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Suggest Treatment For Abnormal Sense Of Smell When On Gabapentin
Question: taking Gabapentin (900 mg/day for smoke smell. Have had all test for seizures including MRI of brain, all tests were negative. Is there anything else or anyone else I can see or do? Had smell for about 9 months.
Brief Answer:
Antidepressants or topical applications
Detailed Answer:
Hi,
I read your query carefully and I understand your concern. Fortunately the tests you have had exclude any threatening cause.
You are not clear on whether you have this abnormal smelling sensation all the time or in transitory episodes. Since you were investigated for seizures I am assuming the last one. How frequent are the episodes and how long do they last? Are there any factors to trigger them?
Also I am assuming you have had an evaluation by an ENT (ear nose throat) specialist for causes like sinusitis, nasal polyps, nasal or oral infections etc.
It is difficult to make evidence based recommendation for cases like yours because there are no studies in large numbers of patients.
The treatment with the anticonvulsant Gabapentin would have been my first choice as well. From the anticonvulsant group some patients reportedly have responded also to an anticonvulsant called Zonisamide.
Among other classes antidepressants are mentioned, with Venlafaxine showing good effect in some case reports. Duloxetine is another alternative.
Another option which can be safely tried is the local application of normal saline 10cc in each nostril 3-4 times a day (applied with the head down and forward and sitting up after 20 seconds). A similarly working alternative is Oxymetazoline nasal drops.
A last resort is an endonasal surgical procedure to excise olfactory epithelium.
I remain at your disposal for further questions.
Antidepressants or topical applications
Detailed Answer:
Hi,
I read your query carefully and I understand your concern. Fortunately the tests you have had exclude any threatening cause.
You are not clear on whether you have this abnormal smelling sensation all the time or in transitory episodes. Since you were investigated for seizures I am assuming the last one. How frequent are the episodes and how long do they last? Are there any factors to trigger them?
Also I am assuming you have had an evaluation by an ENT (ear nose throat) specialist for causes like sinusitis, nasal polyps, nasal or oral infections etc.
It is difficult to make evidence based recommendation for cases like yours because there are no studies in large numbers of patients.
The treatment with the anticonvulsant Gabapentin would have been my first choice as well. From the anticonvulsant group some patients reportedly have responded also to an anticonvulsant called Zonisamide.
Among other classes antidepressants are mentioned, with Venlafaxine showing good effect in some case reports. Duloxetine is another alternative.
Another option which can be safely tried is the local application of normal saline 10cc in each nostril 3-4 times a day (applied with the head down and forward and sitting up after 20 seconds). A similarly working alternative is Oxymetazoline nasal drops.
A last resort is an endonasal surgical procedure to excise olfactory epithelium.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Raju A.T
I have not seen an ENT doctor. But it have heard about it concerning this condition. I will make an appointment to see one.
Thank you.
Thank you.
Brief Answer:
Just make sure it has been considered.
Detailed Answer:
Thanks for getting back to me.
If your neurologist was aware of that possibility (he probably was), has examined your nose and mouth cavities himself and he is confident nothing is wrong that can be considered enough.
I wouldn't want to drive you towards jumping from one specialist to the other, I know how frustrating that might be for patients. I want just that you make sure that that possible cause of your symptoms has been taken into consideration.
Wishing you good health.
Just make sure it has been considered.
Detailed Answer:
Thanks for getting back to me.
If your neurologist was aware of that possibility (he probably was), has examined your nose and mouth cavities himself and he is confident nothing is wrong that can be considered enough.
I wouldn't want to drive you towards jumping from one specialist to the other, I know how frustrating that might be for patients. I want just that you make sure that that possible cause of your symptoms has been taken into consideration.
Wishing you good health.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
I have been seeing the same Neurologist for 20 years for migraines. No, he has not examined my mouth cavities or nose and has not suggested for me to see an ENT doctor, but I will anyway. I need to know why this smoke smell continues and would like for it to disappear.
Thank you for your information, it has been helpful. XXXXXXX
Thank you for your information, it has been helpful. XXXXXXX
Brief Answer:
Thank you!
Detailed Answer:
Thank you for your appreciative words. I really hope things work out for the best.
If you have any more questions I would be happy to answer them. If/when you have no further questions I would kindly ask you to close the query.
Thank you!
Detailed Answer:
Thank you for your appreciative words. I really hope things work out for the best.
If you have any more questions I would be happy to answer them. If/when you have no further questions I would kindly ask you to close the query.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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