Carbamazepine not working anymore

Carbamazepine worked for only a short time for my GPN.

My MRI was read as normal in 2006. I was basically told MVD probably wouldn’t work and might leave me worse off.

I had misery on and off for 6 years, and then it stayed on. After months of this, and failure of the carbamazepine, in desperation I went to a neurosurgeon who looked at my MRI, and he pointed out what he saw: blood vessels impinging on my 9th cranial nerve,

He found tortuous vessels. He did MVD in October 2012.

I have had no pain since I awoke, and I’ve thanked God every day for giving me my life back for 8 years now.

If your meds fail, I’d get that MRI to a neurosurgeon at a nearby university who does a lot of cranial base surgery and see how he interprets it.

It irks me that my local hospital read it wrong, and the answer to my salvation was in the shadows they couldn’t see 6 years before my surgery.

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I had the neurosurgeon who does thousands of MVDs read the MRI. He said that I don’t qualify for that, but could have about 4 other kinds of surgery plus gamma knife. I am not well otherwise, so would choose gamma knife if I had to, to avoid anesthesia.

Whenever I have a time of milder pain, I am literally thanking God for it. It can be just a tiny bit of relief.

I would be so mad that they read it wrong, too!

It’s odd, I asked my PCP and my autonomic neurologist, and neither wanted to switch me. I have a regular neurologist appt coming up on the 27th. I am afraid my sodium levels or something will make me stop this drug and then I’ll be in he// again. I went up a bit and added thiamine 100mg, and thank goodness, the pain is manageable for now!! A friend told me to make sure I’m taking carbamazepine with food for efficacy-I wasn’t because I was eating so little. I think that may have helped too.

Thank you! I am just envisioning a horrible life. If it’s gotten this much worse in 3 months and I’m only 40… it takes me about 5-7 days to “feel” a dose increase. If I can ever see some improvement, that would be amazing.

I had one day like that last week - how can I keep going, I can’t live with this fear of pain or pain, etc. but not sleeping itself will do that to me. It’s brutal. Add a few days of no sleep to not really eating… I will be extremely miserable from that alone. Don’t forget how hopeless I feel and how I’m not particularly getting a lot of help from my doctors.

I’ve been in communication with at least 4 doctors and my nurse case manager every day or two. Most of the doctors are at a loss right now(just tell me to go to the ER - daily?), but I have a neurologist appt on 4/27. My NCM has been amazing in trying to help and get things done.

Thank you so much, this helps!

Thanks so much! The neurosurgeon said he wished I was a candidate for MVD. The radiologist and my autonomic neurologist agreed with him. He is a renowned TN provider. I know my CPAP mask hurts me overnight, too. I have been trying a piece of lidocaine patch cut to fit under it and I think it helps!

What a torturous disease we have. I had no idea it could be like this. Shocks are awful, but I didn’t know we could also have nonstop pain in addition.

Not all MRI’s are equal. I believe it’s a 3T MRI machine which shows the most detail. Possibly your MRI wasn’t clear enough to make you a candidate for MVD.
I had a laporascoptic MVD at Penn Medicine in Philadelphia. My Neurosurgeon found the initial nerve on blood vessel but also saw nerve on vein. Corrected both. This procedure was not extremely invasive, no metal plates in skull needed, just bone putty. I think the T3 MRI definitely helped detect the issues. I am so sorry to hear all the pain you are dealing with. Hang in there this is definitely the forum to get info at. Good luck.

I am 86 going on 87 and so nearing my 25th year with severe TGN. Had all the operations, taken all the drugs, when by accident at my facial=pain doc’s a young salesman trotted in with a carton of a new drug he was touting, VimPat. “Try it out,” my face doc said. “Be sure to dose only as directed. Let me know if it works for you.”

That was 10 years ago.

I took 200 mg. every 4 hours as directed for big males. Miracle! for me. Pain gone. Could brush my teeth again. Eat peanuts. Chew steak. And most of all, sleep for 8 hours. First thing I do in the morning: take dose of Vim Pat, check the time to be sure when next 4 comes, for another dose.

That is the good news: Pain subdued. Gone. Quelled. Controlled. You’re boss again instead of that faulty electrical connection in your head.

Bad news:

Most docs have never heard of VimPat and blanch when they see the price. So did I: $600 a month or maybe more. And never leave home without a necessary supply in your pocket or purse. I never leave home without two-days supply in my pocket. Because I’ve had hospitals refuse to get it for me when there I was, about to howl. Why? Costs too much. How about aspirin instead and a nice bowl of boiled cabbage? I should also mention, one of biggest and allegedly brightest on the West Coast told TGN was fantasy and one of their mental docs would be calling on me. He did. He knew why I was howling and causing coyotes to surface on the lawn outside. He got me the dope I wanted. Which resulted in a lecture from the Chief Nurse, who entered with a retinue of head bobbers. I shan’t write here what, as an old Alaskan frontier boy, I replied to her. They all huffed off.

As an old bird living on a pension, I hunted around the world for a cheaper VimPat price from a good source. Found that in India, for $240 a month for 240 tablets. I would have paid a hell of a lot more than that for my failed brain surgery: $30 K.
(That counts in the price for the major brain infection that also cost me a month in the hospital and almost cost me my life. The hospital did not argue when I said I would not and could not pay for an involuntary month hospitalized so that I could feel TGN again, as I doing every day there, which for its enjoyment I should not and would not pay a penny. I was willing to take a jury if the hospital sued.)

New problem: Indian government has put my Indian supplier in prison for a year for mailing me my VimPat supply without an overseas mailing permit, or so the story goes. (Forgive the tones of a long-retired newspaper editor.)

To sum: For 21 years, for TGN, nothing has worked for me except except VimPat, It costs as the Rolls-Royce TGN drug for me. It is a powerful drug. I ODed on it one morning and spent the next 24 with a very unhappy body and brain.

Again, I am a big guy: 6 foot four with little fat but much meat on me. When I started VP I weighed 260 lbs. I have since pared that to 190 and breakfast on foods good for you but otherwise detestable. I know a couple of folks of smaller build who get by one 100-mg VP pill every four hours.

The trick: Find out how to time VP to quell TGN and stick to it. I am especially careful on days I go to the Metropolitan Opera in NYCity. I can assure you that other opera lovers do care if you suddenly stand up and shove to the nearest exit, all the while howling an aria only we who suffer TGN appreciate. (Wagner’s Ring Series is best for exiting while you fish for your TGN pills and a place to howl without breaking union rules on opera choristers.

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Any time!
I hope that your neurologist has experience, with our condition.
Some, may not specialize in it.
If, you find that this doc , isn’t working for you, then you may want to consider, going for another opinion from a different one.
It took me four visits, + two visits with others, a total of six, to finally even know what I had.
Once, I got to the second neurologist, I started getting some relief. So then it became doable, as I finally knew, what the heck was wrong with me.
Hang in there, :upside_down_face:

  • try meditation or music, anything that calms you, whatever you can do to relieve stress, the pain in and of itself, can be overwhelming.
    I do both of these activities just about every day now. It helps …:wink:

I have had the Gamma Knife done on 2-29-08.
It went well, it relieved the very bad bad burning pain. however, I still felt some dull aching pain.
But tolerated.
Then, 3 years later, the burning pain can back.
Everyone reacts differently to the procedure.
I don’t regret it. It was a real relief.
In retrospect, I’d do it again in a heartbeat.
As even ONE day without that severe pain, made it a worthwhile endeavor.
I wish you success, should you decide, to proceed with GKRS.:wink:

Recipe, I understand fully. I was on carbamezepine too. It worked but they had to keep upping the dosage over time. Also, just like your case, MRI showed no nerve compression on the side where the pain was but did show compression on the other side. Same thing you said. My neurosurgeon said no to the MVD. He recommended, and I opted to go with the Gamma Knife. It worked for me for 9 years. I was 100% pain free, with no side affects. They told me it took 8-12 months to see if it would work. It doesn’t work fore everyone. After 8 months I began scaling down off carbamezepine. At 12 months I was on no med, and pain free – for 9 years. The pain came back with a roaring vengence. Then the neurosurgeon gave me the Cyber Knife (a newer treatment). It helped a lot but it did leave my face numb on that side. They told me it would. I didn’t care !! I suppose it was a higher dose this time. That was 11 years ago. Since then the feeling has come back gradually about 80-90% but for years my right side was numb. Now, take note of this: I take Lyrica every day. 2/day. I still have some residual pain/discomfort. Some from the TN, some from the Cyber Knife treatment. At first you may think, Oh thats bad. No its not. I have pretty much a normal life. The tingling, “novacaine wearing off-like” feeling comes and goes. The Lyrica keeps that in check and I go on with life. NO MORE striking lightning-like pain. Ask your neuro about trying Lyrica. Its thought to “calm overactive nerves”. With some people, Lyrica can cause crazy thoughts, suicide, etc. It doesn’t for me. I’ve taken it for years. But with a friend of mine who took it, he began thinking suicidal thoughts and got off of it. So, it works for some, but not all. As for the Gamma Knife and/or Cyber Knife you have my experience as I’ve stated. Considering the almost screaming pain I had I would take those treatments again. Others I’ve read on this site did not like the GK at all. I don’t know where you are but I would tell you this. When it comes to neurologists or neurosurgeons, the better ones in my opinion are in the bigger cities. Mine is in Birmingham, AL. The one that won’t return your call…forget him. You SHOULD WANT one that has a LOT of experience with Trigeminal Neuralgia. Just an average neuro is not good enough in my opinion. Spend some time looking in the nearest big city and seek out the older more experienced neurosurgeon – one that is not on his first rodeo. When seeking a new Dr I go to BCBS website, then search for a Dr in the field I’m looking for – in your case, neurologist or neurosurgeon. You can tell when they graduated from med school and that will give you an idea of their age. Look at their rating by patients. See which ones have the highest number of reviews. When it comes to TN you need the best and most experienced ones. Those are the ones that truly can relate to the pain you have; they’ve seen so much of it And they care.

Hi, all of us empathies with you. I’m so sorry to hear that the pain is back. I’ve been through all the procedures and it has always come back. I’m off the meds and really do not want to go on them again. There is a friend of mine that is trying Novocain shots you might look into that to see if it helps. So far I have not had anything that keeps it away for long. Best of luck to you.
Wheels for legs said all that?

I was advised by a Dr friend to start at the highest dose ( he said 1,000 mg) and get on top of the pain and then gradually reduce the dosage. I’m sorry you’re suffering. I’ve had TN for over 40 years now - but not all the time - and I do seem to be managing it. I can go for months - years even- without feeling it. Then it gets me again so I take 200 mg immediately. I find moving very helpful ( hanging out washing, Pilates, walking).

Wow, that’s interesting! I have been okay for a couple of days - but it takes a week for the increase in dose to help. A couple of times, early on, I was feeling okay and went down 100mg total a day. Whoa… after 5 days, I was living a nightmare again. The problem is that it takes a week to feel better after I increase the dose. I’m on 900mg a day now.

I hope I can be like you! In just a few months, this has gone from not a problem to making me reconsider my future in a big way. It just keeps getting worse.

I’m super active and that does help. Kayaking, hiking, horseback riding, climbing…