Trigeminal Neuralgia

Bergouignan, Revue de Laryngologie (1942),15 reported the complete cure of essential facial neuralgia in three patients treated with PHT, 200-300 mg/day.

15. Bergouignan, M., Successful cures of essential facial neuralgias by sodium diphenylhydantoinate, Rev. Laryng. (Bordeaux), 63: 34-41, 1942.

Bergouignan and D’Aulnay Revue d’Oto-Neuro-Ophtalmologie (1951),16 reported on the treatment with PHT of seventeen patients with trigeminal neuralgia. On PHT therapy, 300-600 mg/day, sixteen were benefited. The rapidity of the drug’s action was noted. The effects usually were felt within twenty-four hours.

16. Bergouignan, M. and d’Aulnay, N., Effects of sodium diphenylhydantoin in essential trigeminal neuralgia, Rev. Otoneuroopthal. (Paris), 23: 427-431, 1951.

Jensen, Arztliche Wochenschrift (1954), 180 reported on the use of PHT, 300-600 mg/day, in treating forty-five cases of trigeminal neuralgia. Sixteen patients showed complete cessation of pain, which lasted after discontinuance of PHT. Nineteen patients experienced distinct improvement during PHT treatment. Pain recurred when PHT was withdrawn. Four patients showed slight improvement and five patients did not improve. The author pointed out the desirability of PHT to relieve pain, as opposed to the potent pain relievers and opiates which all too easily lead to addiction.

180. Jensen, H. P., The treatment of trigeminal neuralgia with diphenylhydantoin, Arztl. Wochschr., 9: 105-108, 1954.

Jensen, Therapiewoche (1955),518 in a subsequent study of fifty-nine typical cases of trigeminal neuralgia treated with PHT, reported that fifty-seven were completely freed of pain. Twenty remained so after medication was discontinued; but with thirty-seven, pain returned when PHT was withdrawn. Only two cases showed no improvement.

518. Jensen, H. P., The treatment of trigeminal neuralgia with diphenylhydantoin, Therapiewoche, 5: 345, 1955.

Winiker-Blanck, Deutsche Stomatologie (1955),384 reported that of twenty-seven cases of genuine trigeminal neuralgia treated with PHT, 300-600 mg/day, fifteen remained completely free of pain and seven showed lasting improvement making the condition entirely bearable for the patient. After the pain was under control, the patients were maintained on 100 mg/day. Because of its safety, PHT therapy was recommended as the treatment of choice.

384. Winiker-Blanck, E., On the diphenylhydantoin therapy of trigeminal neuralgia, Deutsch Stomat., 5: 321-322, 1955.

Ende, Virginia Medical Monthly (1957),605 reported that over a period of two years he had successfully treated nine consecutive cases of trigeminal neuralgia with PHT. The author found that not only was PHT effective, but frequently relief began with the first capsule. These patients had been subjected previously to nearly every form of therapy recommended.

605. Ende, M., Diphenylhydantoin in tic douloureux and atypical facial pain, Virginia Med. Monthly, 84: 358-359, 1957.

Bergouignon, Revue Neurologique (1958),14 reported that twenty-six of thirty patients who had been treated for trigeminal neuralgia were relieved of their attacks during the first three days of treatment with PHT. Ten of these patients had previously had peripheral or deep alcohol injections with transient or incomplete results and two had neurotomy.

14. Bergouignan, M., Fifteen years of therapeutic trials in essential trigeminal neuralgia: the place of diphenylhydantoin and its derivatives, Rev. Neural. (Paris), 98: 414-416, 1958.

Iannone, Baker and Morrell, Neurology (1958),175 reported that with PHT definite relief of pain was obtained and paroxysms of pain were controlled in all of four patients with trigeminal neuralgia and one with glossopharyngeal neuralgia.

175. Iannone, A., Baker, A. B., and Morrell, F., Dilantin in the treatment of trigeminal neuralgia, Neurology, 8: 126-128, 1958.

Lamberts, Journal of the Michigan State Medical Society (1959),214 reported on thirty patients with trigeminal neuralgia treated with PHT, 200-400 mg/day. In almost every instance relief from pain was complete within forty-eight hours, but usually not before twenty-four hours after treatment commenced. The dosage had to be increased in two of the patients before the pain disappeared.

214. Lamberts, A. E., Tic douloureux, J. Mich. State Med. Soc., 58: 95-96, 1959.

Kugelberg and Lindblom, Journal of Neurology, Neurosurgery and Psychiatry (1959),202 in a study of fifty patients with trigeminal neuralgia, investigated the relationship between stimuli applied to the trigger zone and the pain paroxysm. Intravenous PHT, 3-5 mg/kg, was found to raise the attack threshold as well as to shorten the duration of the attack.

202. Kugelberg, E. and Lindblom, U., The mechanism of the pain in trigeminal neuralgia. J. Neurol. Neurosurg. Psychiat., 22: 36-43, 1959.

Braham and Saia, Lancet (1960),31 used PHT, 300 mg/day, in twenty cases of trigeminal neuralgia. Relief of pain was complete in eight and partial in six.

31. Braham, J. and Saia, A., Phenytoin in the treatment of trigeminal and other neuralgias, Lancet, 2: 892-893, 1960.

Reeve, Lancet (1961),611 reported that PHT was effective in nine cases of trigeminal neuralgia and recommended that a trial of PHT precede more radical treatment.

611. Reeve, H. S., Phenytoin in the treatment of trigeminal neuralgia, Lancet, 1: 404, 1961.

Lindblom, Svensk Lakartidningen (1961),224 reported that of thirty cases of trigeminal neuralgia treated with PHT, 300-600 mg/day, complete relief or considerable reduction of the symptoms occurred in seventeen cases. Improvement lasted as long as the drug was administered.

224. Lindblom, U., Diphenylhydantoin for trigeminal neuralgia, Svensk Lakartidn, 58: 3186-3191, 1961.

Baxi, Antiseptic (1961),9 reported that eleven of fifteen patients with trigeminal neuralgia, treated with PHT, obtained relief within a week. The author stated that PHT not only gave lasting relief of pain but also relieved the apprehension of an impending attack.

9. Baxi, S. M., Trigeminal neuralgia: treatment with diphenylhydantoin, Antiseptic, 58: 329-330, 1961.

Von Albert, Munschener Medizinische Wochenschrift (1978),2109 reported on twelve cases of typical trigeminal neuralgia and two cases of glossopharyngeal neuralgia. Neither oral carbamazepine nor PHT had produced sufficient results. However, intravenous PHT, in some cases up to 750 mg over three to six hours, followed by oral PHT (200-400 mg/day), achieved freedom from pain in the fourteen patients. It was not found effective in four patients with herpetic neuralgia.

2109. von Albert, H. H., Treatment of acute trigeminal neuralgia with intravenous infusions of phenytoin, Munch. Med. Wsch., 120(15): 529-30, 1978.

Von Albert, Advances in Epileptology (1983),3051 reviewing eight years experience with PHT, states that intravenous PHT is very effective, not sedative, has only mild side effects, and is the therapy of choice for trigeminal neuralgia in elderly patients.

3051. Von Albert, H. H., Phenytoin infusion in the treatment of epilepsy, Advances in Epileptology: 14th Epilepsy International Symposium, Parsonage, M, Ed., Raven Press, New York, 307-12, 1983.

Swerdlow, The Pain Clinic (1986), 3223 presents a brief historical survey of the evolution of the use of anticonvulsant drugs for the relief of neuralgic pain. Trigeminal and glossopharyngeal neuralgia, diabetic neuropathy and the lighting pains of tabes have long been known to respond to treatment with this group of drugs. More recently a number of other pain syndromes have also been found to be responsive to this form of therapy. A description is given of the clinical features of this type of pain, and the therapeutic management of the patients is outlined. The drugs involved are carbamazepine, clonazepam, phenytoin and valproate, and details are given of dosage, timing of administration and side effects. It might be necessary to try in turn two or more of these agents to obtain optimal effectiveness with minimal side effects. Anticonvulsant therapy might well need to be maintained for a prolonged period of time. Adequate monitoring of the patient is necessary in order to ensure that effective blood levels are achieved and to avoid serious side effects. The pharmacology of the anticonvulsant drugs is discussed together with recent ideas on their mode of action in this type of usage. Important studies of the subject are described, including some double-blind investigations. There is also a discussion of the neurophysiology of the relevant types of neuralgia and deafferentation pain. Finally, it is pointed out that although a great deal more needs to be learned about the modus operandi of this form of treatment, there is no doubt that from a practical point of view, it can be valuable in many patients with deafferentation-type pain.

3223. Swerdlow, M., Anticonvulsants in the therapy of neuralgic pain, Pain Clinic, 1(1): 9-19, 1986.

Mauskop, Journal of Pain and Symptom Management, (1993), 3224 presents a review of trigeminal neuralgia including the epidemiology, clinical features, differential diagnosis, pathophysiology and therapy of this painful syndrome. In the section on medical therapy, the author includes a discussion of the roles of phenytoin, carbamazepine, and baclofen, all of which he designates as first-line drugs for treatment of trigeminal neuralgia.

3224. Mauskop, A., Trigeminal neuralgia (tic douloureux), J. Pain. Symp. Manage., 8(3): 148-154, 1993.

Qi, Liu and Huang, National Workshop of Clinical Use of Phenytoin, Chengdu, China (1995), 3225 randomly assigned 36 patients with trigeminal neuralgia to three treatment groups: phenytoin (17 pts); carbamazepine (11 pts); and combined phenytoin and carbamazepine (8 pts). After 4 weeks of treatment, the tabulated results showed no statistical difference (p > 0.05) between the effect of phenytoin and carbamazepine given separately (82.35 % and 81.81 %, respectively). The combined treatment was 100 % effective.

3225. Qi, L., Liu, C., and Huang, M., A double-blind study of the effect of phenytoin ion trigeminal neuralgia, Presented at the National Workshop of Clinical Use of Phenytoin, Chengdu, China, 1995.

Chesire, Journal of Pain and Symptom Management, (2001), 3226 treated three patients with trigeminal neuralgia refractory to oral medications and presenting with crisis pain, with fosphenytoin. One patient received .9 g PE of fosphenytoin over 20 minutes and upon completion of the infusion, her expression was beaming with joy and she had no pain. A second patient received 100 mg PE injected intravenously at intervals of 10 minutes with a planned maximum limit of 10 doses. Pain gradually improved during the infusions and fully resolved after the final dose. A third patient also received an incremental dosing regimen, with 10 doses of 100 mg spread over 3 hours. Following a total dosage of 1.0 g (14 mg/kg) PE, the pain had almost completely resolved and by the next morning, the patient was pain free.

3226. Cheshire, W.P., Fosphenytoin: An intravenous option for the management of trigeminal neuralgia crisis, J. Pain Symp. Manage., 21:506-510, 2001.

See also Ref.

3227. Perkin, G.D., Trigeminal neuralgia, Curr. Treatment Options Neurol.,1(5):458-465, 1999.

3228. Cheng, T.M., Cascino, T.L., and Onofrio, .B.M, Comprehensive study of diagnosis and treatment of trigeminal neuralgia secondary to tumors, Neurology, 43(11):2298-302, 1993.

3229. Turp, J.C. and Gobetti, J.P., Trigeminal neuralgia - an update, Compend. Contin. Educ. Dent., 21(4):279-82, 2000.

3230. Wiffen, P., Collins, S., Mcquay, H., Carroll, D., Jasas, A., and Moore, A, Anticonvulsant drugs for acute and chronic pain, Cochrane Database of Systematic Reviews, (3):CD001133, 2000.

3231. Zakrzewska, J.M., Medical management of trigeminal neuralgia, Br. Dent. J.,168: 399-401, 1990.

3232. Zeidman, S.M. and North, R.B., Trigeminal neuralgia, Conn's Current Therapy, 912-914, Rakel, R.E., Ed., W.B. Saunders, Philadelphia, PA, 1994.

3233. Rozen, T.D., Antiepileptic drugs in the management of cluster headache and trigeminal neuralgia, Headache, 1:S25-32, 2001.

3234. Sindrup, S.H. and Jensen, T.S., Pharmacotherapy of trigeminal neuralgia, Clin. J. Pain, 18:22-27, 2002.

3235. Mcquay, H., Carroll, D., Jadad, A.R., Wiffen, P., and Moore, A, Anticonvulsant drugs for management of pain: A systematic review, Br. Med. J., 311:1047-1052, 1995.

3236. Kinzbrunner, B.M., Aanticonvulsant drugs reduce pain in trigeminal neuralgia and diabetic neuropathy and are effective for migraine prophylaxis [Therapeutics], Acp. J. Club, 124:35, 1996.

3237. Rouveix, B., Bauwens, M.C., and Giroud, J.P., Treatment of different types of pain, Bull. Acad. Natl. Med., 183(5):889-901, 1999.

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