Trigeminal Neuralgia Relief With Intrathecal Ziconotide

Michiels, Whitney B.; McGlthlen, Gail L.; Platt, Benjamin J.; Grigsby, Eric

doi:10.1097/ajp.0b013e3181fb22f4

Cited by 12 publications

(9 citation statements)

References 17 publications

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“…She then had ziconotide placed into her morphine/clonidine pump at a rate of 1 µg/day. 17 Our case represents the first case of migraine improvement with intrathecal ziconotide.…”

Section: Discussionmentioning

confidence: 67%

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Resolution of chronic migraine headaches with intrathecal ziconotide: a case report

Narain¹,

Al-Khoury²,

Chang³

2015

JPR

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BackgroundMigraine headaches are a common and functionally debilitating disorder affecting approximately 17% of women and 5.6% of men. Compared to episodic migraine patients, chronic migraineurs are more likely to be occupationally disabled, miss family activities, have comorbid anxiety and/or chronic pain disorders, and utilize significantly more health care dollars. Ziconotide is a calcium channel blocker used for the treatment of chronic severe pain without issues of tolerance or dependency found with opioid therapy.CaseA 59-year-old female had an intrathecal baclofen pump placed for spasticity secondary to multiple sclerosis. Her symptoms also included lower extremity neuropathic pain and severe migraine headaches with 22 migraine headache days per month. Prior treatments included non-steroidal anti-inflammatory drugs, triptans, anticonvulsants, antihypertensives, and Botox injections which reduced her symptoms to four migraine days per month at best. While her spasticity had markedly improved with intrathecal baclofen, ziconotide was added to help her neuropathic pain complaints. Following initiation of low-dose ziconotide (1 µg/day), the patient noted both lower extremity pain improvement and complete resolution of migraine headaches resulting in zero migraine days per month. She has now been migraine free for 8 months.ConclusionUpon review of the available literature, there are no published cases of migraine improvement with intrathecal ziconotide. This represents the first case describing resolution of migraine symptoms with low-dose ziconotide.

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“…She then had ziconotide placed into her morphine/clonidine pump at a rate of 1 µg/day. 17 Our case represents the first case of migraine improvement with intrathecal ziconotide.…”

Section: Discussionmentioning

confidence: 67%

“…In fact, another patient with head/neck pain from trigeminal neuralgia pain was successfully treated with ziconotide at the T12–L1 level suggesting that the catheter tip position may not influence the therapeutic role in symptom management. 17 …”

Section: Discussionmentioning

confidence: 99%

Resolution of chronic migraine headaches with intrathecal ziconotide: a case report

Narain¹,

Al-Khoury²,

Chang³

2015

JPR

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“…However, Rauck and associates 59 demonstrated that slow titration can provide comparable pain relief while minimizing the side effects experienced by patients. 66 The main limitations regarding the use of IT ziconotide are its steep cost and the high incidence (> 80% in many studies) of side effects, which can include the neurologic, psychiatric, cardiovascular, gastrointestinal, and genitourinary systems. More than 644 patients with severe chronic pain participated in this open-label, multicenter longer-term trial.…”

Section: Box 433 Intrathecal Calcium Channel Medicationsmentioning

confidence: 99%

Neuraxial Agents

Hurley¹,

Anderson²,

Cohen³

2014

Practical Management of Pain

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“…Die Wirksamkeit von Ziconotid wird in mehreren Publikationen bei neuropathischem und zentralem Schmerz beschrieben [16,22], wobei aber nicht erkennbar ist, inwieweit Patienten mit (neuropathischen) Gesichtsschmerzen in die Studien eingeschlossen worden sind [5,15,23]. Michiels et al [13] [20]. Die Konzentration der Zikonotid-Lösung sollte auch in der externen Pumpe aufgrund möglicher Spaltung von Disulfidbrücken des Zikonotids nicht unter 5 µg/ ml liegen, dieses ist bei Verwendung einer Crono-five®-Pumpe in der Titrationsphase möglich.…”

Section: Tab 3 Fall 3: Veränderungen Im Therapieverlaufunclassified

Erfahrungen mit intrathekaler First-line-Therapie mit Ziconotide bei Patienten mit neuropathischen Gesichtsschmerzen

Lux

Rasche

2011

Schmerz

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We report on the intrathecal use of ziconotide in three patients with idiopathic facial pain after surgery of the mouth, jaw or face and one patient with neuropathic pain after damage of the lingual nerve. The therapy was successful in three patients but one patient with idiopathic facial pain had pain relief only during the test phase of ziconotide with an external pump and not after implanting the Synchromed® pump. With intrathecal morphine therapy this patient achieved good pain relief. We recommend that patients with neuropathic facial pain should be treated with ziconotide after implementation of guideline-based therapy. In the test phase the ziconotide dose should be increased by 0.6 µg/day per week after an initial dose of 0.6-1.2 µg/day to avoid side-effects.

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Trigeminal Neuralgia Relief With Intrathecal Ziconotide

Abstract: Ziconotide should be considered for treatment of TN, although further investigation is recommended.

Cited by 12 publications

References 17 publications

Resolution of chronic migraine headaches with intrathecal ziconotide: a case report

Resolution of chronic migraine headaches with intrathecal ziconotide: a case report

Neuraxial Agents

Erfahrungen mit intrathekaler First-line-Therapie mit Ziconotide bei Patienten mit neuropathischen Gesichtsschmerzen

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