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Refractory atypical trigeminal neuralgia associated with reactivated herpesvirus infection: pathogenetic link and efficacy of combination antiviral therapy

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Abstract

The purpose of this study is to diagnose herpesvirus infections in refractory atypical trigeminal neuralgia, to assess pathogenetic links, and to explore the efficacy of antiviral treatment. In a prospective controlled study, 95 patients with trigeminal neuralgia received antiviral therapy (valacyclovir + alpha2b-interferon) (experimental group, EG). Other patients refused to receive treatment (control group 1 (CG1), n = 31). Control group 2 (CG2) included 32 healthy individuals of the same age and sex. Herpesvirus infection was diagnosed in blood leukocytes by PCR (Biocom, Russian Federation). Serum concentrations of IgM, IgA and IgG to HSV-1/2, VZV (ELISA, Vector-Best, Russian Federation) were determined. Reactivation of herpesvirus infections was observed in the EG in 87% of cases. The heterogeneity of herpesvirus-associated damage of trigeminal nerves and anatomically related areas of the central nervous system (CNS) has been demonstrated. The treatment applied was effective for herpesvirus infection (77%) and pain (61%) and ineffective for immunity correction (26% of cases). Atypical refractory trigeminal neuralgia is associated with herpesvirus infections that reactivate due to minor immunodeficiencies. Antiviral treatment suppresses herpesviruses and reduces the intensity of pain.

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Funding

The study was performed as a fragment of scientific work commissioned by the Ministry of Health of Ukraine, grant No. 0121U107940.

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Authors and Affiliations

  1. Experimental and Clinical Medicine Institute, Bogomolets National Medical University, Kiev, Ukraine

    Dmitry Maltsev

  2. Department of Subtentorial Neurooncology, Romadanov Institute of Neurosurgery, Kiev, Ukraine

    Volodymyr Fedirko

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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by DM. The first draft of the manuscript was written by VF. All authors read and approved the final manuscript.

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Correspondence to Dmitry Maltsev.

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The research complies with the guidelines for human studies and was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The author declares that the work is written with due consideration of ethical standards. The study was conducted in accordance with the ethical principles approved by the Human Experiments Ethics Committee of O'Bogomolets National Medical University (protocol No. 140, 21.12.2020).

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Maltsev, D., Fedirko, V. Refractory atypical trigeminal neuralgia associated with reactivated herpesvirus infection: pathogenetic link and efficacy of combination antiviral therapy. VirusDis. 33, 155–165 (2022). https://doi.org/10.1007/s13337-022-00769-9

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