Intravenous fosphenytoin therapy for rescue of acute trigeminal neuralgia crisis in patients awaiting neurosurgical procedures: A cross-sectional study

Noro, Shusaku; Seo, Yoshinobu; Honjo, Kaori; Okuma, Masahiro; Asayama, Bunsho; Amano, Yuki; Kyono, Masanori; Sako, Kazuya; Nakamura, Hirohiko

doi:10.1016/j.jocn.2021.09.040

Cited by 9 publications

(24 citation statements)

References 11 publications

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“…A retrospective study of 39 patients with TN (both classic, idiopathic and secondary TN) treated with intravenous phenytoin infusion found that 89% of patients achieved pain relief of ≥50% immediately after infusion (17). Similar results were found in another retrospective observational study of 20 patients with classical TN (18). Common for all of the above-mentioned studies is that they are limited by a short follow-up period and great variability in the administration of fosphenytoin, both regarding loading dose and infusion time.…”

Section: Discussionsupporting

confidence: 90%

Intravenous fosphenytoin as treatment for acute exacerbation of trigeminal neuralgia: A prospective systematic study of 15 patients

et al. 2022

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Introduction Intravenous fosphenytoin is widely used for acute exacerbation of trigeminal neuralgia, however, few studies have investigated this treatment. We aimed to examine the efficacy and side effects of initial intravenous fosphenytoin plus oral tapering of phenytoin for exacerbation of trigeminal neuralgia. Methods Consecutive patients with primary trigeminal neuralgia were included in this prospective observational 90-days follow-up study. Data were collected using standardized interviews before, at 24 hours, day 7, 30 and 90 post loading dose. The primary outcome was the proportion of responders defined as a 50% reduction in pain intensity 24 hours post loading dose. Results We included 15 patients. Nine patients (60%) were responders. Pain intensity 24 hours post loading dose was reduced by 5.00 points on the numerical rating scale (p < 0.001), and at day 7 by 5.5 points (p < 0.001). The most common side effects were hypotension and dizziness. Conclusion Intravenous fosphenytoin relieves trigeminal neuralgia pain in most patients and provides a window for titrating prophylactic trigeminal neuralgia medications or planning neurosurgery. The decision to administer intravenous fosphenytoin should be taken with support from trigeminal neuralgia experts and involves considerations of co-morbidities and other treatment options for acute exacerbation of trigeminal neuralgia. Clinical Trial: Preregistered (ClinicalTrials.gov Identifier: NCT03712254

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Section: Discussionsupporting

confidence: 90%

Intravenous fosphenytoin as treatment for acute exacerbation of trigeminal neuralgia: A prospective systematic study of 15 patients

et al. 2022

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“…To the best of our knowledge, this is the first case series to provide such evidence, although the effectiveness for trigeminal neuralgia crisis was known. [7][8][9][10][11] The present findings may help improve treatment for GPN crises.…”

Section: Discussionmentioning

confidence: 98%

“…The included patients accepted the risks of major complications from the treatment, such as dizziness, nystagmus, gait disturbance, dysarthria, diplopia, ataxia, drowsiness, palpitations, phlebitis, hypotension, and arrhythmia. 7 This work was approved by the ethics committee of our hospital (approval no. 2021061702) and conformed to the Declaration of Helsinki.…”

Section: Case Report/case Presentationmentioning

confidence: 99%

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Intravenous Fosphenytoin Therapy as Acute Rescue Treatment for Glossopharyngeal Neuralgia Crisis in Patients Awaiting Neurosurgical Procedures: A Case Series

et al. 2022

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Introduction: Few treatments exist for acute attacks of glossopharyngeal neuralgia (GPN). We investigated the efficacy of intravenous fosphenytoin therapy (IFT) during GPN crisis. Case Presentation:We evaluated records of 4 consecutive patients with GPN awaiting microvascular decompression (MVD) who received IFT (total, 750 mg). Pain severity was evaluated using a Numerical Rating Scale (NRS). The score was 10 (maximum pain) before treatment. Case 1 (a 52-year-old woman, left GPN): for 12 hours after IFT, pain was eliminated (NRS 0/10); however, severe pain recurred 2 days later. She received MVD 9 days after IFT. Case 2 (a 72-year-old woman, right GPN): pain score reduced to 0/10 immediately after IFT and remained so for 2 days. Severe pain recurred, and she underwent MVD 4 days after IFT. Case 3 (a 69-year-old woman, right GPN): pain was reduced (NRS, 5/10) immediately after IFT and nearly eliminated (1/10) 1 hour later. After 6 hours, severe pain recurred; she received a second IFT 3 days later, and pain score dropped to 1/10. She was pain-free for 24 hours but intermediate pain recurred in 2 days. Microvascular decompression was performed 9 days after the second IFT. Case 4 (a 32-year-old woman, right GPN): Pain score reduced to 0/10 immediately after IFT and remained so for 4 days. She underwent MVD 4 days after IFT. No evidence of recurrence was found throughout the 24-, 22-, 20-, and 5-month follow-ups.Conclusions: These results provide new insights into the innovative therapeutic option of intravenous fosphenytoin and contribute to advancements in treating acute GPN crisis.

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“…Patients with acute exacerbations of TN may benefit from intravenous fosphenytoin or lidocaine, under specialist supervision and cardiac monitoring. Noro and colleagues published a single‐center, retrospective, observational study of 20 patients treated with intravenous fosphenytoin as rescue treatment for acute TN crisis and found that there was a significant reduction in pain 24 h following treatment 23 . There is currently an observational prospective cohort study underway on the management of acute exacerbations of TN with fosphenytoin (ClinicalTrials.gov Identifier: NCT03712254).…”

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confidence: 99%

Novel ways of approaching the pharmacologic treatment of trigeminal neuralgia

Dominguez

Stefano

2022

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Intravenous fosphenytoin therapy for rescue of acute trigeminal neuralgia crisis in patients awaiting neurosurgical procedures: A cross-sectional study

Cited by 9 publications

References 11 publications

Intravenous fosphenytoin as treatment for acute exacerbation of trigeminal neuralgia: A prospective systematic study of 15 patients

Intravenous fosphenytoin as treatment for acute exacerbation of trigeminal neuralgia: A prospective systematic study of 15 patients

Intravenous Fosphenytoin Therapy as Acute Rescue Treatment for Glossopharyngeal Neuralgia Crisis in Patients Awaiting Neurosurgical Procedures: A Case Series

Novel ways of approaching the pharmacologic treatment of trigeminal neuralgia

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