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   DIR Return to: AMPYRA (dalfampridine)
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       #Post#: 566--------------------------------------------------
       Ampyra may aggravate preexisting trigeminal neuralgia
       By: agate Date: November 23, 2014, 7:52 pm
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       From the MS International Federation newsletter, November 20,
       2014:
       [quote]Trigeminal neuralgia and fampridine: further
       contraindication
       Fampridine must be used with caution in people with a history of
       MS-related trigeminal neuralgia
       Background
       Fampridine (also called 4-aminopyridine or dalfampridine in the
       USA) is an oral drug recently approved for patients with MS as
       it can help improve symptoms of walking impairment.
       Walking problems, which affect a large proportion of people with
       MS, may have many causes.
       Although not everyone taking fampridine will see improvements in
       walking, in clinical trials between a third and a half of those
       taking it found walking speed improved, with an average
       improvement of about 25 per cent.
       Fampridine seems to be more effective in patients who walk very
       slowly. There are no major contraindications to fampridine, but
       people with a history of epilepsy cannot take the drug.
       Study
       In this study, a team at the MS Treatment and Research Center of
       Minneapolis treated 71 MS patients with fampridine for walking
       impairment.
       Five of these patients had a history of preexisting trigeminal
       neuralgia (episodes of sudden, severe facial pain originating
       from the trigeminal nerve).
       The researchers observed that, in four of these patients,
       trigeminal neuralgia worsened when they took fampridine. In
       three patients, recurrences of facial pain started within a
       month of starting treatment with fampridine, while in another
       patient the appearance of severe facial pain occurred after 18
       months.
       Although fampridine was stopped as soon as patients’ pain
       started to get worse, in some case the facial pain became
       resistant to medication.
       These results suggest that fampridine can cause a reactivation
       of neuropathic pain due to trigeminal neuralgia.
       This means that fampridine must be used with caution in people
       with a history of MS-related trigeminal neuralgia.
       [/quote]
       This article can be seen here
  HTML http://www.msif.org/news/2014/11/17/trigeminal-neuralgia-fampridine-contraindication/.
       The study referred to is abstracted in PubMed, October 28, 2014:
       [quote]Neurology. 2014 Oct 28;83(18):1610-2.
       Dalfampridine may activate latent trigeminal neuralgia in
       patients with multiple sclerosis
       Birnbaum G1, Iverson J2.
       Author information
       1From the MS Treatment and Research Center, Minneapolis Clinic
       of Neurology, Golden Valley, MN. birnb001@umn.edu.
       2From the MS Treatment and Research Center, Minneapolis Clinic
       of Neurology, Golden Valley, MN.
       OBJECTIVE:
       To determine the effect of dalfampridine (4-aminopyridine), a
       broad-spectrum, voltage-dependent potassium channel blocker, on
       patients with trigeminal nerve dysfunction due to multiple
       sclerosis (MS).
       METHODS:
       We reviewed histories of 71 patients in our clinic with
       clinically definite MS who were treated with dalfampridine for
       at least 2 to 3 months. Of the 71 patients, 5 had a history of
       either trigeminal neuralgia or altered facial sensation.
       RESULTS:
       Of these 5 patients, 3 with preexisting trigeminal neuralgia had
       a marked worsening of facial pain in close proximity to starting
       dalfampridine. One patient with altered facial sensation
       developed trigeminal pain after being on dalfampridine for 18
       months. Pain in this individual rapidly subsided when
       dalfampridine was discontinued. Pain in the worsened 3 patients
       persisted, became more refractory to previously effective
       medications, and in one instance required trigeminal surgery for
       pain control.
       CONCLUSIONS:
       Dalfampridine should be used with caution in persons with
       trigeminal neuralgia due to MS.
       CLASSIFICATION OF EVIDENCE:
       This study provides Class IV evidence that treatment with
       dalfampridine may precipitate or exacerbate preexisting
       trigeminal neuralgia.[/quote]
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