Trigeminal Neuralgia

Focused Ultrasound Therapy

Early Stage squareFocused ultrasound is an early-stage, noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with trigeminal neuralgia. This novel technology focuses beams of ultrasound energy precisely and accurately on targets deep in the brain without damaging surrounding normal tissue. Where the beams converge, the ultrasound produces precise ablation (thermal destruction of tissue) enabling trigeminal neuralgia to be treated without surgery.

There are two approaches to using focused ultrasound to treat trigeminal neuralgia. One group believes that focused ultrasound could provide a noninvasive way to heat and destroy the pain fibers of the trigeminal nerve as an alternative to radiofrequency ablation and gamma knife surgery. A recent preclinical study has demonstrated the feasibility of focused ultrasound to heat the trigeminal nerve. More work is needed in preclinical models and, eventually, in patients to determine the efficacy and safety of focused ultrasound treatment for trigeminal neuralgia.

Another group considers that trigeminal neuralgia is a given localization of neuropathic pain. Therefore, they treat this syndrome like any other form of neuropathic pain. Currently, they perform a type of medial thalamotomy which has been shown to provide an average pain relief of 60 percent, and which does not bring a risk of iatrogenic pain production nor produce somatosensory deficits. This group is treating trigeminal neuralgia as part of the neuropathic pain CE approval in Europe.

The primary options for treatment of trigeminal neuropathy include medication or invasive surgery.

For certain patients, focused ultrasound could provide a noninvasive alternative to surgery with reduced risk of complications and lower cost.

Advantages:

  • Focused ultrasound is noninvasive, so it does not carry added concerns like surgical wound healing or infection.
  • Focused ultrasound can reach the desired target without damaging surrounding tissue.
  • It can be repeated, if necessary.

Clinical Trials

A current clinical trial at the University of Virginia is looking to treat patients with chronic trigeminal pain.
See a full list of trigeminal neuralgia clinical trials. 

See a list of treatment sites >
See a list of laboratory research sites >

Regulatory Approval and Reimbursement 

Trigeminal neuralgia treatment in the US has not been approved by regulatory bodies or covered by medical insurance companies. In Europe, trigeminal neuralgia has been treated under the neuropathic pain CE Mark.

Notable Papers

Dallapiazza RF, Timbie KF, Holmberg S, Gatesman J, Lopes MB, Price RJ, Miller GW, Elias WJ. Noninvasive neuromodulation and thalamic mapping with low-intensity focused ultrasound. J Neurosurg. 2018 Mar;128(3):875-884. doi: 10.3171/2016.11.JNS16976. Epub 2017 Apr 21.

Monteith SJ, Medel R, Kassell NF, Wintermark M, Eames M, Snell J, Zadicario E, Grinfeld J, Sheehand JP, Elias WJ. Transcranial magnetic resonance-guided focused ultrasound surgery for trigeminal neuralgia: a cadaveric and laboratory feasibility study. J Neurosurg. 2013;118(2):319-28.

Pirrotta R1, Jeanmonod D, McAleese S, Aufenberg C, Opwis K, Jenewein J, Martin-Soelch C. Cognitive Functioning, Emotional Processing, Mood, and Personality Variables Before and After Stereotactic Surgery: A Study of 8 Cases With Chronic Neuropathic Pain. Neurosurgery. 2013 Jul;73(1):121-8. doi: 10.1227/01.neu.0000429845.06955.70.

Daniel Jeanmonod, Beat Werner, Anne Morel, Lars Michels, Eyal Zadicario, Gilat Schiff, Ernst Martin. Transcranial magnetic resonance imaging–guided focusedultrasound: noninvasive central lateral thalamotomy forchronic neuropathic pain. Neurosurg Focus. 2012 Jan;32(1):E1. doi: 10.3171/2011.10.FOCUS11248.

Michels L, Moazami-Goudarzi M, Jeanmonod D. Correlations between EEG and clinical outcome in chronic neuropathic pain: surgical effects and treatment resistance. Brain Imaging Behav. 2011 Dec;5(4):329-48. doi: 10.1007/s11682-011-9135-2.

Click here for additional references from PubMed.