More MS news articles for June 2001

Fosphenytoin Relieves Trigeminal Neuralgia Crisis

http://www.medscape.com/reuters/prof/2001/06/06.25/20010622clin016.html

WESTPORT, CT (Reuters Health) Jun 22 - Intravenous fosphenytoin can alleviate trigeminal neuralgia temporarily, allowing time to adjust oral medications or prepare for neurosurgical intervention, according to Dr. William P. Cheshire, Jr., from the Mayo Clinic in Jacksonville, Florida.

In the June issue of the Journal of Pain and Symptom Management, Dr. Cheshire reports on three patients with recurrent trigeminal neuralgia refractory to oral anticonvulsants. In a tertiary care neurology clinic, he treated each urgently with intravenous phenytoin sodium equivalents of fosphenytoin for an episode of extreme pain.

A 66-year-old woman with a 10-year history of recurrent "paroxysmal left mandibular pain described as sharp jabs or electrical shocks" was treated with 0.9 g (18 mg/kg) fosphenytoin for 20 minutes. The patient remained pain-free for 2 days.

An 80-year-old man with "a 4-year history of paroxysmal, sharp, shooting or burning right mandibular pain, triggered by touching the lower lip, speaking, chewing, drinking, or swallowing" received 1.0 g (11 mg/kg) fosphenytoin, given in 100-mg doses every 10 minutes. This patient remained pain-free for about 3 days.

A 75-year-old woman with "a 14-year history of paroxysmal, left lower facial pain described in terms of electricity, burning or tingling" received fosphenytoin in the same dosage as the patient in the previous case and remained pain-free for 2 days.

Pain returned in all cases despite treatment with carbamazepine, gabapentin and carbamazepine, or baclofen and carbamazepine. The patients eventually required suboccipital craniectomy or balloon compression.
Dr. Cheshire maintains that, compared with phenytoin treatment, fosphenytoin is safer, better tolerated and can be given at a faster infusion rate. "Fosphenytoin," he concludes, "would appear to be an attractive and reliable substitute for parenteral phenytoin as a rapid onset, short-team treatment in select patients with acute, severe trigeminal neuralgia crisis episodes."

J Pain Symptom Manage 2001;21:506-510.