Refactory Trigeminal Neuralgia successfully treated by combination therapy (Pregabalin plus Lamotrigine)

Abstract

In MS patients (PwMS), paroxysmal symptoms (PS) are frequently reported and are often the cause of suffering. PS include Trigeminal Neuralgia (TN) that is the most widely recognized neurophatic pain syndrome. TN treatment primarily consists of antiepileptic medications such as Carbamazepine (CBZ) and Lamotrigine (LTG). CBZ is reported to be not well tolerated by PwMS for its side effects that mimic an MS exacerbation. Pregabalin (PGB) was successfully used in treating paroxysmal symptoms in PwMS. We performed a prospective open-label pilot study of PGB in combination with LTG in a group of MS patients with TN to evaluate the efficacy and tolerability of the two medications in subjects who were no-responsive or intolerant to conventional treatment. The combination of PGB and LTG may prove effective in the treatment of TN in PwMS, at small dosages, along with the possibility of minimizing adverse effects, while significantly improving pain control.

Keywords: Combination therapy; Lamotrigine; Multiple Sclerosis; Pregabalin; Trigeminal Neuralgia.