Search

Multipla skleroza (MS)je kronična, demijelinizirajuća bolest za koju se dugo smatralo da ju ne prati bol. Cilj ovoga istraživanja bio je utvrditi učestalost i trajanje bolnih stanja u bolesnika s MS liječenih na Klinici za neurologiju, KB «Sestre milosrdnice». U razdoblju od tri godine obuhvatili smo 280 bolesnika. Sto šezdeset četiri bolesnika (60%) je imalo akutni ili kronični bolni sindrom. šest bolesnika (2.1%) s akutnim bolnim stanjem imalo je paroksizmalne bolne atake u području trigeminalnog živca. Kronični bolni sindrom dijagnosticiran je u 55% (n=154) bolesnika i uključivao je razne oblike glavobolje (38%), bol u vratnom ili lumbosakralnom dijelu kralješnice (58%) te bolne spazme u 4% bolesnika. Na temelju rezultata ove retrospektivne studije vidljivo je da su akutni i kronični bolni sindromi prisutni u velikom broju bolesnika oboljelih od MS te da terapija svakog bolesnika mora biti individualizirana., Multiple sclerosis is a disease of the central nervous system, beginning most often in late adolescence and early adult life, and expressing itself by recurrent attacks of spinal cord, brainstem, cerebellar, optic nerve and cerebral dysfunction, the result of foci of myelinated fiber destruction. In this retrospective study, 280 patients hospitalized at University Department of Neurology during the last three years were evaluated. Study results showed 104 (60%) patients to have suffered either acute or chronic pain syndrome at some time during the course of disease. Six (2.1%) patients with acute pain syndromes had episodes of paroxysmal pain attacks in the trigeminal nerve distribution. Chronic pain syndromes, present for a mean duration of 4.2 years occurred in 154 (55%) patients and included headache in 38% , cervical and lumbosacral syndrome in 58%, and painful leg spasms in 4% of study patients.

Multiple sclerosis is a disease of the central nervous system, beginning most often in late adolescence and early adult life, and expressing itself by recurrent attacks of spinal cord, brainstem, cerebellar, optic nerve and cerebral dysfunction, the result of foci of myelinated fiber destruction. In this retrospective study, 280 patients hospitalized at University Department of Neurology during the last three years were evaluated. Study results showed 104 (60%) patients to have suffered either acute or chronic pain syndrome at some time during the course of disease. Six (2.1%) patients with acute pain syndromes had episodes of paroxysmal pain attacks in the trigeminal nerve distribution. Chronic pain syndromes, present for a mean duration of 4.2 years occurred in 154 (55%) patients and included headache in 38% , cervical and lumbosacral syndrome in 58%, and painful leg spasms in 4% of study patients.

Radicular pain syndromes caused by disk herniation are often accompanied by incomplete central cord syndrome. Intensive pain is difficult to control with standard analgesics. Antiepileptics of new generation have shown significant efficacy in treating pain syndromes, trigeminal neuralgia, diabetic neuropathy, migraines, etc. The treatment of radicular pain with lamotrigine, a new generation antiepileptic, turned out to be effective in lumbar disk radicular conflicts, justifying its application for resistant pain in cervical segment. In our patient, pain intensity was significantly reduced with gradual titration of lamotrigine to a dose of 200 mg/day. Pain intensity measured by the visual analog scale significantly decreased from 100 to 20 mm during eight weeks of titration. The blood concentration of the drug measured by the method of high performance liquid chromatography was 13.65 µmol/L. The patient.s quality of life improved greatly. It is necessary to further evaluate the efficacy of lamotrigine in the treatment of resistant radicular damage., Radikularni bolni sindromi uzrokovani hernijacijom diska obično su udruženi s nepotpunim sindromom kralježnične moždine. Intenzivna bol se teško kontrolira standardnim analgeticima. Antiepileptici nove generacije pokazuju značajan učinak u liječenju bolnih sindroma, neuralgije trigeminusa, dijabetične neuropatije, migrene itd. Liječenje radikularne boli lamotriginom, antiepileptikom nove generacije, pokazalo se učinkovitim u lumbarnom disk-radikularnom konfliktu pa smo ga pokušali primijeniti i u rezistentnoj boli vratnoga segmenta. Postupnom titracijom lamotrigina do doze od 200 mg/dan intenzitet boli značajno se smanjio. Intenzitet boli mjeren ljestvicom VAS smanjio se sa 100 na 20 mm kroz razdoblje od osam tjedana titracije lijeka. Razina lijeka u krvi određena pomoću metode HPLC bila je 13,65 µmol/L. Kvaliteta života naše bolesnice značajno se poboljšala. Potrebno je procijeniti učinkovitost lamotrigina u liječenju rezistentne radikularne boli.