Low-Dose Gabapentin Combined with either Lamotrigine or Carbamazepine Can Be Useful Therapies for Trigeminal Neuralgia in Multiple SclerosisSolaro C.a,c · Messmer Uccelli M.c · Uccelli A.a · Leandri M.b · Mancardi G.L.a
aDepartment of Neurological Sciences and Rehabilitation and bInteruniversity Centre for Pain Neurophysiology, University of Genoa, and cDepartment of Social and Health Services and Research, The Italian Multiple Sclerosis Society, Genoa, Italy
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Paroxysmal symptoms occur frequently in multiple sclerosis (MS). Usually they are treated with carbamazepine (CBZ) and phenytoin, although these medications are often interrupted due to adverse effects. We report 11 MS patients with trigeminal neuralgia (TN): 6 intolerant to a therapeutic dosage of CBZ, showing serious adverse effects and subsequently treated with a combination of low-dose CBZ and gabapentin (GBP) (group 1); 5 treated with lamotrigine (LMT), showing adverse effects and subsequently treated with GBP (group 2). Subjective pain level and impairment in performing daily activities were rated utilizing a 3-point scale at time 0 and at optimal dosage time (T1). GBP was initiated at 300 mg daily and titrated, until pain control was achieved without new adverse effects, to a maximum dose of 1,200 mg daily. CBZ or LMT were reduced to a level which no longer produced adverse effects, although resulting in a lack of efficacy in relieving pain. Pain control was obtained in all patients but 1, with no side effects. The plasma level analysis, performed in 5 patients, resulted in normal values. The mean dosages at T1 were: group 1 CBZ 400 mg and GBP 850 mg daily; group 2 LMT 150 mg and GBP 780 mg daily. Combining drugs with complementary modes of action may provide a rational pharmacological approach to the management of TN in MS.
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Matthews B: Symptoms and signs of multiple sclerosis; in Compston A (ed): McAlpine’s Multiple Sclerosis. London, Churchill Livingstone, 1998, pp 145–190.
Wilder BJ: The treatment of epilepsy: An overview of clinical practices. Neurology 1995;45(suppl 2):S7–S11.
Schapiro RT, Baumhefner RW, Tourtellotte WW: Multiple sclerosis: A clinical viewpoint to management; in Raine CS, McFarland HF, Tourtellotte WW (eds): Multiple sclerosis: Clinical and Pathogenetic Basis. London, Chapman & Hall, 1997, pp 391–420.
- Lunardi G, Leandri M, Albano C, Cultrera S, Fracassi M, Rubino VA, Favale E: Lamotrigine clinical effectiveness and plasma levels in idiopathic and symptomatic trigeminal neuralgia. Neurology 1997;48:1714–1717.
- Solaro C, Lunardi G, Capello E, Inglese M, Messmer Uccelli M, Uccelli A, Mancardi GL: An open-label trial of gabapentin treatment of paroxysmal symptoms in multiple sclerosis patients. Neurology 1998;51:609–611.
- Khan OA: Gabapentin relieves trigeminal neuralgia in multiple sclerosis. Neurology 1998;51:611–614.
- Solaro C, Messmer-Uccelli M, Mancardi GL: A patient with multiple sclerosis and Down’s syndrome with a rare paroxysmal symptom at onset. Eur J Neurol 1999;6:505–507.
- Poser CM, Paty DW, Scheinberg L, et al: New diagnostic criteria for multiple sclerosis: Guidelines for research protocols. Ann Neurol 1983;13:227–231.
Panayiotopoulos CP, Ferrie CD, Knott C, Robinson RO: Interaction of lamotrigine with sodium valproate. Lancet 1993;341:445.
- Leach JP, Brodie MJ: Synergism with GABAergic drugs in refractory epilepsy. Lancet 1994;343:1650.
- Stephen LJ, Silis GJ, Brodie MJ: Lamotrigine and topiramate may be a useful combination. Lancet 1998;351:958–959.
- Stolarek I, Blacklaw J, Forrest G, Brodie MJ: Vigabatrin and lamotrigine in refractory epilepsy. J Neurol Neurosurg Psychiatry 1994;57:921–924.
- Chadwick D: Gabapentin. Lancet 1994;343:89–91.
- Taylor CP, Gee NS, Ti-Zhi Su, Kocsis JD, Welty DF, Brown JP, Dooley DJ, Boden P, Singh L: A summary of mechanistic hypotheses of gabapentin pharmacology. Epilepsy Res 1998;29:233–249.
McLean MJ: Clinical pharmacokinetics of gabapentin. Neurology 1994;44(suppl 5):S17–S22.
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