Abstract Details

Title Severe Worsening of Trigeminal Neuralgia Associated with Dalfampridine Treatment in Patients with Multiple Sclerosis

Topic MS and Related Diseases

Presentation(s) S30 - (-)

Poster/Presentation
Number 004

Objective

Background Dalfampridine (4-aminopyridine), a broad spectrum, voltage dependent potassium channel blocker, improves action potential conduction in demyelinated axons and has modest success in improving ambulation in a subset of patients with multiple sclerosis (MS). However, by improving conduction in injured sensory nerves, the potential for inducing or worsening sensory symptoms, such as trigeminal neuralgia, is possible.

Design/Methods We reviewed records of persons in our clinic with MS who were placed on dalfampridine since the availability of this drug in 2010. Details of their histories and responses to withdrawal of dalfampridine are described below.

Results In this retrospective analysis four patients, three women and one man, noted either a de-novo appearance of, or a major exacerbation of, severe facial pain characteristic of trigeminal neuralgia within weeks of starting dalfampridine. Facial pain was new in the male, though he had previous facial numbness on the side of the pain. Pre-existing facial pain in the three women, previously well controlled on low doses of carbamazepine, dramatically worsened. Brain MRIs obtained in all patients at onset of their worsened pain were stable. Stopping dalfampridine was associated with improved facial pain in two patients within several weeks of drug cessation. In the remaining two patients the worsened facial pain has persisted for more than a year, in one case refractory to even high doses of carbamazepine, a pattern different than previously noted.

Conclusions Administration of the potassium channel blocking drug dalfampridine, while improving motor function in a subset of persons with MS, was associated with the appearance or worsening of severe trigeminal neuralgic pain, in one insistence refractory for over a year after drug withdrawal. Dalfampridine should be used with caution in patients with substantive sensory nerve dysfunction.

Authors/Disclosures
Gary Birnbaum, MD, FAAN PRESENTER	No disclosure on file
Walter Poellmann, MD (Marianna-Strauss-Klinik)	No disclosure on file
	No disclosure on file

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