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What Does This CT Scan Report Indicate?
Question: hi Dr XXXX pain is very severe now.but bp id very normal.the pain goes from the head to the left eye like an electric shock.been giving her gabapentine 300mg,but it seems not to be active again. Pls can u recommend sometin for the pain? I sent u her ct scan result some days back.
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
That type of pain is characteristic for what is called trigeminal neuralgia, pain related to the trigeminal nerve irritation, the nerve which is responsible for sensation in the face.
Now regarding the cause, it can at times not be found. However it must be searched through proper imaging tests. CT scan usually is not enough to detect the cause as we are speaking of very small lesions in the posterior part of the brain which the CT doesn't see that well. It is for that reason that a MRI is required as it can study the nerve and its potential compression or lesion.
As for the treatment usually the first choice treatment is Carbamazapine (Tegretol). Gabapentine is used at times, but in higher dosage than 300 mg which you mention. But Tegretol remains first choice. It is started at a low dose, incrementing it gradually up to at least 600 mg a day (3 tablets). When effective it is not interrupted but continued for at least 6 months.
If Carbamazepoine is not effective, other anticonvulsant class options may be Lyrica, Lamotrigine, Phenytoin, Baclofen or Gabapentin at higher dosage. These medications can also be combined with Amitriptyline but should be done very cautiously for possible side effects.
At times depending on the findings on MRI there are surgical procedures possible to decompress the nerve or neutralize it. However shouldn't think that far as we have no MRI for now and medication is always tried first.
I remain at your disposal for further questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
That type of pain is characteristic for what is called trigeminal neuralgia, pain related to the trigeminal nerve irritation, the nerve which is responsible for sensation in the face.
Now regarding the cause, it can at times not be found. However it must be searched through proper imaging tests. CT scan usually is not enough to detect the cause as we are speaking of very small lesions in the posterior part of the brain which the CT doesn't see that well. It is for that reason that a MRI is required as it can study the nerve and its potential compression or lesion.
As for the treatment usually the first choice treatment is Carbamazapine (Tegretol). Gabapentine is used at times, but in higher dosage than 300 mg which you mention. But Tegretol remains first choice. It is started at a low dose, incrementing it gradually up to at least 600 mg a day (3 tablets). When effective it is not interrupted but continued for at least 6 months.
If Carbamazepoine is not effective, other anticonvulsant class options may be Lyrica, Lamotrigine, Phenytoin, Baclofen or Gabapentin at higher dosage. These medications can also be combined with Amitriptyline but should be done very cautiously for possible side effects.
At times depending on the findings on MRI there are surgical procedures possible to decompress the nerve or neutralize it. However shouldn't think that far as we have no MRI for now and medication is always tried first.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
can I give her gabapentine and carbamazepine together?
Brief Answer:
Not advisable.
Detailed Answer:
I am afraid that is not recommended, since their side effects would add to each other and might be dangerous. So they are not used together at a full dose. While it is passed from the one to the other they might be used together as the dosage of Carbamazepine is increased and that of Gabapentin lowered.
If you have been taking Gabapentin only at 300mg though, perhaps before making a switch you might want to try to raise the dose. It goes up to 1800mg, though in an elderly subject I wouldn't go beyond 1200 mg a day. That is since you are already on this drug, to make sure it really is ineffective and not just an insufficient dosage. If confirmed that it doesn't work should go on with Carbamazepine.
I hope to have been of help.
Not advisable.
Detailed Answer:
I am afraid that is not recommended, since their side effects would add to each other and might be dangerous. So they are not used together at a full dose. While it is passed from the one to the other they might be used together as the dosage of Carbamazepine is increased and that of Gabapentin lowered.
If you have been taking Gabapentin only at 300mg though, perhaps before making a switch you might want to try to raise the dose. It goes up to 1800mg, though in an elderly subject I wouldn't go beyond 1200 mg a day. That is since you are already on this drug, to make sure it really is ineffective and not just an insufficient dosage. If confirmed that it doesn't work should go on with Carbamazepine.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
started carbamazepine 100mg already. can I give her twice daily?or just 100mg daily?pls advice.
Brief Answer:
Yes.
Detailed Answer:
Yes you can give her twice daily already it is alright.
Afterwards increase the dose by 100 mg every 3 days up to at least 600 mg a day.
Yes.
Detailed Answer:
Yes you can give her twice daily already it is alright.
Afterwards increase the dose by 100 mg every 3 days up to at least 600 mg a day.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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