Mayo Clinic Proceedings: Gabapentin opens window of communication

ROCHESTER, Minn. — For patients with quadriplegia, mutism and lower cranial nerve paralysis (locked-in syndrome), their only means of interacting with others is through vertical gaze and upper eyelid movements, using eye-coded communication strategies.

In the June issue of Mayo Clinic Proceedings, researchers from Italy describe four patients with locked-in syndrome who also had dancing eye syndrome (opsoclonus-myoclonus syndrome). Because these patients’ eyes spontaneously and continuously oscillated in a variety of directions beyond their control, they could no longer interact with family members, physicians or other people.

The lead author, Francesca Pistoia, M.D., University of L’Aquila, Italy, reports that a decision was made to treat these patients with daily continuous gabapentin therapy based on a previous successful experience. Gabapentin was started as a single 300 mg dose on the first day followed by 600 milligrams per day in divided doses on the second day. In two of the patients, this dosage reduced ocular symptoms, and communication and quality of life improved. For the other two patients, the dose was further increased, with the best response achieved with a daily 1,200 mg dose.

In all four patients, attempts to stop treatment resulted in recurrence of dancing eye symptoms six hours after the last dose. Thus, gabapentin use was promptly resumed. Researchers found none of the patients experienced adverse effects from the treatment.

In an accompanying editorial, Joseph Sirven, M.D., Mayo Clinic neurologist, discusses the off-label use of gabapentin, which was approved by the U.S. Food and Drug Administration in 1994 for use as an adjunctive medication to control partial seizures. Dr. Sirven writes, “Ironically, despite the fact that the drug was invented and synthesized for its use in seizure prevention, its smallest market today is epilepsy and seizures.”

“The study by Pistoia and colleagues has a potential profound impact for treatment of patients with locked-in syndrome and opsoclonus-myoclonus syndrome,” writes Dr. Sirven. “Because this neurologic condition is so rare, small observational studies serve as the main source of clinical evidence and could be the cornerstone for clinical practice with no other evidence.”

A peer-reviewed journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical
Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at www.mayoclinicproceedings.com.

About Mayo Clinic

For more than 100 years, millions of people from all walks of life have found answers at Mayo Clinic. These patients tell us they leave Mayo Clinic with peace of mind knowing they received care from the world’s leading experts. Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. At Mayo Clinic, a team of specialists is assembled to take the time to listen, understand and care for patients’ health issues and concerns. These teams draw from more than 3,700 physicians and scientists and 50,100 allied staff that work at Mayo Clinic’s campuses in Minnesota, Florida, and Arizona; and community-based providers in more than 70 locations in southern Minnesota, western Wisconsin and northeast Iowa. These locations treat more than half a million people each year. To best serve patients, Mayo Clinic works with many insurance companies, does not require a physician referral in most cases and is an in-network provider for millions of people. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. For information about research and education, visit www.mayo.edu. MayoClinic.com (www.mayoclinic.com) is available as a resource for your general health information.

Contact:

Rebecca Finseth

507-284-5005 (days)

507-284-2511 (evenings)

e-mail: [email protected]

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