Intravenous Fosphenytoin as Rescue Treatment in Trigeminal Neuralgia Crisis (P5.10-013)

Abstract

Objective: The aim of this study is to analyze the response to intravenous (iv) fosphenytoin in Trigeminal Neuralgia (TN) crisis in order to gather evidence for its use in daily neurological practice.

Background: TN is a common cause of facial pain. Its treatment relies on preventive therapy with either carbamazepine or oxcarbazepine. During a severe pain episode patients are unable to eat, drink or continue with oral medication, requiring inhospital treatment. There is scarce evidence based support for iv medications for TN, hindering the management of these situations.

Design/Methods: A retrospective review was carried out from clinical records of patients with TN crisis, who attended the emergency department in a referral tertiary neurological center in Buenos Aires, Argentina, and received iv fosphenytoin as analgesic strategy; having being followed-up for at least one month afterwards. Demographic features, magnetic resonance imaging (MRI) and emergency room pharmacological management were analyzed. Patients were diagnosed of TN and classified according to ICHD-3 diagnostic criteria.

Results: Thirty-nine patients with TN were included, over 50% received iv fosphenytoin applications more than once (separated by at least 24hs), reaching a total of 73 infusions.

Immediate pain relief was achieved in 85% of cases. Furthermore, alongside with preventive therapy adjustments, individualized attendance to the emergency service decreased after each infusion in 58% episodes.

Adverse effects were seen in 26% of patients, being dizzines and nausea the most frequent (n=10 and n=3, respectively).

Conclusions: According to our results, iv fosphenytoin may be a safe and useful strategy for TN crisis, considering the lack of treatment choices for these situations. Nonetheless a prospective placebo controlled study is needed to make a valid statement.