Trigeminal neuralgia, treatment

GlaserMA. 1931. Treatment of trigeminal neuralgia with trichloroethylene. JAMA 96 916-920. 

Carbamazepine is an anti-epileptic, which may also be used in the treatment of trigeminal neuralgia. Monitoring of carbamazepine plasma concentrations is required if high doses are administered as carbamazepine tends to be an autoinducer, meaning that the half-life is shortened following repeated administration of the drug. 

Baclofen, labeled as a skeletal muscle relaxant binds to GABA receptors and depresses excitation. It is also useful in the treatment of paroxysms of trigeminal neuralgia. Baclofen is effective in patients with carbamazepine-resistant pain and has been used successfully to relieve attacks in patients previously unresponsive to carbamazepine or phenytoin. 

Antiepileptic drugs as a class have been widely smdied and prescribed for the relief of acute and chronic pain. In general, there is the greatest support for the efficacy of antiepileptics in the treatment of trigeminal neuralgia and diabetic neuropathy and for migraine prophylaxis. 

Carbamazepine is an effective agent for the treatment of partial seizures and generalized tonic-clonic seizures its use is contraindicated in absence epilepsy. Carbamazepine is also useful in the treatment of trigeminal neuralgia and is an effective agent for the treatment of bipolar disorders (see Chapter 33). 

Phenytoin Adjunct in treatment of tricyclic antidepressant toxicity, muscle relaxant in treatment of muscle hyperirritability, treatment of digoxin-induced arrhythmias and trigeminal neuralgia... 

It is structurally and chemically related to tricyclic antidepressant drug imipramine and pharmacologically it is similar to diphenyl hydantoin sodium. It is effective in grandmal and psychomotor epilepsy and also in the treatment of trigeminal neuralgia (a condition characterized by paroxysms of intense pain of stabbing nature within the area of distribution of trigeminal nerve without sensory loss). 

Closely related to imipramine and other antidepressants, carbamazepine is a tricyclic compound effective in treatment of bipolar depression. It was initially marketed for the treatment of trigeminal neuralgia but has proved useful for epilepsy as well. 

Considerable concern exists regarding the occurrence of idiosyncratic blood dyscrasias with carbamazepine, including fatal cases of aplastic anemia and agranulocytosis. Most of these have been in elderly patients with trigeminal neuralgia, and most have occurred within the first 4 months of treatment. The mild and persistent leukopenia seen in some patients is not necessarily an indication to stop treatment but requires careful monitoring. The most common idiosyncratic reaction is an erythematous skin rash other responses such as hepatic dysfunction are unusual. 

Carbamazepine is recommended as the drug of first choice in the treatment of trigeminal neuralgia... 

In fact, carbamazepine is recommended as the drug of first choice in the treatment of trigeminal neuralgia. Results from clinical trials have been positive in the treatment of painful diabetic neuropathy (Rull et al., 1969 Wilton, 1974 Gomez-Perez et al., 1996). After 4 weeks treatment with carbamazepine, central pain after stroke was improved only in five out of 14 patients (Leijon and Boivie, 1989). Carbamazepine was found to be effective for migraine prophylaxis (Rompel and Bauermeister,... 

In a clinical trial in trigeminal neuralgia patients, Lindstrom (1987) reported significant pain relief after treatment with 900-2100 mg/day oxcarbazepine which was comparable to the effects of carbamazepine (400-1200 mg/day). 

Blom, S. Trigeminal neuralgia its treatment with a new anticonvulsant drug, Lancet 1962, I, 839-840. 

In 122 patients with trigeminal neuralgia who underwent percntaneons retrogasserian glycerol injection (4), complications associated with the treatment were... 

Herishanu Y, Milwitzki A. Trigeminal neuralgia induced by nitrofurantoin treatment. J Neurol 1977 216(l) 77-8. 

Premsagar IC, Moss T, Coakham HB. Teflon-induced granuloma following treatment of trigeminal neuralgia by micro-vascular decompression. Report of two cases. J Neurosurg 1997 87(3) 454-7. 

Carbamazepine is used in the treatment of epilepsy and trigeminal neuralgia. Unlabeled uses include treatment of postherpetic pain syndrome, neurogenic diabetes insipidus, bipolar disorder, alcohol withdrawal, and cocaine dependence. 

In North America, extracts of local hemp were used [36-40]. Most of the work reported was based on the British experience. Attacks of neuralgia, including trigeminal neuralgia, were successfully treated. It was considered a valuable remedy in the treatment of persistent headaches, in spasmodic asthma and as an oxytocic. The antivomiting effect was recorded again, as was the general hypnotic effect. 

Carbamazepine is useful in the prophylaxis and therapy of partial seizures and psychomotor seizures. It is also useful in the therapy of trigeminal neuralgia, and as adjunct therapy in the treatment of manic-depressive disorders. 

It is an anticonvulsant employed in the treatment of grand mal and psychomotor epilepsy. It is considered to be one of the most vital drugs for the relief of pain associated with trigeminal neuralgia. 

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