Paroxysmal symptoms due to multiple sclerosis

Paroxysmal symptoms (eg dystonic posturing, tonic spasms) in patients with multiple sclerosis usually respond to carbamazepine. Use:

carbamazepine modified-release 100 mg orally, once or twice daily; increase as tolerated and according to response every 7 days to a maximum of 600 mg twice daily1. paroxysmal symptoms (multiple sclerosis) carbamazepine    

Carbamazepine can aggravate fatigue and ataxia.

Often the patient can sense when the paroxysms have stopped. If so, long-term carbamazepine therapy may not be needed—an appropriate strategy is to slowly wean the drug (eg by reducing the daily dose by 100 mg per week).

1 Pharmacogenetic studies are identifying an increasing number of genes that confer a predisposition to cutaneous drug reactions. Testing for the HLA-B*1502 allele in patients of Asian origin (other than Japanese) is advised before starting therapy with carbamazepine.Return