Refractory Trigeminal Neuralgia Successfully Treated with Gabapentin-A Case Report

Carbamazepine and its related anticonvulsants are the treatment of choice for trigeminal neuralgia for many years. But trigeminal neuralgia refractory to conventional anticonvulsant agents is still the main challenge to clinicians. We report a 42-year-old male who was a victim of trigeminal neuralgia for four years. Beside, he had undergone craniotomy and radiotherapy for right middle fossa meningioma five years ago. In general, his pain could be controlled by carbamazepine and baclofen. But the frequency and duration of the attack became severe despite the medical treatment. He described the pain sensation as sharp, stabbing and burning and it could be triggered by touch, shaving or chewing. Secondary trigeminal neuralgia was diagnosed because brain MRI examination revealed right trigeminal nerve root compression by a right parasellar area recurrent tumor. The neurologist had adjusted the medications to other traditional anticonvulsants but the pain was not resolved. The patient even tried not to eat or drink to avoid triggering the attack. Since the right internal carotid artery was involved and the risk of surgical treatment was high, radiotherapy was arranged. At the same time, we were consulted for neurolytic block. Considering the risk of the procedure, we suggested the use of gabapentin, a novel anticonvulsant and analgesic. Fortunately, the pain was relieved after one-week treatment of gabapentin and did not attack again during the 3 months follow-up. We present this case to offer another therapeutic option for trigeminal neuralgia that is refractory to traditional anticonvulsant drugs.