Phenytoin relieves acute exacerbations of trigeminal neuralgia: Results of a retrospective case series

Abstract

Introduction The management of acute exacerbations of trigeminal neuralgia remains a major clinical challenge due to the limited availability of clinical evidence. This retrospective case series aims to evaluate the effectiveness and safety of intravenous phenytoin in the treatment of these exacerbations. Methods We retrospectively analyzed the outcome of patients treated with intravenous phenytoin for acute exacerbations of trigeminal neuralgia at the University Hospital Zurich between January 2016 and December 2023. Statistical analyses were performed to assess the associations of patient and disease characteristics with phenytoin response. Results In our sample of 45 cases, treatment with phenytoin resulted in a significant or complete relief in 30 cases (66.7%), while 11 (24.4%) experienced slight relief and 4 (8.9%) none. Patient or disease characteristics were not associated with treatment response. Side effects were rare, with skin itching occurring in only one case. Conclusion This retrospective case series demonstrates, that phenytoin is a safe and effective treatment for acute exacerbations of trigeminal neuralgia. However, larger prospective studies are needed.