Severe Pain Attack Associated with Neurocardiogenic Syncope Induced by Glossopharyngeal Neuralgia: Successful Treatment with Carbamazepine and a Permanent Pacemaker -A Case Report-

Abstract

Glossopharyneal neuralgia (GPN) is generally considered to be a pain disease. However, it can be also be a life-threatening cardiac cause of syncope. Neuralgia in the throat and neck can trigger severe bradycardia up to the point of asystole, which can progress to cardiac syncope with or without seizures. A 65 year-old male patient diagnosed with glossopharyngeal neuralgia complained of severe paroxysmal pain in his right chin and ear followed by bradycardia, aystole and syncope. We report a case successfully treated with a permanent pacemaker and carbamazepine in a patient with GPN who had syncopal attacks preceded by paroxysms of pain.

Opiate‐Free Pain Therapy Using Carbamazepine‐Loaded Microparticles Provides Up to 2 Weeks of Pain Relief in a Neuropathic Pain Model

“…As such, there is an unmet medical need to develop better analgesic options for managing pain without such potentially debilitating side effects or rendering the region numb and unmovable. Anticonvulsants represent a clinically proven, alternative class of therapeutics for the management of neuropathic pain; however, oral doses are often high in order to counteract short biological half‐lives and to achieve therapeutic concentrations at the anatomical site of interest. Therefore, the use of anticonvulsants in pain management strategies is often limited.…”

A Bone-Breaking Case of Syncope Due to Glossopharyngeal Neuralgia

“…In some reports [17,18] treatment with carbamazepine abolished the pain and associated cardiovascular manifestations. However, in other cases, treatment with carbamazepine alone [19,20], carbamazepine and gabapentin combination [21] or clonazepam [22] was not sufficient to alleviate the pain and syncopal episodes in GPN, necessitating the insertion of a permanent pacemaker to prevent syncope. Other successful treatments of refractory cases included section of the ninth (glossopharyngeal) nerve alone [23,24], or combined with rhizotomy and microvascular decompression of the lower cranial nerves [25].…”

Successful implanted pacemaker for an extreme inhibitory reflex syncope evoked by post herpetic trigeminal neuralgia

“…This has led to recommendations by the European Society of Cardiology and the European Heart Rhythm Association to assign a Class IIa for pacemakers in patients older than 40 years and with documented cardioinhibitory mediated syncope [1]. In the past, permanent pacemakers have been implanted in patients with syncope due to glossopharyngeal neuralgia which can have an unpredictable course [12,13].…”