TY - JOUR

T1 - Motor-related white matter tracts are prominently affected in primary trigeminal neuralgia

AU - Pashkov, Anton

AU - Filimonova, Elena

AU - He, Jianzhong

AU - Feng, Yuanjing

AU - Moysak, Galina

AU - Rzaev, Jamil

N1 - Anton Pashkov, Elena Filimonova, Jianzhong He, Yuanjing Feng, Galina Moysak, Jamil Rzaev, Motor-related white matter tracts are prominently affected in primary trigeminal neuralgia, Clinical Neurology and Neurosurgery, Volume 270, 2026, 109601, ISSN 0303-8467, https://doi.org/10.1016/j.clineuro.2026.109601.

PY - 2026/11

Y1 - 2026/11

N2 - BACKGROUND: Primary trigeminal neuralgia (PTN) is a severe chronic pain disorder, yet whole-brain white matter microstructural alterations beyond the trigeminal nerve remain poorly understood, partly due to limitations of conventional diffusion tensor imaging in crossing fiber regions.METHODS: We prospectively enrolled 57 patients with classical PTN and 29 age‑ and sex-matched healthy controls. Seventy-two whole‑brain white matter tracts were reconstructed using constrained spherical deconvolution and fixel-based analysis. Fractional anisotropy (FA) was compared between groups using permutation testing with false discovery rate correction. Additional analyses examined associations with clinical variables, surgical outcomes, and neurovascular conflict status.RESULTS: Six tracts showed significantly reduced FA in PTN patients compared to controls (all p < 0.05, FDR-corrected). All six belong to motor-related systems: right fronto-pontine tract, left corticospinal tract, and four striatal tracts (right striato-prefrontal, right striato-fronto-orbital, right striato-occipital, left striato-parietal). No significant correlations with pain severity or disease duration survived multiple comparisons.CONCLUSIONS: Microstructural white matter alterations in PTN are not limited to sensory trigeminal pathways but prominently involve motor-associated striato-cortical and corticofugal projection tracts, suggesting that motor system reorganization may be one of the core features of PTN pathophysiology.

AB - BACKGROUND: Primary trigeminal neuralgia (PTN) is a severe chronic pain disorder, yet whole-brain white matter microstructural alterations beyond the trigeminal nerve remain poorly understood, partly due to limitations of conventional diffusion tensor imaging in crossing fiber regions.METHODS: We prospectively enrolled 57 patients with classical PTN and 29 age‑ and sex-matched healthy controls. Seventy-two whole‑brain white matter tracts were reconstructed using constrained spherical deconvolution and fixel-based analysis. Fractional anisotropy (FA) was compared between groups using permutation testing with false discovery rate correction. Additional analyses examined associations with clinical variables, surgical outcomes, and neurovascular conflict status.RESULTS: Six tracts showed significantly reduced FA in PTN patients compared to controls (all p < 0.05, FDR-corrected). All six belong to motor-related systems: right fronto-pontine tract, left corticospinal tract, and four striatal tracts (right striato-prefrontal, right striato-fronto-orbital, right striato-occipital, left striato-parietal). No significant correlations with pain severity or disease duration survived multiple comparisons.CONCLUSIONS: Microstructural white matter alterations in PTN are not limited to sensory trigeminal pathways but prominently involve motor-associated striato-cortical and corticofugal projection tracts, suggesting that motor system reorganization may be one of the core features of PTN pathophysiology.

KW - Primary trigeminal neuralgia

KW - White matter

KW - Neuroimaging

KW - Motor system

KW - MR tractography

KW - Первичная тригеминальная невралгия

KW - Белое вещество

KW - Нейровизуализация

KW - Моторная система

KW - МР-трактография

UR - https://www.scopus.com/pages/publications/105046503608

U2 - 10.1016/j.clineuro.2026.109601

DO - 10.1016/j.clineuro.2026.109601

M3 - Article

C2 - 42551242

VL - 270

SP - 109601

JO - Clinical Neurology and Neurosurgery

JF - Clinical Neurology and Neurosurgery

SN - 0303-8467

ER -