Front Neurol

IV anticonvulsant reduces pain in trigeminal neuralgia crises

May 5, 2025

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/