Author Topic: Ampyra may aggravate preexisting trigeminal neuralgia  (Read 203 times)

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Offline agate

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Ampyra may aggravate preexisting trigeminal neuralgia
« on: November 23, 2014, 03:52:33 pm »
From the MS International Federation newsletter, November 20, 2014:

Trigeminal neuralgia and fampridine: further contraindication

Fampridine must be used with caution in people with a history of MS-related trigeminal neuralgia


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.


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 patientsí 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.

This article can be seen here.

The study referred to is abstracted in PubMed, October 28, 2014:

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.

2From the MS Treatment and Research Center, Minneapolis Clinic of Neurology, Golden Valley, MN.


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).


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.


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.


Dalfampridine should be used with caution in persons with trigeminal neuralgia due to MS.


This study provides Class IV evidence that treatment with dalfampridine may precipitate or exacerbate preexisting trigeminal neuralgia.
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