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Gabapentin In Multiple Sclerosis

  1. Gabapentin effect on Spasticity in MS
    Arch Phys Med Rehabil 2000 Feb;81(2):164-9

  2. Gabapentin for Spasticity In MS
    Am J Phys Med Rehabil 1998 Sep-Oct;77(5):451-4

  1. Gabapentin for Pain In Multiple Sclerosis
    Mult Scler 1997 Aug;3(4):250-253

  2. An open-label trial of Gabapentin treatment of paroxysmal symptoms in Multiple Sclerosis
    Neurology 1998 Aug;51(2):609-11

  3. Gabapentin for the treatment of postherpetic Neuralgia
    JAMA 1998 Dec 2;280(21):1837-42

  4. Gabapentin relieves Spasticity In Multiple Sclerosis
    Arch Phys Med Rehabil 1997 May 78:5 521-4



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#1
Neurontin For Pain In
Multiple Sclerosis

Houtchens MK, Richert JR, Sami A, Rose JW
Mult Scler 1997 Aug;3(4):250-253
NeuroVirology Research Laboratory, VAMC, Salt Lake City, Utah, USA
UI# 98039778
Abstract

Pain is a frequent and distressing complaint in patients with Multiple Sclerosis (MS) and may present a difficult therapeutic problem.

Conventional therapy is moderately effective and includes, among others, a variety of AntiConvulsant medications.

Gabapentin (Neurontin) is a new generation AntiEpileptic drug which appears to be advantageous in treatment of intractable pain of Reflex Sympathetic Dystrophy.

This study investigates the benefits of open-label treatment with Gabapentin for Pain control in 25 patients with Multiple Sclerosis.

Excellent to moderate Pain Relief was obtained in a substantial number of patients. Throbbing Pins & Needles, and Cramping Pains responded best, and dull aching pains responded least to the medication.

There was no significant change in distribution and type of Pain as a result of this treatment.

Mild to moderate side effects were observed. Cautious escalation of the dose of Gabapentin is advisable in MS patients.

Further clinical trials with larger patient groups are recommended.



#2

An Open-Label Trial Of Gabapentin Treatment Of Paroxysmal Symptoms In Multiple Sclerosis

Solaro C, Lunardi GL, Capello E, Inglese M, Messmer Uccelli M, Uccelli A, Mancardi GL
Neurology 1998 Aug;51(2):609-11
Univ of Genoa, Dept of Neurological Sciences and Neurorehabilitation, Genoa, Italy
PMID# 9710049; UI# 98373823
Abstract

We conducted an open-label trial of Gabapentin (GBP) as therapy for Paroxysmal Symptoms (PS) in 21 MS patients, including Trigeminal Neuralgia (6 patients), Painful Tonic Spasms (11), Dysesthetic Or Paresthetic Symptoms (3) and Ocular Ataxia (1).

Complete resolution of symptoms or partial improvement was obtained, respectively, in 14 and 4 of 18 patients who ended the study.

Sustained improvement with minor side effects was obtained at dosages ranging from 600 to 1200 mg/d. Our findings suggest that GBP may be effective for PS in MS and warrant a further study in a double-blind placebo-controlled trial.



#3

Gabapentin For The Treatment Of PostHerpetic Neuralgia: A Randomized Controlled Trial

Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L
JAMA 1998 Dec 2;280(21):1837-42
Univ of California, UCSF Pain Clinical Research Center, San Francisco 94115, USA
PMID# 9846778; UI# 99061235
Abstract

Context
PostHerpetic Neuralgia (PHN) is a syndrome of often intractable Neuropathic Pain following Herpes Zoster (Shingles) that eludes effective treatment in many patients.

Objective
To determine the efficacy and safety of the AntiConvulsant drug Gabapentin in reducing PHN Pain.

Design & Setting
Multicenter, randomized, double-blind, placebo-controlled, parallel design, 8-week trial conducted from August 1996 through July 1997. Sixteen US outpatient clinical centers.

Participants & Intervention
A total of 229 subjects were randomized. A 4-week titration period to a maximum dosage of 3600 mg/d of Gabapentin or matching placebo. Treatment was maintained for another 4 weeks at the maximum tolerated dose.

Concomitant Tricyclic AntiDepressants and/or narcotics were continued if therapy was stabilized prior to study entry and remained constant throughout the study.

Main Outcome Measures
The primary efficacy measure was change in the average daily Pain score based on an 11-point Likert scale (0, No Pain; 10, worst possible Pain) from baseline week to the final week of therapy.

Secondary measures included average daily sleep scores, Short-Form McGill Pain Questionnaire (SF-MPQ), Subject Global Impression of Change and investigator-rated Clinical Global Impression of Change, Short Form-36 (SF-36) Quality of Life Questionnaire, and Profile of Mood States (POMS).

Safety measures included the frequency and severity of adverse events.

Results
One hundred thirteen patients received Gabapentin, and 89 (78.8%) completed the study; 116 received placebo, and 95 (81.9%) completed the study.

By intent-to-treat analysis, subjects receiving Gabapentin had a statistically significant reduction in average daily Pain score from 6.3 to 4.2 points compared with a change from 6.5 to 6.0 points in subjects randomized to receive placebo (P<.001).

Secondary measures of Pain as well as changes in Pain and Sleep Interference showed improvement with Gabapentin (P<.001). Many measures within the SF-36 and POMS also significantly favored Gabapentin (P< or =.01).

Somnolence, Dizziness, Ataxia, Peripheral Edema, and Infection were all more frequent in the Gabapentin group, but withdrawals were comparable in the 2 groups (15 [13.3%] in the Gabapentin group vs 11 [9.5%] in the placebo group).

Conclusions
Gabapentin is effective in the treatment of Pain and Sleep Interference associated with PHN. Mood and quality of life also improve with Gabapentin therapy.

  • Comment in: JAMA 1998 Dec 2;280(21):1863-4
  • Comment in: JAMA 1999 Jul 14;282(2):134-5


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