Neuropathic Pain In Epileptic Patient

Question

I have a patient known epileptic on phenobarbitol 3 tab for 30 years now c/o neuropathic pain in legs and upper limb for 2 months All vitamin ,tsh,b12 d3,lfts,rfts ,Hb A1c are normal I believe it's due to phenobarbitol my planning is to put her on pregabalin and referring to neurologist for review of anti epileptic medication which can start her on some new anti epileptic and taper off phenobarbitol

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Dr. Shaukat Mamoon · Answer

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Dr. Azrung Fayaz · Answer

You're on the right track thinking about phenobarbitol as a possible cause. Chronic use can cause neuropathy, though we usually call it a diagnosis of exclusion.

Before boxing it as drug-related, I would just ask

– Any weight loss, diabetes, thyroid history, or toxin exposure?
– Any recent infections or immune symptoms?
– Any family history of nerve problems?

Pregabalin can help symptoms short term, but the bigger issue is long-term seizure control and side effects. A slow taper and switch makes sense but best done with a clear roadmap. Happy to help if you need support planning the transition.

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Dr. Shaukat Mamoon - Neurologist

MBBS, Master of Science & Community Health / M.Phil. Certified Stroke Physician (Neurology) | PGCC in Mood Disorders & Management of Epilepsy | MEA Dermatology (France) | Diplomate (Nutrition Post Graduate) | Diploma (Public Health) | Post Graduate Diploma in Diabetes (UK) | | Bahawalpur

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Dr. Azrung Fayaz - Neurologist

MBBS, FCPS Neurology*, MRCP (UK) | Peshawar

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