Abstract Details

Title Poor Carbamazepin Response in Patients with Classical Trigeminal Neuralgia and Polytherapy Treatment Options

Topic Headache

Presentation(s) P01 - (-)

Poster/Presentation
Number 088

Objective

Background Classical trigeminal neuralgia is the most common facial pain in patients aged over 50 years. Affects more women than men in a rate of 1,5-2:1. Pharmacological is the first treatment option and monotherapy with carbamazepine reaches pain relief in almost 70% of the cases. Polytherapy regimens have fewer descriptions in TN patients and ideal combination is far from consensual.

Design/Methods Fifty five patients with NT were clinically evaluated regarding current and prior therapeutical regimen and each subjective pain control. Carbamazepine was the first option for all 55 patients and politherapy was considered for non-responders.

Results Thirty five women (63.3%) and 20 men (36.7%) with a mean age and disease duration of 60.1 ± 14.3 and 9.57 ± 6.9 years, respectively were evaluated. Mean age at symptoms onset was 50.1 ± 14.3 years. Pain distribution through trigeminal branches was: V2:34%, V2/V3: 30.9%, V3: 16.3% and others: 18.1%. First treatment option was carbamazepin with crescent increasing until maximal tolerated doses (mean doses 900mg/day) which reached satisfactory pain relief in 16/55 (29%) of the patients. Polytherapy involved phenytoin, periciazine, baclofen, valproate, gabapentin and others in different combinations was necessary in 39/55 (71%) patients. Pain relief was acquired in 30/39 (77%) patients and 17/39 (43%) patients became free of pain symptoms. Periciazine associated to carbamazepin was the association with the most effective pain control among the polytherapy group 10/39 (25%) patients pain free.

Conclusions Although carbamazepine alone is described as an effective prophylactic option in NT patients, in this terciary hospital series it was effective in monotherapy for less that 30% of patients. The polytherapy may be necessary for the refractory patients and periciazine should be considered in association with carbamazepine.

Authors/Disclosures
Alberto R. Martinez, MD PRESENTER	No disclosure on file
A. M. Barrett, MD, FAAN (UMass Memorial)	The institution of Dr. Barrett has received research support from Veterans Health Association. The institution of Dr. Barrett has received research support from National Institutes of Health. The institution of Dr. Barrett has received research support from Mabel H Flory Trust. Dr. Barrett has received personal compensation in the range of $0-$499 for serving as a author, chapter with WebMD. Dr. Barrett has received personal compensation in the range of $10,000-$49,999 for serving as a scientific advisor with Winifred Masterson Burke Foundation.
	No disclosure on file
Ingrid F. De Vasconcellos, MD	No disclosure on file
Marina K. Alvim (Hospital Das Clinicas Unicamp)	Dr. Alvim has nothing to disclose.
	No disclosure on file

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