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Approximately 1% of patients with MS experience trigeminal neuralgia. This disorder is more common in patients with MS than in the general population.1 Typically, trigeminal neuralgia is treated with a variety of medications, either alone or in various combinations, including anticonvulsants, antispasticity medications, nonsteroidal anti-inflammatory drugs (NSAID), tricyclic antidepressants, and other pain-relieving medications. Surgery in refractory cases may provide pain relief, though patients may be reluctant to consider surgical options. Surgical procedures to treat trigeminal neuralgia in MS are generally less effective than in patients with the idiopathic form.2 Topiramate, a novel anticonvulsant, has also been reported to be effective in the treatment of neuropathic pain.3
We report six patients with MS treated with topiramate who had incapacitating trigeminal neuralgia refractory to conventional medical therapy.
Methods.
Six consecutive patients with MS with refractory trigeminal neuralgia were evaluated (four men, two women; mean age 36.6, range: 32 to 43 years). Mean duration of MS was 7.5 years (range: 4 to 11 years); mean duration of trigeminal neuralgia was 3.8 years (range: 1 to 6 years). Trigeminal neuralgia was described as episodes of severe unilateral facial pain, usually lasting less than 5 minutes. Pain could occur several times …
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