eslicarbazepine and Trigeminal-Neuralgia

Lacosamide is an antiepileptic drug whose exact mechanism of action remains unknown. It acts by increasing the slow inactivation of the voltage-dependent sodium channels of the cell membranes. It is indicated in the treatment of focal seizures with or without secondary generalisation and is occasionally used as adjunct treatment in neuropathic pain. Although the most frequent side effects are mild (dizziness, diplopia, blurred vision, headache, tremor, etc.), others such as supraventricular tachyarrhythmias, changes in repolarisation, atrioventricular blocks and even cardiac arrest or sudden death have been reported.. A 74-year-old male, diagnosed with classic trigeminal neuralgia treated with 200 mg/12 h of carbamazepine, who visited due to a worsening of the pain in the trigeminal V1-V2 region. On the sixth day after admission, after adjusting the carbamazepine treatment to a descending regime, 400 mg/24 h of eslicarbazepine and 100 mg/12 h of intravenous lacosamide, he presented a complete atrioventricular block with extreme bradycardia that required the placement of a pacemaker.. Voltage-dependent sodium channel blockade mainly affects non-sinusal cardiac tissue. An alteration in the atrioventricular or infrahisian node is more consistent with its mechanism of action. Other cases of atrioventricular block in this kind of polytherapy have been reported. Precaution is advised in the concomitant use of antiepileptic drugs, above all among those that prolong the PR interval, and they should be contraindicated in patients with a history of atrioventricular block, ischaemic heart disease or heart failure. Before starting, a baseline electrocardiogram and regular electrocardiographic monitoring are advised during the first few weeks.. Lacosamida asociada a bloqueo de alto grado en un paciente con neuralgia del trigemino.. Introduccion. La lacosamida es un farmaco antiepileptico cuyo mecanismo de accion exacto se desconoce. Actua aumentando la inactivacion lenta de los canales de sodio dependientes del voltaje de las membranas celulares. Indicado en el tratamiento de crisis focales con o sin generalizacion secundaria, ocasionalmente se emplea como tratamiento coadyuvante en el dolor neuropatico. Aunque los efectos adversos mas frecuentes son leves (mareo, diplopia, vision borrosa, cefalea, temblor…), se han descrito taquiarritmias supraventriculares, cambios en la repolarizacion, bloqueos auriculoventriculares e incluso parada cardiaca o muerte subita. Caso clinico. Varon de 74 años, diagnosticado de neuralgia del trigemino clasica en tratamiento con 200 mg/12 h de carbamacepina, que acude por reagudizacion del dolor en el territorio trigeminal V1-V2. El sexto dia de ingreso, tras ajustar el tratamiento con carbamacepina en pauta descendente, 400 mg/24 h de eslicarbacepina y 100 mg/12 h de lacosamida intravenosa, presenta bloqueo auriculoventricular completo con bradicardia extrema que precisa la implantacion de un marcapasos definitivo. Conclusiones. El bloqueo de canales de sodio dependientes del voltaje afecta predominantemente al tejido cardiaco no sinusal. Una alteracion en el nodo auriculoventricular o infrahisiano es mas congruente con su mecanismo de accion. Existen mas casos comunicados de bloqueo auriculoventricular en este tipo de politerapia. Se recomienda precaucion en el uso concomitante de farmacos antiepilepticos, sobre todo entre los que prolonguen el intervalo PR, asi como su contraindicacion en pacientes con antecedentes de bloqueo auriculoventricular, cardiopatia isquemica o insuficiencia cardiaca. Antes de su inicio, se aconseja realizar un electrocardiograma basal y monitorizacion electrocardiografica regular durante las primeras semanas.

Topics: Aged; Anticonvulsants; Atrioventricular Block; Bradycardia; Carbamazepine; Cardiopulmonary Resuscitation; Combined Modality Therapy; Contraindications, Drug; Dibenzazepines; Drug Substitution; Electrocardiography; Heart Arrest; Humans; Lacosamide; Male; Nerve Block; Nociceptors; Pacemaker, Artificial; Trigeminal Neuralgia; Voltage-Gated Sodium Channel Blockers