Abstract text (incl. figure legends and references)

Introduction & Objectives

First-line treatment in trigeminal neuralgia (TN) is limited to carbamazepine (CBZ) and oxcarbazepine (OXC), but inefficacy or intolerability is frequent and valid alternatives are scarce. Lacosamide (LCM), a novel sodium channel blocker, has been proposed as an alternative option in a few case reports. Our objective is to describe a series of patients who received oral LCM after first-line treatment failure.

Methods

In this retrospective analysis, we included patients who were prescribed LCM for TN pain control and were followed at our tertiary hospital. We recorded demographic information, TN characteristics and treatment data. Primary endpoints were pain relief and adverse events. Secondary endpoints were absence of pain and time to pain worsening.

Results

86 patients were included, with a mean age of 61.9 ±15.6 years, 62.8% women. Median time since TN diagnosis was 4.44 years (range 48 years). Pain was purely paroxysmal in 66.3%. Etiology was secondary in 18.6%. 88.37% of patients had previously been treated with CBZ or OXC. Mean daily initial LCM dose was 143 ±63.32mg, and mean daily maintenance dose was 228.5 ±113.64mg. 53.49% of patients concomitantly received CBZ or OXC. Pain relief was accomplished in 74.4% of cases, with a 31.4% of adverse events (mainly dizziness in 18.6%, somnolence in 4.65% and instability in 3.48%). One patient presented a first-degree cardiac blockade. Absence of pain was reported in 33.7%. Pain worsening was recorded in 43% or patients, with a mean time of 441.26 ±478.93 days after LCM initiation.

Conclusions

LCM could be an effective and relatively safe treatment of refractory pain in TN, after first-line treatments failure. Further prospective studies are needed.