MS news articles for June 2001
Relieves Trigeminal Neuralgia Crisis
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,
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
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.
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.
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.
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.
Copyright © 2001 Reuters Ltd