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Role of inhibitory mechanisms in trigeminal neuralgia

From the Departments of Neurology (Drs. Fromm, Chattha, and Terrence) and Pharmacology (Dr. Glass), University of Pittsburgh School of Medicine, and the Neurology Service, (Dr. Terrence), VA Hospital, Pittsburgh, PA.

Segmental inhibition was elicited in the spinal trigeminal nucleus of cats by delivering a conditioning stimulus to the maxillary nerve 100 msec before the test stimulus. Carbamazepine, baclofen, and phenytoin markedly facilitated this segmental inhibition, as well as depressing the response to an unconditioned maxillary nerve stimulus. Phenobarbital, on the other hand, usually depressed the segmental inhibition. These results suggest that drugs that relieve trigeminal neuralgia both facilitate inhibitory mechanisms and depress excitatory mechanisms in the spinal trigeminal nucleus. The facilitation of inhibitory mechanisms appears to be at least as important as the depression of excitatory mechanisms and suggests that a failure of inhibitory mechanisms may play a significant role in the pathogenesis of trigeminal neuralgia.

Address correspondence and reprint requests to Dr. Fromm, Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261.

Supported in part by Grant No. W-3 from the Health Research and Services Foundation of Pittsburgh, and by a grant from the University of Pittsburgh Research Development Fund.

Presented in part at the thirty-second annual meeting of the American Academy of Neurology, New Orleans, LA, May 1980.

Accepted for publication September 9, 1980.

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