Intravenous fosphenytoin as treatment for acute exacerbation of trigeminal neuralgia: A prospective systematic study of 15 patients

Abstract

Introduction Intravenous fosphenytoin is widely used for acute exacerbation of trigeminal neuralgia, however, few studies have investigated this treatment. We aimed to examine the efficacy and side effects of initial intravenous fosphenytoin plus oral tapering of phenytoin for exacerbation of trigeminal neuralgia. Methods Consecutive patients with primary trigeminal neuralgia were included in this prospective observational 90-days follow-up study. Data were collected using standardized interviews before, at 24 hours, day 7, 30 and 90 post loading dose. The primary outcome was the proportion of responders defined as a 50% reduction in pain intensity 24 hours post loading dose. Results We included 15 patients. Nine patients (60%) were responders. Pain intensity 24 hours post loading dose was reduced by 5.00 points on the numerical rating scale (p < 0.001), and at day 7 by 5.5 points (p < 0.001). The most common side effects were hypotension and dizziness. Conclusion Intravenous fosphenytoin relieves trigeminal neuralgia pain in most patients and provides a window for titrating prophylactic trigeminal neuralgia medications or planning neurosurgery. The decision to administer intravenous fosphenytoin should be taken with support from trigeminal neuralgia experts and involves considerations of co-morbidities and other treatment options for acute exacerbation of trigeminal neuralgia. Clinical Trial: Preregistered (ClinicalTrials.gov Identifier: NCT03712254

Lidocaine aerosol sprayed on oral and/or nasal mucosa for the rescue of acute trigeminal neuralgia exacerbations: A retrospective study

“…Acute TN exacerbation is a common reason for frequent visits to the emergency department, that often occur while waiting for surgery, but evidence on effective drugs in acute TN attacks is scant and no option is considered the gold standard up to now. Treatment options such as lidocaine (topical or systemic application), anticonvulsant (intravenous infusion), phenytoin or fosphenytoin (intravenous infusion), serotonin agonist (subcutaneous injection), sumatriptan (subcutaneous injection) and botulinum toxin (trigger point injection) are beneficial for acute exacerbations of TN (4–6), but evidence-based studies are scarce and future investigations should report on outcomes within 24h to improve knowledge of the acute TN exacerbation treatments.…”