Tabetic lightning pains: high-dosage intravenous penicillin versus carbamazepine therapy

The relief of tabetic lightning pains (LP) by carbamazepine (CBZ) was questioned as in some instances penicillin was given simultaneously. Only 1 out of 6 cases became pain-free on high-dosage intravenous penicillin, while CBZ rapidly abolished LP in those unresponsive to penicillin. Gastric crises were similarly abated by CBZ in 1 case under a placebo-controlled study. Inflammatory and degenerative changes in the posterior nerve root and ganglia may be the underlying pathologic basis that explains these two different responses to penicillin.