Efficacy of IV Fosphenytoin for Acute Attacks of Trigeminal Neuralgia

Trigeminal neuralgia (TN) is characterized by sudden, severe, electric-shock–like facial pain. According to European Academy of Neurology guidelines, hospitalization may be necessary for management that includes infusions of fosphenytoin, despite limited evidence supporting this treatment. In this industry-funded, multicenter, double-blind, placebo-controlled, phase 3 trial, 21 hospitalized participants (62% female) with classic or idiopathic TN were randomized and received either intravenous (IV) fosphenytoin (18 mg/kg loading dose followed by 7.5 mg/kg daily for 4 days) or placebo. The primary end point was the change in facial pain rating on an 11-point scale, from baseline to 2 hours after the initial dose.