Influence of lamotrigine over the sunct syndrome: one patient follow-up for two years

Abstract

-The SUNCT syndrome is characterized by a short-lasting headache in the first division of the trigeminal nerve, associated with ipsilateral autonomic symptoms. It is highly refractory to prophylactic medication. We describe a case where lamotrigine reduced the intensity, duration, and frequency of attacks and increased the remission period of this disorder. Over a two-year period, the attacks came back immediately whenever the patient reduced the dose or neglected treatment. We concluded that lamotrigine is effective in treating SUNCT syndrome when used in high doses for a prolonged period of time.KEY WORDS: lamotrigine, prophylactic treatment, SUNCT syndrome, trigeminal autonomic cephalalgia.Influência da lamotrigina sobre a síndrome SUNCT: comportamento de um paciente durante período de dois anos RESUMO -A sindrome SUNCT caracteriza-se por cefaléia de curta duração localizada na primeira divisão do nervo trigêmio e associada com sintomas autonômicos ipsilaterais. A resposta clínica aos diversos tratamentos profiláticos propostos têm sido caracterizados pela alta refratoriedade. Nós descrevemos um caso em que a lamotrigina reduziu a intensidade, duração e frequência dos ataques, aumentando o período de remissão. Por um período de dois anos em que utilizamos a lamotrigina, surgiram novos ataques quando o paciente reduziu a dose ou negligenciou o seu tratamento.Concluímos que lamotrigina é tratamento eficaz para a síndrome SUNCT quando utilizada em altas doses e por período prolongado de tempo. PALAVRAS-CHAVE: cefaléias trigemino-autonomicas, lamotrigina, SUNCT sindrome, tratamento profilático. Dr. Elcio Juliato Piovesan -Rua Jorge Manços do Nascimento Teixeira 868 -83005-500 São José dos Pinhais PR -Brasil.Shortlasting, unilateral, neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome) was first described by Sjaastad 25 years ago 1 . During this period, some new clinical evidences were included in the spectrum of this syndrome, but our knowledge of this disorder is constantly advancing.We describe a case responsive to lamotrigine and review the current literature on SUNCT. CASEA 45-year-old man had a five-year history of severe shooting pain over the left eye that lasted 30 seconds and occured as often as 20 times a day. These symptoms were accompanied by intense ipsilateral tearing, conjunctival injection, and nasal congestion. Attacks could be provoked by touching the left temporal region, putting his foot on the ground, eating, or moving his neck. General physical and neurologic examinations, routine blood analysis, and CT and MRI of the brain were normal. The patient tried indomethacin 200mg/day, verapamil 480mg/day, carbamazepine 1200mg/day, phenytoin 300mg/day, valproate 1000mg/day, and greater occipital and supraorbital blocker with bupivacaine and steroids, all without effect. During the attacks, he used oxygen and triptans but had poor results. The patient also had thermocoagulation of the ipsilateral trigeminal ganglion performed. He had a good result and was symptom-f...

SUNCT syndrome associated with pituitary tumor: case report

“…There have been re p o rts of impro v ement upon the use of amitriptyline, carbamazepine, gabapentin, prednisone, topiramate 5 , lamotrigine 6 , nifedipine and sumatriptan 4 . Anesthetic blockades do not work very well, although there have been re p o rts of improvement following the local opioid blockade of the superior cervical ganglion 7 .…”

Trigemino-autonome Kopfschmerzen – neue Aspekte und Konzepte

“…Studien zur Behandelbarkeit existieren nicht, lediglich einzelne Fallberichte in der Literatur zeigen vereinzelte Erfolge durch die Gabe von Lamotrigin [53], Gabapentin [120,121] und Topiramat [122] oder Triptanen [123], z. T. auch in Kombination. In letzter Zeit häufen sich Einzelfallbeschreibungen zur Wirksamkeit von Lamotrigin [53,124,125], sodass ein Therapieversuch mit dieser Substanz vielversprechend erscheint. Operative Verfahren wie eine Rhizolyse [126] oder radio-chirurgische Verfahren [127] sind beschrieben worden, ohne dass sie jedoch aktuell abschließend bewertet werden können.…”

The Role of Lamotrigine in the Treatment of Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing Syndrome

“…Lamotrigine 300 mg/day completely abolished SUNCT attacks in a 45-year-old man who had failed numerous other treatments (indomethacin, verapamil, carbamazepine, phenytoin, valproate, greater occipital and supraorbital blocker, oxygen, and triptans) and was intolerant to methysergide and celecoxib. 25 He had a 5-year history of 20 attacks per day. After 5 successful months of lamotrigine 300 mg/day, the dose was tapered and the attacks recurred with 100 mg/day.…”