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Seven patients with tabes dorsalis who had severe lightning pains were treated with carbamazepine (Tegretol), 400 to 800 mg daily. In all patients freedom from pain was obtained within 24 to 72 hours. On discontinuing the treatment the pains recurred, but disappeared within one to three days when medication was reinstituted. The mean observation period was 22 months. Two patients received prolonged treatment (53/4 and 41/2 years) without a wearing off of the effect of the drug. The serum concentration of carbamazepine in these patients was the same as in ten control subjects. Observations indicate that the lightning pains are maintained by afferent impulses from the periphery and are followed by a short refractory period of varying duration. In one patient local anesthesia of the painful area blocked the pain impulses from this area.
K Ekbom (Sat,) studied this question.