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Return to: AMPYRA (dalfampridine)
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#Post#: 566--------------------------------------------------
Ampyra may aggravate preexisting trigeminal neuralgia
By: agate Date: November 23, 2014, 7:52 pm
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From the MS International Federation newsletter, November 20,
2014:
[quote]Trigeminal neuralgia and fampridine: further
contraindication
Fampridine must be used with caution in people with a history of
MS-related trigeminal neuralgia
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.
[/quote]
This article can be seen here
http://www.msif.org/news/2014/11/17/trigeminal-neuralgia-fampridine-contraindic…
The study referred to is abstracted in PubMed, October 28, 2014:
[quote]Neurology. 2014 Oct 28;83(18):1610-2.
Dalfampridine may activate latent trigeminal neuralgia in
patients with multiple sclerosis
Birnbaum G1, Iverson J2.
Author information
1From the MS Treatment and Research Center, Minneapolis Clinic
of Neurology, Golden Valley, MN. [email protected].
2From the MS Treatment and Research Center, Minneapolis Clinic
of Neurology, Golden Valley, MN.
OBJECTIVE:
To determine the effect of dalfampridine (4-aminopyridine), a
broad-spectrum, voltage-dependent potassium channel blocker, on
patients with trigeminal nerve dysfunction due to multiple
sclerosis (MS).
METHODS:
We reviewed histories of 71 patients in our clinic with
clinically definite MS who were treated with dalfampridine for
at least 2 to 3 months. Of the 71 patients, 5 had a history of
either trigeminal neuralgia or altered facial sensation.
RESULTS:
Of these 5 patients, 3 with preexisting trigeminal neuralgia had
a marked worsening of facial pain in close proximity to starting
dalfampridine. One patient with altered facial sensation
developed trigeminal pain after being on dalfampridine for 18
months. Pain in this individual rapidly subsided when
dalfampridine was discontinued. Pain in the worsened 3 patients
persisted, became more refractory to previously effective
medications, and in one instance required trigeminal surgery for
pain control.
CONCLUSIONS:
Dalfampridine should be used with caution in persons with
trigeminal neuralgia due to MS.
CLASSIFICATION OF EVIDENCE:
This study provides Class IV evidence that treatment with
dalfampridine may precipitate or exacerbate preexisting
trigeminal neuralgia.[/quote]
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