Treatment of paroxysmal disorders in multiple sclerosis with carbamazepine (Tegretol)

Abstract

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.

Trigeminal Neuralgia Commonly Precedes the Diagnosis of Multiple Sclerosis

“…Controlled clinical trials have suggested that carbamazepine is helpful for paroxysmal pain syndromes, including TN. 18,19 Other studies, generally small open-label trials and observational studies, suggest that gabapentin reduces pain 20,21 and that misoprostol may also be effective. 22 Thus, many of the therapies tried by the present study population have not been shown to be effective for TN.…”

Involuntary tonic spasms of a limb due to a brain stem lacunar infarction.

“…The symptoms typically respond well to carbamazepine. 14 It is unclear what mechanism caused involuntary tonic spasms in the paretic limb of this patient with a pontine lacunar infarction. The absence of any change on the EEG during a typical spell argues against an epileptic phenomenon.…”

Paroxysmal symptoms as the first manifestations of multiple sclerosis.

“…Four patients (1,8,9 and 10) had clinically definite MS, four (11)(12)(13)(14) latent MS and the remaining six (2-7) suspected MS, according to …”