Lack of effect of topiramate for central pain

Central pain (CP) remains difficult to treat in spite of recent advances.1 Topiramate, a novel antiepileptic agent, has been reported to be effective for intercostal, MS-associated, and idiopathic trigeminal neuralgia and sundry peripheral neuropathic pain conditions in some but not all open-label case series (e.g., see Gilron et al.2). There are no studies on the use of topiramate for CP. We report no effect in this prospective open-label study of seven patients with refractory CP. Seven consecutive patients with CP of both brain and spinal cord origin were evaluated (three men, four women; mean age: 59.4 years; range: 48 to 73 years). Mean duration of CP was 5.8 years (range 3 to 13 years). In all cases, CP was described as a constant burning dysesthetic pain with thermal or mechanical allodynia in appropriate bodily areas. Pain was due to …