Intravenous fosphenytoin therapy for the rescue of acute trigeminal neuralgia crisis in pre- and post-neurosurgical patients: a retrospective observational study
BackgroundThere is no established treatment for the acute exacerbation of trigeminal neuralgia. We aimed to investigate the efficacy and safety of intravenous fosphenytoin for this disease.MethodsWe conducted a retrospective observational study of data from 41 patients with trigeminal neuralgia who...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2024.1493274/full |
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| author | Shusaku Noro Hideki Endo Bunsho Asayama Yuki Amano Masahiro Okuma Ryota Nomura Kaori Honjo Yoshinobu Seo Hirohiko Nakamura |
| author_facet | Shusaku Noro Hideki Endo Bunsho Asayama Yuki Amano Masahiro Okuma Ryota Nomura Kaori Honjo Yoshinobu Seo Hirohiko Nakamura |
| author_sort | Shusaku Noro |
| collection | DOAJ |
| description | BackgroundThere is no established treatment for the acute exacerbation of trigeminal neuralgia. We aimed to investigate the efficacy and safety of intravenous fosphenytoin for this disease.MethodsWe conducted a retrospective observational study of data from 41 patients with trigeminal neuralgia who received intravenous fosphenytoin therapy. Fosphenytoin diluted with physiological saline was administered intravenously at a loading dose of 9.8–20.7 mg/kg or at a dose of 7.5–9.5 mg/kg when maintenance therapy was needed. Pain was evaluated using a numerical rating scale (NRS), assessed immediately before administration (baseline) and at 2, 12, and 24 h after administration.ResultsThe mean (± standard deviation) NRS score was 9.85 ± 0.69, 0.49 ± 1.47, 1.60 ± 2.19, and 3.46 ± 3.19 at baseline, 2, 12, and 24 h after administration, respectively (p < 0.001). Intravenous fosphenytoin therapy was effective for the acute exacerbation of trigeminal neuralgia regardless of whether it was administered during the perioperative period of microvascular decompression (MVD) or the type of drugs used concomitantly. Fosphenytoin was effective when re-administered (n = 14) or at a maintenance dose (n = 2). The adverse drug reactions observed were mild dizziness in six patients, abnormal auditory perception and thirst in three patients each, and somnolence, decreased SpO2, and drug eruption in one patient each, all of which were transient.ConclusionsIntravenous fosphenytoin therapy can immediately eliminate pain during acute exacerbation of trigeminal neuralgia and can be a useful therapeutic drug in emergency response or until elective treatment, such as MVD, is performed. |
| format | Article |
| id | doaj-art-96456e808192405fb17bf9d63f50ec6d |
| institution | Kabale University |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj-art-96456e808192405fb17bf9d63f50ec6d2025-01-07T05:23:53ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-01-011510.3389/fneur.2024.14932741493274Intravenous fosphenytoin therapy for the rescue of acute trigeminal neuralgia crisis in pre- and post-neurosurgical patients: a retrospective observational studyShusaku NoroHideki EndoBunsho AsayamaYuki AmanoMasahiro OkumaRyota NomuraKaori HonjoYoshinobu SeoHirohiko NakamuraBackgroundThere is no established treatment for the acute exacerbation of trigeminal neuralgia. We aimed to investigate the efficacy and safety of intravenous fosphenytoin for this disease.MethodsWe conducted a retrospective observational study of data from 41 patients with trigeminal neuralgia who received intravenous fosphenytoin therapy. Fosphenytoin diluted with physiological saline was administered intravenously at a loading dose of 9.8–20.7 mg/kg or at a dose of 7.5–9.5 mg/kg when maintenance therapy was needed. Pain was evaluated using a numerical rating scale (NRS), assessed immediately before administration (baseline) and at 2, 12, and 24 h after administration.ResultsThe mean (± standard deviation) NRS score was 9.85 ± 0.69, 0.49 ± 1.47, 1.60 ± 2.19, and 3.46 ± 3.19 at baseline, 2, 12, and 24 h after administration, respectively (p < 0.001). Intravenous fosphenytoin therapy was effective for the acute exacerbation of trigeminal neuralgia regardless of whether it was administered during the perioperative period of microvascular decompression (MVD) or the type of drugs used concomitantly. Fosphenytoin was effective when re-administered (n = 14) or at a maintenance dose (n = 2). The adverse drug reactions observed were mild dizziness in six patients, abnormal auditory perception and thirst in three patients each, and somnolence, decreased SpO2, and drug eruption in one patient each, all of which were transient.ConclusionsIntravenous fosphenytoin therapy can immediately eliminate pain during acute exacerbation of trigeminal neuralgia and can be a useful therapeutic drug in emergency response or until elective treatment, such as MVD, is performed.https://www.frontiersin.org/articles/10.3389/fneur.2024.1493274/fulltrigeminal neuralgiaacute exacerbationfosphenytoinphenytoinnumerical rating scalemicrovascular decompression |
| spellingShingle | Shusaku Noro Hideki Endo Bunsho Asayama Yuki Amano Masahiro Okuma Ryota Nomura Kaori Honjo Yoshinobu Seo Hirohiko Nakamura Intravenous fosphenytoin therapy for the rescue of acute trigeminal neuralgia crisis in pre- and post-neurosurgical patients: a retrospective observational study Frontiers in Neurology trigeminal neuralgia acute exacerbation fosphenytoin phenytoin numerical rating scale microvascular decompression |
| title | Intravenous fosphenytoin therapy for the rescue of acute trigeminal neuralgia crisis in pre- and post-neurosurgical patients: a retrospective observational study |
| title_full | Intravenous fosphenytoin therapy for the rescue of acute trigeminal neuralgia crisis in pre- and post-neurosurgical patients: a retrospective observational study |
| title_fullStr | Intravenous fosphenytoin therapy for the rescue of acute trigeminal neuralgia crisis in pre- and post-neurosurgical patients: a retrospective observational study |
| title_full_unstemmed | Intravenous fosphenytoin therapy for the rescue of acute trigeminal neuralgia crisis in pre- and post-neurosurgical patients: a retrospective observational study |
| title_short | Intravenous fosphenytoin therapy for the rescue of acute trigeminal neuralgia crisis in pre- and post-neurosurgical patients: a retrospective observational study |
| title_sort | intravenous fosphenytoin therapy for the rescue of acute trigeminal neuralgia crisis in pre and post neurosurgical patients a retrospective observational study |
| topic | trigeminal neuralgia acute exacerbation fosphenytoin phenytoin numerical rating scale microvascular decompression |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2024.1493274/full |
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