of the trigeminal root were quantitatively assessed. Clinical characteristics were systematically collected through a dedicated questionnaire. A logistic regression model was implemented to predict radiological and clinical characteristics based on sex.

Results: A total of 114 patients with classical (87) or idiopathic trigeminal neuralgia (27) were enrolled. Female sex was predictive for idiopathic trigeminal neuralgia. Male sex was predictive, among the comorbidities and clinical characteristics, for hypertension, the involvement of the left side and the second trigeminal division, alone or with the ophthalmic division.

Discussion: The preponderance of TN in the female sex and the association between idiopathic TN and the female sex suggest the role of additional etiological factors in the framework of a multi-hit model. The identification of clinical variables predicted by sex suggests the possibility that distinct phenotypes, with peculiar pathophysiological and therapeutic aspects, may occur in females and males.

Keywords: Multi-hit model; Neurovascular conflict; Paroxysmal pain; Sex differences; Trigeminal neuralgia; Trigeminal root.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
MRI CISS images of an exemplary patient with classical (A) and idiopathic (B) right TN. In (A) a vessel (arrow) impacts the right trigeminal root (arrowhead), which appears atrophic compared to the contralateral (star). In (B) no clear pathology affects the right trigeminal root (arrowhead), which appears similar to the contralateral (star)
Fig. 2
Fig. 2
ROC curve and AUC of the logistic regression for sex prediction
See this image and copyright information in PMC

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