Efficacy and safety of lacosamide in patients with trigeminal neuralgia: an 8-week pilot dose-escalation study

TL;DR

This study explores lacosamide as a treatment for trigeminal neuralgia, finding it effective and safe with mild side effects.

Contribution

The study introduces lacosamide as a potential alternative to carbamazepine for trigeminal neuralgia.

Findings

Lacosamide reduced pain scores in trigeminal neuralgia patients at 2 weeks.

No significant difference in pain reduction was found between lacosamide and carbamazepine at 4 weeks.

Adverse effects of lacosamide were mild and included somnolence and vertigo.

Abstract

Background: Trigeminal neuralgia (TN) is a severe neuropathic pain condition in the
orofacial region, with carbamazepine recommended as the first-line treatment.
Nonetheless, its application is constrained by unfavorable drug responses and
side effects. The objective of this research was to assess the effectiveness and
safety of lacosamide, a third-generation anticonvulsant, in individuals with TN,
and to juxtapose the findings with observational records from recently diagnosed
TN patients who underwent carbamazepine monotherapy within the corresponding
timeframe. Methods: An 8-week flexible dose titration of lacosamide was performed on newly
diagnosed 12 TN patients who were divided into two groups: 200 mg/day (n = 5),
and 400 mg/day (n = 7). Outcome measures included average pain score, Brief Pain
Inventory-facial scores, and side effects. Patients were followed-up at 2, 4 and
8 weeks after baseline. Results: The percentage change of pain score at 4-week visit was
compared between both lacosamide groups and patients receiving carbamazepine
(n = 6) for four weeks during concurrent period. Both
lacosamide groups experienced a decrease in pain score at 2-week follow-up, and
differences in average pain score reduction were not observed between the two
groups across all visits (p > 0.05). The mean Brief Pain
Inventory-facial score in the lacosamide 200 mg/day group was higher than that in
the 400 mg/day group at the 2-week follow-up (p = 0.03). Interestingly,
the 4-week follow-up revealed that there were no significant variances in pain
intensity between the lacosamide and the contemporaneous carbamazepine cohorts
(p > 0.05). Frequently noted adverse events were mild somnolence (n =
9), slight vertigo (n = 5), and emotional lability (n = 2) without instances of
severe adverse drug responses. Conclusions: Lacosamide demonstrates potential as a
therapeutic option for patients suffering from trigeminal neuralgia. Clinical Trial Registration: TCTR20210811002.

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