Original Paper

Low-Dose Gabapentin Combined with either Lamotrigine or Carbamazepine Can Be Useful Therapies for Trigeminal Neuralgia in Multiple Sclerosis
C. Solaro^a,c, M. Messmer Uccelli^c, A. Uccelli^a, M. Leandri^b, G.L. Mancardi<sup>a

a</sup>Department 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

Address of Corresponding Author

Eur Neurol 2000;44:45-48 (DOI: 10.1159/000008192)

  Key Words

• Lamotrigine
• Gabapentin
• Multiple sclerosis
• Trigeminal neuralgia

  Abstract

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.

Copyright © 2000 S. Karger AG, Basel

  Author Contacts

Dr.C. Solaro
Department of Neurological Sciences, University of Genoa
Via De Toni 5, I-16132 Genoa (Italy)
Tel. +39 10 3537057, Fax +39 10 3538631
E-Mail labunit@cisi.unige.it, Csolaro@tn.village.it

  Article Information

Received: Received: September 2, 1999
Accepted: January 20, 2000
Number of Print Pages : 4
Number of Figures : 0, Number of Tables : 2, Number of References : 15