What are the side effects with higher doses of carbamazepine?
Dr JP: Most common is drowsiness and sleepiness. The other side effects are difficulty in concentration, confusion, unsteadiness, nausea and vomiting, double vision and reduction in blood cells that help us fight infection. If one gets any kind of skin rash a doctor must be consulted at once. Same is with feeling of depression. There are some other severe toxic effects too.
What are the other options?
Dr JP: We recommend brain surgery to patients who need carbamazepine more than 400 mg per day or even lesser if it has to be taken on regular basis.
What is this surgery called?
Dr JP: Microvascular Decompression Surgery. MVD as we call it in short is a surgical procedure to relieve the agonising pain caused by compression of trigeminal nerve by an artery or vein. MVD involves surgically opening the skull and exposing the nerve at the base of the brainstem to insert a tiny sponge between the compressing vessel and the nerve. This sponge isolates the nerve from the pulsating effect and pressure of the blood vessel. This operation basically cures the TN. This is a far better option even when carbamazepine works even in small doses.