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CompletedNCT03396406Updated Jan 11, 2018

Treatment of Recurrent Trigeminal Neuralgia by Using Extended Duration of Pulsed Radiofrequency

An interventional study of Pulsed radiofrequency (PRF) and thermocoagulation in Trigeminal Neuralgia, sponsored by Assiut University. Completed at 1 site in Egypt. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2018-01-11.

Sponsored by Assiut University · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
40
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

Forty patients with history of recurrent TN were recruited in Assiut University Hospitals, Pain Unit from 2012 to 2017. Before the study, all patients were given adequate and informative data about the nature of the study, interventional procedure and its possible complications, and a well-informed written consent was obtained from each patients.

Read the detailed description

All interventions were done in a specialized well-equipped unit at Assiut University hospital and continuous hemodynamic monitoring with pulse oximetry, blood pressure and ECG applied for each patient. Light sedation by using midazolam 5mg bolus. In a supine position with slightly extended head and under fluoroscopic control, C arm rotated caudo-cranially and ipsilateraly to produce an oblique submental view and visualize foramen ovale beside the ramus of the mandible. The point of entry varied according to the affected branch, but it ranged from 0.5-1.5 cm from the corner of the mouth. The point of entry cleaned by aseptic solution and anaesthetized with 1% of Lidocaine. C arm has been rotated laterally to confirm the depth of penetration once the needle entered into Meckel's cavity. RF electrode (22-G, 10 cm needle, with a curved 5 mm active tip, Neurotherm 1100) was used and the exact position of the needle confirmed by sensory stimulation, motor stimulation and negative aspiration as the following criteria:-

  1. Sensory stimulation (50 Hz) threshold between 0.1-0.3 V which made paresthesia and/ or tingling in the affected painful area. Patient was awake to respond to the sensory stimulation
  2. Motor stimulation at 2Hz with 0.1-1.5V caused muscle contraction of the lower mandible.

After confirming the position of the RF electrode, each patient received 0.5 ml of 1% of Lidocaine to avoid discomfort during treatment. Then the type of intervention determined by the person who was responsible for randomisation process and who did not involve in assessing eligibility or interventional technique and divided into:-

  • Group A: pulsed radiofrequency was applied for 4 cycles of 120 seconds ( 8 minutes in total) at 45 V and temperature was set at 42 C. then conventional radiofrequency thermal lesion was applied for 3 cycles of 90 seconds at 60 c.
  • Group B: thermal energy was applied gradually for 3 cycles of 90 seconds at 70 C.
02

Conditions studied

  • Trigeminal Neuralgia

Keywords

  • trigeminal neuralgia, radiofrequency
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

    • Patient with severe, recurrent TN for more than 6 months, non-satisfactory pain relief with medical treatment or/and intolerable to medical drugs

      • Age more than 18 years old
      • Pain score ≥ 7
      • Patient consent to participate

Exclusion criteria

Exclusion Criteria:

    • Known concurrent neurological or neurodegenerative diseases such as multiple sclerosis, and myasthenia gravis

      • Breast feeding or pregnant women
      • Advanced malignancy or brain stem tumors
      • Coagulopathy or patients on anticoagulant medications
      • Allergy/ sensitivity to Lidocaine anesthetic or/and non- ionic contrast media
      • Presence of Progressive Motor or sensory deficit in the distribution of trigeminal nerve
      • Active psychological or mental diseases
      • Uncontrolled medical or respiratory conditions
      • Patients who are unwilling to participate
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Care provider, Investigator)
Enrollment
40 participants (actual)

Study arms

  • Experimental
    PCRF group

    received Pulsed radiofrequency (PRF) at 42°C for 8 minutes followed by CRF at 60°C for 270s

    Device: Pulsed radiofrequency (PRF)

  • Experimental
    CRF group

    received sole thermocoagulation at 70°C for 270 s

    Device: thermocoagulation

Interventions

  • DevicePulsed radiofrequency (PRF)

    received PRF at 42°C for 8 minutes followed by CRF at 60°C for 270s

  • Devicethermocoagulation

    received sole CRF at 70°C for 270 s

05

What researchers measure

Primary outcomes

  1. Visual analog pain score

    The response for interventional treatment was evaluated in subsequent visits at pain clinic or by telephone

    Time frame: one month

  2. Visual analog pain score

    The response for interventional treatment was evaluated in subsequent visits at pain clinic or by telephone

    Time frame: 6 months

  3. Visual analog pain score

    The response for interventional treatment was evaluated in subsequent visits at pain clinic or by telephone

    Time frame: one year

  4. Visual analog pain score

    The response for interventional treatment was evaluated in subsequent visits at pain clinic or by telephone

    Time frame: 2 years

Secondary outcomes

  1. change in medical treatment

    need for tricyclic antidepressant

    Time frame: 2 years

06

Study locations

1 site
  • Assiut university faculty of medicine
    Assiut, 7111, Egypt
07

References and documents

Publications

  • Elias WJ, Burchiel KJ. Microvascular decompression. Clin J Pain. 2002 Jan-Feb;18(1):35-41. doi: 10.1097/00002508-200201000-00006. PubMed 11803301 ↗
  • Abdel-Rahman KA, Elawamy AM, Mostafa MF, Hasan WS, Herdan R, Osman NM, Ibrahim AS, Aly MG, Ali AS, Abodahab GM. Combined pulsed and thermal radiofrequency versus thermal radiofrequency alone in the treatment of recurrent trigeminal neuralgia after microvascular decompression: A double blinded comparative study. Eur J Pain. 2020 Feb;24(2):338-345. doi: 10.1002/ejp.1489. Epub 2019 Oct 16. PubMed 31571339 ↗

Individual participant data

Plan to share: Undecided

08

Registry details

Key details

Study ID
NCT03396406
Lead sponsor
Assiut University
Responsible party
Abdelrady S Ibrahim, MD (Assistant professor of Anesthesia and Intensive care, Assiut University) — Principal investigator
First posted
Jan 11, 2018
Start date
Aug 2012
Primary completion
Jun 2017
Completion
Sep 2017
Last update
Jan 11, 2018

Study contacts

Abdelrady S Ibrahim, M.D.
principal investigator · Assiut university faculty of medicine

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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