SummaryThe results of treating 143 patients with trigeminal neuralgia with carbamazepine (CBZ) over a 16-year period have been reviewed. The drug was effective initially with few mild side effects in 99 patients (69 %). Of these, 19 developed resistance later, i.e. between 2 months and 10 years after commencing treatment, and required alternative measures. Of the remaining 80 (56 %), the drug was effective in 49 for 1-4 years and in 31 for 5-16 years. Thirty-six patients (25%) failed to respond to CBZ initially and required alternative measures, as did 8 (6 %) who were intolerant of the drug. One patient developed CBZ-induced water intoxication with hyponatraemia. Subsequently hyponatraemia was excluded in 17 patients who had been taking CBZ for between 4 months and 7 years. This study has thus confirmed the efficacy of CBZ in the treatment of trigeminal neuralgia and shown that it may continue to be effective for many years.

Transient neurological disturbances are not infrequently encountered in multiple sclerosis (MS) and may be precipitated by such factors as exercise, hot baths, smoking and emotion,' neck flexion2 and eye movements.3 It is also of interest that many of the familiar manifestations of MS which typically have a duration of weeks or months may also occur in the form of shortlived repetitive paroxysms. The nature of the paroxysmal symptoms depends on their site of origin, which is usually in the brain stem or spinal cord. The main types that have been reported are tonic seizures, paroxysmal dysarthria and ataxia, paroxysmal paraesthesiae and pains including trigeminal neuralgia, and paroxysmal akinesia. These may be distinguished firstly by their brevity, lasting usually for just a few seconds to one to two minutes, and secondly by recurring in a stereotyped fashion from a few times a day to several times an hour. Most come on spontaneously, but some are triggered by hyperventilation, anxiety, muscular activity and tactile stimuli. They continue to recur in this way for a few days, weeks or months whereupon remission ensues, but the response to treatment with carbamazepine is often dramatic.

SUMMARY During an eight year period, 32 patients with definite or suspected multiple sclerosis (MS) were seen with paroxysmal neurological disturbances, which included tonic seizures, paroxysmal dysarthria, paraesthesiae and pain in the limbs, as well as trigeminal neuralgia. In 21 of these patients the paroxysmal disorders were treated with carbamazepine, and in six the effect was compared with placebo. In the majority carbamazepine was effective in controlling the paroxysmal symptoms. Side-effects were troublesome in a few patients, but they could usually tolerate small doses, which still gave relief. Although the patho-physiological basis for these paroxysmal disorders remains unexplained, their response to carbamazepine suggests a common mechanism.

Migraine is a common condition thought to result from vasomotor changes usually in the distribution of the carotid and vertebro-basilar arteries. According to Kunkle and Wolff (1951)

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