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Oxcarbazepine (Trileptal) has recently been approved in the United States for use as monotherapy or adjunctive therapy in the treatment of partial seizures in adults with epilepsy and as adjunctive therapy in the treatment of partial seizures in children (1). Several published reports suggest efficacy in idiopathic trigeminal neuralgia (2, 3). The potential for usefulness of oxcarbazepine in treating painful peripheral neuropathies is thus suggested. A 69-year-old man was seen for an initial consultation in 1996 with a 2-year history of continuous aching pain in the feet. His past medical history was significant for type II diabetes treated with insulin for 3 years and complicated by diabetic retinopathy. His neurological examination demonstrated mild distal weakness in the upper and lower extremities and hypoactive deep tendon reflexes with no pathological toe signs. Sensory examination revealed a distal decrease to pinprick and temperature in all four extremities with distal decreased vibratory sense. An EMG demonstrated an axonal polyneuropathy compatible with a diabetic neuropathy. The patient was on amitriptyline, fluoxetine, insulin, and glyburide at the initial visit. The patient was started on carbamazepine for treatment of the painful peripheral neuropathy. The patient noted some improvement but had persistent painful paresthesias on the carbamazepine. The dose was increased until it was no longer tolerated due to decreased coordination. The carbamazepine was thus discontinued and gabapentin was initiated. There was initial improvement with gabapentin but no persistent relief. Gabapentin was thus tapered and discontinued |
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