Front Neurol
IV anticonvulsant reduces pain in trigeminal neuralgia crises
IV fosphenytoin resulted in rapid and significant pain relief for patients experiencing acute trigeminal neuralgia crises, making it a valuable option for emergency management and bridging therapy until elective procedures like microvascular decompression can be performed. Data from this small phase 3 trial were shared at the recent American Academy of Neurology (AAN) 2025 annual meeting.
Study details: This retrospective observational study analyzed data from 41 patients with acute trigeminal neuralgia who received IV fosphenytoin therapy at Nakamura Memorial Hospital in Japan. Fosphenytoin was administered at a loading dose of 9.8–20.7 mg/kg or a maintenance dose of 7.5–9.5 mg/kg. Pain levels were assessed using a numerical rating scale (NRS) at baseline and at 2, 12, and 24 hours post-administration.
Results: Mean NRS scores significantly decreased from 9.85 ± 0.69 at baseline to 0.49 ± 1.47 at 2 hours, 1.60 ± 2.19 at 12 hours, and 3.46 ± 3.19 at 24 hours post-administration (p < 0.001). Fosphenytoin was effective regardless of perioperative status or concomitant drug use. Adverse reactions were mild and transient, including dizziness, abnormal auditory perception, thirst, somnolence, decreased SpO2, and drug eruption.
Source:
Noro S, et al. (2025, January 7). Front Neurol. Intravenous fosphenytoin therapy for the rescue of acute trigeminal neuralgia crisis in pre- and post-neurosurgical patients: a retrospective observational study. https://pubmed.ncbi.nlm.nih.gov/39839861/