Effects of Topiramate on Dysaesthetic Pain in a Patient with Multiple Sclerosis
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CASE REPORT
Effects of Topiramate on Dysaesthetic Pain in a Patient with Multiple Sclerosis Antonio Siniscalchi • Luca Gallelli Giovambattista De Sarro
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Published online: 4 January 2013 Ó Springer International Publishing Switzerland 2012
Abstract Dysaesthetic pain is a common neuropathic pain in patients with multiple sclerosis. Both tricyclic antidepressants (i.e., amitriptyline and duloxetine) and antiepileptic drugs (i.e., carbamazepine, gabapentin and pregabalin) represent first-line treatment of neuropathic pain. However, topiramate, an antiepileptic drug, also demonstrated clinical efficacy in these patients. In this report we describe the case of a 42-year-old woman with an 8-year history of multiple sclerosis who developed dysaesthetic pain in the lower limbs, and was successfully treated with topiramate at a final dose of 150 mg/day. About 8 months after beginning topiramate treatment, the patient had not shown any dysaesthetic pain, and no adverse events related to topiramate had been recorded.
1 Introduction Pain is the most common symptom in multiple sclerosis (MS), affecting about 50 % of patients [1–3]. Based on pathophysiological criteria, the pain syndrome in MS patients may be classified as: (i) nociceptive (somatic/visceral) pain; (ii) neuropathic pain and (iii) psychogenic pain
[1–3]. Dysaesthetic pain is a neuropathic pain commonly described in MS patients [1–3] and is defined as a constant (and often burning) pain that predominantly affects the legs and feet as ongoing extremity pain [4]. Although several antiepileptic drugs such as carbamazepine, lamotrigine, levetiracetam and gabapentin may be used to treat dysaesthetic pain in patients with MS [2, 3], tricyclic antidepressants (i.e., amitriptyline) represent the most common treatment [2, 3]. However, these studies have been conducted in relatively small samples and the optimal dosage has not yet been confirmed. Many authors documented the effects of cannabinoid agonists in MS patients [4–6]. Moreover, the use of cannabis derivatives has been recently accepted as a useful alternative for the treatment of spasticity and pain in patients with MS, even though adverse events (dizziness, dry mouth, sedation, fatigue, gastrointestinal effects, oral discomfort), which have been described in about 90 % of patients in a long-term extension study (up to 3 years), and the risk of abuse limits their use [7]. Therefore, in the management of pain in MS patients, both published guidelines and expert recommendations suggest using cannabinoids as second-line therapy only [4]. In this report, we describe the effects of topiramate on dysaesthetic pain of the lower limbs in patient with MS.
Dr Siniscalchi and Dr Gallelli contributed equally to this work.
2 Case Report A. Siniscalchi Department of Neuroscience, Neurology Division, ‘‘Annunziata’’ Hospital, Cosenza, Italy L. Gallelli (&) G. De Sarro Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit Mater Domini University Hospital,
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