Trigeminal neuralgia and fampridine: further contraindication

Background

Fampridine (also called 4-aminopyridine or dalfampridine in the USA) is an oral drug recently approved for patients with MS as it can help improve symptoms of walking impairment.

Walking problems, which affect a large proportion of people with MS, may have many causes.

Although not everyone taking fampridine will see improvements in walking, in clinical trials between a third and a half of those taking it found walking speed improved, with an average improvement of about 25 per cent.

Fampridine seems to be more effective in patients who walk very slowly. There are no major contraindications to fampridine, but people with a history of epilepsy cannot take the drug.

Study

In this study, a team at the MS Treatment and Research Center of Minneapolis treated 71 MS patients with fampridine for walking impairment.

Five of these patients had a history of preexisting trigeminal neuralgia (episodes of sudden, severe facial pain originating from the trigeminal nerve).

The researchers observed that, in four of these patients, trigeminal neuralgia worsened when they took fampridine. In three patients, recurrences of facial pain started within a month of starting treatment with fampridine, while in another patient the appearance of severe facial pain occurred after 18 months.

Although fampridine was stopped as soon as patients’ pain started to get worse, in some case the facial pain became resistant to medication.

These results suggest that fampridine can cause a reactivation of neuropathic pain due to trigeminal neuralgia.

This means that fampridine must be used with caution in people with a history of MS-related trigeminal neuralgia.

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Thessaloniki, Greece, 10/2011. Finding an effective MS therapy has been a particular challenge for Vasiliki Garopoulou; every medication she tried has caused intolerable side effects. On average, she has a relapse once per month, many of which land her in hospital for cortisone treatment. Credit: Maximiliano Braun. Published on this website by kind permission of the European Multiple Sclerosis Platform.

Thessaloniki, Greece, 10/2011. In May 2011, loss of balance forced Pangiotta Tsinoni (44) to give up her career as an oncologic surgeon specialising in breast cancer. Now, even though she does physiotherapy to improve balance and wears a prosthetic brace on her leg, the fear of falling in the street keeps her close to home. She takes her dog, Nino, for daily walks but never strays far from home. Credit: Maximiliano Braun. Published on this website by kind permission of the European Multiple Sclerosis Platform.