Open AccessMisoprostol as a Therapeutic Option for Trigeminal Neuralgia in Patients with Multiple Sclerosis
Author(s) -
PFAU GISELHER,
BRINKERS MICHAEL,
TREUHEIT TIM,
KRETZSCHMAR MORITZ,
SENTüRK MERT,
HACHENBERG THOMAS
Publication year - 2012
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/j.1526-4637.2012.01472.x
Subject(s) - medicine , trigeminal neuralgia , multiple sclerosis , misoprostol , trigeminal nerve , neuralgia , anesthesia , neuropathic pain , pregnancy , psychiatry , abortion , biology , genetics
Dear Editor,Trigeminal neuralgia (TN) is characterized by attacks of recurring, paroxysmal, shock-like pain within the distribution of one or more branches of the trigeminal nerve [1]. About 2% of all TN patients have multiple sclerosis (MS); similarly, about 2% of all MS patients present with TN symptoms [2]. The combination of TN and MS is one of the rare, so-called “symptomatic” forms of TN.We present three cases of “therapy-resistant MS-related” TN, in which misoprostol therapy was successful.Case 1 reports of a 65-year-old female patient with a 32-year history of MS and a 4-year history of TN (V2 only). Further findings were a hemiparesis and hemiplegia lasting 1 year and a history of hypertension. She was suffering from pain attacks with a visual analog scale (VAS) of 10/10, which made eating impossible. The bouts appeared 20 times per day and lasted approximately 10 minutes. During the neurological follow-up, she received carbamazepine (CBZ) and nutrients parenterally. Increasing the doses of CBZ caused complications such as intermittent hyponatremia and hypocalcemia. She received additional administrations of 3–4 × 10 mg/day morphine subcutaneously. As the pain attacks persist, the medication was broadened to baclofen 4 × 5 mg/day, morphine retard 3 × 10 mg/day, and gabapentin at …