415 - Rare Gabapentin Side Effect in Treatment of Atypical Cauda Equina: A Case Study

Case Diagnosis: New onset stuttering after increasing Gabapentin dose for neuropathic pain.

Case Description: A 33 year old healthy male suffered a work injury thought to originate from the thoracic spine. He underwent T1-T2 interlaminar epidural steroid injection (ESI) with Depomedrol and Lidocaine, then was discharged home. A few hours later, he woke up from a nap with bowel and bladder incontinence, leg weakness, and loss of sensation from the waist down. Symptoms were ultimately attributed to local anesthetic toxicity during the ESI.


He slowly regained full leg strength, bowel and bladder continence, and sexual function by 11 months after ESI, however his lower extremity numbness transitioned into intense neuropathic pain. He was started on Gabapentin 300 mg three times daily. His nighttime dose was increased to 600mg then 900mg in one month increments. At one month telehealth follow-up, patient noted new onset stuttering two weeks after last increase. Speech impairment resolved within 2 weeks of decreasing his Gabapentin to nighttime dosing only.

Discussions: To our knowledge, there are two other cases in which Gabapentin is cited to cause stuttering speech. In one case, it was used for the treatment of seizures and stuttering resolved four days after discontinuing Gabapentin. In the second, for treatment of post-herpetic neuralgia, stuttering resolved a few weeks after discontinuing the drug.

Conclusions: Gabapentin is a widely used medication in rehabilitation. It is important to be aware of the potential neurological side effect of stuttering speech.