Felbamate relieved trigeminal neuralgia

Objective: The analgesic efficacy of the novel anticonvulsant felbamate was evaluated in trigeminal neuralgia. Patients and Setting: This trial was offered in a tertiary referral center to three outpatients with severe pain who had exhausted other medical options, yet did not wish to undergo surgery. Interventions: Felbamate was prescribed as the sole analgesic for approximately 1 month. Outcome Measures: A visual analogue scale was utilized. Results: Felbamate potently diminished the severe pain of trigeminal neuralgia and was well tolerated. The drug was withdrawn because of subsequent reports elsewhere of aplastic anemia and hepatic failure associated with it when used for epilepsy. Conclusions: Preliminary evidence suggested that felbamate was effective in relieving trigeminal neuralgia. Stabilization of neuronal membrane depolarization was the most likely mechanism of action. However, significant potential risks preclude further use of felbamate in the management of nonmalignant pain. Principles that have proven useful in screening for new anticonvulsant drugs might be relevant to the development of methods by which to search for new analgesic drugs.