Abstract
Patients: A 78-year-old woman complained of pain as paroxysmal electrical sparks on the left cheek. The pain was triggered by eating or speaking. She was given carbamazepine(CBZ) therapy 200 mg per day, which was later discontinued owing to side effects. On her first visit to our clinic, we prescribed zonisamide 100 mg per day; however, her pain was not relieved. Next month, she was hospitalized for stoke. For the next 2 years and 6 months, she had no pain. At her next visit to our clinic, we prescribed CBZ 100 mg per day, after which her pain was relieved significantly. Approximately 2 months later, her pain intensified. We raised the CBZ dose to 200 mg per day; however, the patient developed dizziness. Application of alternating current iontophoresis (AC IOP) relieved her pain. In addition to CBZ, she was also started on Kampo medicine (Rikkousan and Goreisan). Approximately 6 weeks later, her pain intensified again. We increased the CBZ dose to 280 mg per day and applied acupuncture treatment, following which her pain alleviated. Approximately 3 weeks later, her pain developed again. She underwent gamma knife therapy, but her pain was not relieved. Therefore, we continued to administer AC IOP, acupuncture treatment, and medication (CBZ and Kampo medicine), her pain was relieved about 2 months later.
Discussion: We often have difficulty in treating trigeminal neuralgia, when CBZ therapy produces side effects. We report a case of such a resistant patient who was successfully treated by using a combination of CBZ medication and other treatments (AC IOP, acupuncture treatment, and Kampo medicine).
Conclusion: The combination of AC IOP and acupuncture treatment may be a useful for the treatment of resistant trigeminal neuralgia.
