Trigeminal neuralgia treated with human immunoglobulin (IgG) by pkv14415


									European Journal of Neuroscience; 2000 12(11): 360. Abstract presentation at FENS-meeting 2000 in


A.Goebel, S.Netal, R.Schedel, G.Sprotte

Department of Anesthesiology, University of Würzburg, Germany

A proportion of patients do not have continuous benefit from medications currently used in the treatment of
trigeminal neuralgia. Surgical treatment is associated with both morbidity and mortality (1). We report the
results of treatment with human IgG in 10 consecutive patients (6 male, 4 female, mean age 64 years, mean
duration of disease: 11.6 years) who had minimal improvement following treatment with carbamazepine.
Informed consent was obtained from all patients. A starting dose of 4.5g was used, split into three
applications given over 7 days. Upon demonstration of definite and incomplete pain relief 28 days after
administration, treatment was repeated with dosages increasing to a maximum dose of 30g. Treatment was
stopped if either complete pain relief was reported or if no cumulative benefit was observed with repeated
administration of the highest dose. Treatment was recommenced on return (or increase) of pain. The
median follow-up period following commencement of treatment was 2 years. One patient was lost to
follow up. Of the remaining patients, four had pain-free intervals of more than one year without treatment.
One patient was pain free for 9 months and then received additional medical treatment. One patient
reported a reduced frequency of trigeminal attacks with continuous IgG-treatment in 28 day intervals.
Three patients did not show any reduction in pain levels.
Human IgG may be an effective therapy in patients with trigeminal neuralgia refractory to treatment with
carbamazepine. A multi-centered, placebo-controlled study will help to establish the usage of IgG in
trigeminal neuralgia.

1. Brisman-R. Surgical Treatment of Trigeminal Neuralgia. Seminars in Neurology 1997; 17(4): 367-372

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