Acth is a rescue treatment for intractable Trigeminal neuralgia

Abstract

Trigeminal neuralgia (TN)is a common disease impairing quality of life. It's still difficult to control. The predicted site of pain ectopic impulses is local demyelination at root entry attributed to compression by a adjacent blood vessel. Brain cells are target and source of melanocortins. A number of studies validated the neuroprotective and Immunoregulation properties of neuronal melanocortin receptors. This study was attempting treatment of severe TN by ACTH. The study included 26 Trigeminal neuralgia patients meeting the diagnostic criteria of Headache Classification Committee of the International Headache Society in whom pain is not controlled by anordinary TN drugs. Their Numering Rating Scale (NRS-11) score were 7 or more. Each patient counted the number of pain attacks by a Finger-Held Digital counter for 1 day before receiving ACTH )Tetracosactide acetate Depot ampoule 1mg/ml(by a single intramuscular daily injection for 3consecutive days. Patients were followed up at days 4th, 10th and 28th by counting the number of pain attacksand pain intensity by(NRS-11). For all patients There was a decline of 30 (45.9%), 39 (57.3%) and 46 (67.6%) of mean number of pain attacks /day (npa/d) at 4th, 10th and 28th days respectively. Furthermore number of patients have reduction of more than 50% of pretreatment npa/d were 10 (38.5%), 12 (46.2%) and 15 (57.7%) at 4th, 10th and 28th days consecutively. And 11 (42.3%), 13 (50%) and 14 (53.8%) patients had a drop of (NRS-11) score below 3 at days 4th, 10th and 28th after ACTH injections sequentially. ACTH injections significantly improve pain of sever Trigeminal neuralgia.