Treatment of refractory trigeminal neuralgia with intravenous phenytoin

Tate, Rebekah; Rubin, Lisa M.; Krajewski, Kristin C.

doi:10.2146/ajhp100636

Cited by 36 publications

(32 citation statements)

References 11 publications

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“…11 Historically, PHT was the first effective treatment for TN. 11,15,17 PHT-induced sodium channel block on neuronal membranes, in this case of the trigeminal nerve, is capable of reducing electrical signal propagation, 15 hence stabilizing the membrane. 11,[15][16][17] Factors influencing PHT as our choice for TN crisis treatment included its mechanism of action, the extensive evidence on its tolerability, and the rapid increase in plasma concentrations after IV administration.…”

Section: Discussionmentioning

confidence: 99%

Trigeminal Neuralgia Crisis – Intravenous Phenytoin as Acute Rescue Treatment

et al. 2020

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Objective The aim of this retrospective cohort study was to analyze responses to intravenous (IV) phenytoin (PHT) for trigeminal neuralgia (TN) crisis in a group of patients treated at our institution. Background TN is one of the most common causes of facial pain. Its treatment relies on preventive therapy with either carbamazepine or oxcarbazepine. During severe pain episodes, patients may be unable to eat, drink, or even swallow oral medication, requiring in‐hospital treatment. There is scarce evidence to support IV medication use for TN, making management of this condition difficult. Methods We reviewed clinical records of patients with TN crisis consulting the emergency department at a tertiary neurological referral center in Buenos Aires, Argentina, treated with IV PHT as analgesic strategy, and with at least 1‐month posttreatment follow‐up. Demographic features, magnetic resonance imaging findings, and therapeutic management were analyzed. Results Thirty‐nine patients with TN were included, 18 (46.2%) receiving IV PHT more than once (total number of infusions administered, 65). Immediate pain relief was observed in 89.2% (58/65) and 15.4% (10/65) presented side effects. Conclusions We recommend IV PHT as acute rescue treatment in TN crisis.

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Section: Discussionmentioning

confidence: 99%

Trigeminal Neuralgia Crisis – Intravenous Phenytoin as Acute Rescue Treatment

et al. 2020

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“…Carbamazepine (CBZ) is drug of choice in TN; baclofen, lamotrigine, clonazepam, oxcarbazepine, topiramate, phenytoin, gabapentin, pregabalin, and sodium valproate can be used. [ 63 64 65 ] Multi drugs are useful when patients are unable to tolerate higher doses of CBZ. [ 66 ] With an availability of increasing number of anticonvulsant drugs, it is likely that surgical option may not be offered for many years.…”

Section: Medical Treatmentmentioning

confidence: 99%

Trigeminal neuralgia

Yadav

Pande

et al. 2017

Asian J Neurosurg

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Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Type 1 as intermittent and Type 2 as constant pain represent distinct clinical, pathological, and prognostic entities. Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Diagnosis is essentially clinically; magnetic resonance imaging is useful to rule out secondary causes, detect pathological changes in affected root and neurovascular compression (NVC). Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine, phenytoin, and topiramate are also useful. Multidrug regimens and multidisciplinary approaches are useful in selected patients. Microvascular decompression is surgical treatment of choice in TN resistant to medical management. Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures. Partial sensory root sectioning is indicated in negative vessel explorations during surgery and large intraneural vein. Endoscopic technique can be used alone for vascular decompression or as an adjuvant to microscope. It allows better visualization of vascular conflict and entire root from pons to ganglion including ventral aspect. The effectiveness and completeness of decompression can be assessed and new vascular conflicts that may be missed by microscope can be identified. It requires less brain retraction.

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“…The antiepileptic drugs, such as carbamazepine [23,24] oxcarbazepine [25,26] and phenytoin [27,28], are commonly used in the treatment of TN, but a substantial proportion of patients have poor response to this treatment, predominantly because of their side effects related to the central nervous system [6]. Eventually, many TN patients become refractory to antiepileptic drugs and other drugs [29-32].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic efficacy and safety of botulinum toxin type A in trigeminal neuralgia: a systematic review

Guan

Fan

et al. 2013

J Headache Pain

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Trigeminal neuralgia is a common disorder caused mainly by compression of the trigeminal nerve root by an overlying blood vessel. Pharmacotherapy and surgery are ineffective or unsuitable in many patients. Therefore, other therapeutic modalities have been tried, including injection of botulinum toxin type A (BTX-A). This study aims to systematically review the therapeutic efficacy and safety of BTX-A in trigeminal neuralgia. PubMed, EMBASE, Cochrane Library Clinical Trials and Web of Science from January 1966 to March 2013 were searched with the terms of “botulinum toxin” AND “trigeminal neuralgia”, and references of related articles were traced. Data on the efficacy and safety of BTX-A in this disorder were extracted and analyzed by at least 2 reviewers. Data for individual studies were reported, and pooled data were analyzed if appropriate. Five prospective studies and one double-blind, randomized, placebo-controlled study were identified. Response was achieved in approximately 70-100% of patients, and the mean pain intensity and frequency were reduced by approximately 60-100% at 4 weeks after treatment in most studies. Major adverse events were not reported. Available studies show BTX-A may be effective in treatment of trigeminal neuralgia. However, well-designed randomized, controlled, double-blinded trial is still lacking. Future BTX-A treatment studies on optimal dose, duration of the therapeutic efficacy, common AEs, and the time and indications for repeat injection would be promising.

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Treatment of refractory trigeminal neuralgia with intravenous phenytoin

Abstract: Phenytoin sodium 15 mg/kg i.v. divided into two doses separated by four hours was safe and effective in treating an acute exacerbation of refractory TN.

Cited by 36 publications

References 11 publications

Trigeminal Neuralgia Crisis – Intravenous Phenytoin as Acute Rescue Treatment

Trigeminal Neuralgia Crisis – Intravenous Phenytoin as Acute Rescue Treatment

Trigeminal neuralgia

Therapeutic efficacy and safety of botulinum toxin type A in trigeminal neuralgia: a systematic review

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