Lacosamide in trigeminal neuralgia: report of a case refractory to first- and second-generation anticonvulsants

ABSTRACT

Background

The treatment of trigeminal neuralgia (TN) involves first- and second-generation anticonvulsants. However, side effects (SEs) impair compliance with treatment, especially in elderly patients. Lacosamide (LCM) is a third-generation anticonvulsant with a mechanism of action that is not completely clear. It has few SEs and has been considered in the treatment of neuropathic pain.

Clinical Presentation

LCM was prescribed as a monotherapy for a 60-year-old female with TN who had proven refractory to previous treatments in terms of both the absence of any pain relief and the appearance of severe leukopenia. The treatment dosage was 100 mg twice daily. Pain relief was obtained after three weeks of treatment without any SEs. Currently, the patient takes a maintenance dosage of 100 mg/daily, remaining in a state of complete well-being.

Conclusion

LCM has shown evidence of a potential efficacy and a good safety profile in the treatment of this patient with TN.

KEYWORDS:

• Trigeminal neuralgia
• lacosamide
• leukopenia
• side effects
• facial pain

Acknowledgments

Dr. D.A. designed the treatment protocol and wrote the article. Dr. N.C. designed and edited the figures and tables. Prof. M.N. and M.M. evaluated the patient and edited the final version of the article. All of the authors have read the final version of the manuscript and approved its content.

Consent

Written informed consent was given by the patient for the publication of this case report and the accompanying images.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Disclosure statement

The authors declare that there are no conflicts of interest regarding the publication of this article.

Additional information

Funding

The work was supported by the Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, of the “Federico II University of Naples,” Italy.