To the Editor:— Confirmation of the finding of Ekbom1 that carbamazepine (Tegretol) helps patients with tabetic lightning pains is important because there is no other treatment for this distress. Report of a Case:— A 63-year-old woman consulted because of longstanding severe lightning pains of either lower extremity which occurred without relationship to activity. She had advanced neuropathic arthropathy (Charcot's disease) of the knees and feet, and an arthrodesis had been performed two years previously. Flocculation tests for syphilis had been positive, both in the serum and in the cerebrospinal fluid, and, because of this, she had received penicillin treatment in adequte doses. Neurologic examination revealed ataxia; Argyll Robertson pupils; loss of deep pain, of vibration sensitivity, and of deep-tendon reflexes. Carbamazepine therapy was started with a dosage of 200 mg twice daily. The lightning pains subsided promptly, but they returned when medication was stopped and again abated when it