topiramate and Trigeminal-Neuralgia

Carbamazepine is currently the drug of first choice in the treatment of trigeminal neuralgia. However, it is reported as efficacious in only 70-80% of patients, and can be associated with adverse effects such as drowsiness, confusion, nausea, ataxia, nystagmus and hypersensitivity, which may necessitate discontinuation of medication. Therefore, alternative drugs such as oxcarbazepine, baclofen and topiramate are also used to treat the disease.. The aim of this study was to compare the effectiveness and safety of topiramate with carbamazepine in the treatment of classical trigeminal neuralgia.. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) [Issue 3 of 12, March 2011], MEDLINE, EMBASE, the Chinese Biomedical Database (CBM), the Chinese National Knowledge Infrastructure (CNKI) and the Chinese Science and Technique Journals Database (VIP) for the period January 1998 to March 2011, and we also manually searched all relevant journals. We included all confirmed randomized controlled trials treating trigeminal neuralgia with topiramate and carbamazepine. We evaluated the risk of bias of the included trials according to the Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1. The Cochrane Collaboration's software RevMan 5.1 was used for the meta-analysis.. A total of six randomized controlled trials with poor methodological quality were included. All trials were conducted in China. Altogether, they included 354 patients with trigeminal neuralgia. The results of the meta-analysis showed that topiramate was more effective than carbamazepine after a treatment duration of 2 months (relative risk [RR] = 1.20, 95% CI 1.04, 1.39, p = 0.01). However, no difference was found in the effectiveness rate after a treatment duration of 1 month (RR = 1.00, 95% CI 0.87, 1.14, p = 0.94), in the remission rate after a treatment duration of 1 month (RR = 1.06, 95% CI 0.83, 1.36, p = 0.63), in the remission rate after a treatment duration of 2 months (RR = 1.31, 95% CI 0.96, 1.80, p = 0.09) or in adverse events when comparing topiramate with carbamazepine.. Present trials comparing topiramate with carbamazepine are all poor in methodological quality. A meta-analysis of these studies showed that the overall effectiveness and tolerability of topiramate did not seem to differ from carbamazepine in the treatment of classical trigeminal neuralgia. However, the meta-analysis yielded a favourable effect of topiramate compared with carbamazepine after a treatment duration of 2 months. RESULTS were limited due to the poor methodological quality and the geographic localization of the randomized controlled trials identified. Therefore, large, international, well conducted, randomized controlled trials are needed to further assess the relative efficacy and tolerability of topiramate and carbamazepine in this indication.

Topics: Adult; Aged; Aged, 80 and over; Carbamazepine; Fructose; Humans; Middle Aged; Randomized Controlled Trials as Topic; Topiramate; Trigeminal Neuralgia

NMDA and non-NMDA receptors are involved in spinal transmission of nociceptive information in physiological and pathological conditions. Our objective was to study the influence of NMDA and non-NMDA receptor antagonists on pain control in the trigeminal system using a formalin-induced orofacial pain model. Motor performance was also evaluated. Male Rattus norvegicus were pre-treated with topiramate (T) (n=8), memantine (M) (n=8), divalproex (D) (n=8) or isotonic saline solution (ISS) (n=10) intraperitoneally 30 minutes before the formalin test. Formalin 2.5% was injected into the right upper lip (V2 branch) and induced two phases: phase I (early or neurogenic) (0-3 min) and phase II (late or inflammatory) (12-30 min). For motor behavior performance we used the open-field test and measured latency to movement onset, locomotion and rearing frequencies, and immobility time. Pre-treatment of animals with M and D only attenuated nociceptive formalin behavior for phase II. T increased locomotion and rearing frequencies and reduced immobility time. Treatment with M increased immobility time and with D reduced locomotion frequency. Our results showed that the NMDA antagonist (M) is more potent than the non-NMDA antagonists (D and T) in the control of pain in the inflammatory phase. The non-NMDA topiramate improved motor performance more than did D and M, probably because T has more anxiolytic properties.

Topics: Animals; Exploratory Behavior; Facial Pain; Fructose; Inflammation; Male; Memantine; Motor Activity; Pain Measurement; Placebos; Rats; Receptors, N-Methyl-D-Aspartate; Topiramate; Trigeminal Neuralgia; Valproic Acid

The purpose of this study was to investigate the current prescription pattern of oral healthcare professionals in the management of patients with trigeminal neuralgia at a local hospital.. Data relating to a consecutive series of patients (n = 49) with typical trigeminal neuralgia was collected over a period of 6 months.. Over half the subjects (70%) were using carbamazepine as the only form of medical therapy. Gabapentin was used in 20% of the subjects. A combination therapy or Topiramate was used in few of the patients in the study group (7.5%).. Carbamazepine is still the main drug of choice in the management of trigeminal neuralgia. New anti-epileptic drugs have broadened the therapeutic options in those who cannot tolerate conventional carbamazepine therapy or surgical treatment.

Topics: Adult; Age of Onset; Aged; Aged, 80 and over; Amines; Anticonvulsants; Carbamazepine; Cyclohexanecarboxylic Acids; Drug Combinations; Female; Fructose; Gabapentin; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Practice Patterns, Dentists'; Topiramate; Trigeminal Neuralgia

Topiramate was administered to eight patients with classical trigeminal neuralgia with or without previous symptomatic therapy with other antiepileptic drugs. The topiramate doses ranged from 50 to 100 mg a day, according to the clinical response and the reported side effects. Three patients had complete symptoms remission, three reported moderate improvement, and the treatment was not effective in two. The most frequently registered side effects were dizziness, somnolence and weight loss. Topiramate can be considered an alternative treatment for patients with trigeminal neuralgia.

Topics: Anticonvulsants; Female; Fructose; Humans; Male; Middle Aged; Topiramate; Treatment Outcome; Trigeminal Neuralgia

Topics: Anticonvulsants; Female; Fructose; Humans; Middle Aged; Multiple Sclerosis; Receptors, AMPA; Topiramate; Trigeminal Neuralgia

Two cases of paroxysmal hemicrania (PH) associated with trigeminal neuralgia are reviewed. The paroxysmal hemicrania component in one patient was episodic, while it was chronic in the other. Each headache type responded completely to separate treatment, highlighting the importance of recognizing this association. We review the six other cases of chronic paroxysmal hemicrania-tic (CPH-tic) reported, and suggest that the term paroxysmal hemicrania-tic syndrome (PH-tic) be used to describe this association.

Topics: Aged; Carbamazepine; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Fructose; Humans; Indomethacin; Male; Middle Aged; Syndrome; Topiramate; Trigeminal Neuralgia; Vascular Headaches; Verapamil

Topics: Adult; Anticonvulsants; Female; Fructose; Humans; Male; Middle Aged; Topiramate; Trigeminal Neuralgia

Topics: Adult; Female; Fructose; Humans; Male; Multiple Sclerosis; Topiramate; Trigeminal Neuralgia