Diagnóstico y tratamiento de la neuralgia del trigémino: documento de consenso del Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología

Latorre, G.; González‐García, Nuria; García-Ull, Jésica; González-Oria, C.; Porta‐Etessam, J.; Molina, Francisco; Ál, Guerrero-Peral; Belvís, R.; Rodríguez, R.; Bescós, Agustín; Irimia, P.; Santos-Lasaosa, S

doi:10.1016/j.nrl.2021.09.015

Cited by 16 publications

(16 citation statements)

References 71 publications

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“…ej., tumor, accidente cerebrovascular, placa de esclerosis múltiple, malformación vascular, otras lesiones que comprimen el nervio trigémino o interrumpen sus vías en el tronco encefálico). (Rubin, 2022) Asimismo, Latorre et al, (2021) en su documento de consenso del Grupo de Estudio de Cefaleas de la Sociedad Espanola de Neurología acerca del diagnóstico y tratamiento de la neuralgia del trigémino, recomiendan la realización de una Resonancia Magnética (RM) craneal a todo paciente con diagnóstico clínico de NT para descartar causas secundarias. Se utilizan técnicas de reconstrucción en 3D que reemplazan a las clásicas secuencias en 2D, permitiendo una óptima evaluación anatómica del nervio.…”

Section: Diagnósticounclassified

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Neuralgia del Trigémino

Morán¹,

Sánchez²,

Latorre³

et al. 2023

RECIMUNDO

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La Neuralgia del Trigémino se considera el trastorno más doloroso conocido en la práctica médica. Asimismo, esta patología repercute significativamente en los pacientes que la padecen, disminuyendo su calidad de vida. Se trata de una afección que provoca sensaciones dolorosas similares a una descarga eléctrica en un lado de la cara. Esta afección de dolor crónico afecta el nervio trigémino, que trasmite las sensaciones de la cara al cerebro. La presente revisión tiene el propósito de compendiar lo relativo al diagnóstico y tratamiento de la Neuralgia del Trigémino. La investigación se realizó bajo una metodología de tipo documental bibliográfica, bajo la modalidad de revisión. De la investigación se desprende que el diagnóstico está basado en los antecedentes médicos de cada paciente, así como en la descripción de sus síntomas, adicional al examen físico, y un examen neurológico exhaustivo. Asimismo, recomiendan la realización de una resonancia magnética craneal a todo paciente con diagnóstico clínico de Neuralgia del Trigémino para descartar causas secundarias. En cuanto al tratamiento, no tiene una cura definitiva. Su tratamiento es paliativo con un adecuado manejo de acuerdo con su posible etiología, esto pretende disminuir los síntomas al menos en un 50% y de esta forma, mejore la calidad de vida del paciente. El tratamiento, basado en el diagnóstico, normalmente empieza con terapia farmacológica. La primera línea del tratamiento son los bloqueantes de canales de sodio activables por voltaje, como la carbamazepina y la oxcarbazepina. Si los medicamentos no alivian el dolor o producen efectos secundarios intolerables, tales como como fatiga excesiva, se puede recomendar un tratamiento quirúrgico. Los tratamientos quirúrgicos son: la microdescompresión vascular del nervio trigémino y los procedimientos percutáneos sobre el ganglio de Gasser.

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Section: Diagnósticounclassified

“…(Marín Medina & Gámez Cárdenas, 2019, pág. 196) Latorre et al, (2021) refiere acerca de la lamotrigina o baclofeno son fármacos de se-gunda línea. En consecuencia, se recomienda el uso de lamotrigina en monoterapia en caso de contraindicación o intolerancia a los fármacos de primera línea.…”

Section: Tratamientounclassified

Neuralgia del Trigémino

Morán¹,

Sánchez²,

Latorre³

et al. 2023

RECIMUNDO

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“…Many drugs have been assessed as potential monotherapy alternatives or as adjunctive treatments, including baclofen, lamotrigine, gabapentin, pimozide, lidocaine, phenytoin, and onabotulinumtoxinA injections. Nevertheless, none of these therapies have reached a sufficient level of evidence due to a low number of patients and inconsistent results 6 ; thus, they are not recommended as treatments of choice in clinical guidelines, and their prescription is only resorted to after first‐line treatment failure, either as a switch or an add‐on treatment at the discretion of the treating physician 5,7 …”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, none of these therapies have reached a sufficient level of evidence due to a low number of patients and inconsistent results 6 ; thus, they are not recommended as treatments of choice in clinical guidelines, and their prescription is only resorted to after first-line treatment failure, either as a switch or an add-on treatment at the discretion of the treating physician. 5,7 Recently, there has been a growing interest in new drugs that act by blocking voltage-gated sodium channels, 8,9 similar to carbamazepine or oxcarbazepine, but with novel mechanisms of action that may decrease the very common side effects of these drugs. 10 For instance, lacosamide blocks voltage-gated sodium channels in a slow inactivating manner 11 and has recently shown efficacy in the treatment of neuropathic pain.…”

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confidence: 99%

Oral lacosamide for the treatment of refractory trigeminal neuralgia: A retrospective analysis of 86 cases

et al. 2023

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Background and Objectives: First-line treatment for trigeminal neuralgia (TN) is limited to carbamazepine and oxcarbazepine, and in refractory cases, alternatives are scarce.Lacosamide has been suggested as a valid option. In this study, we describe a series of patients who received oral lacosamide as treatment for TN after first-line drug failure. Methods:In this retrospective descriptive cohort study, we included patients with refractory TN who attended a tertiary center between 2015 and 2021 and were prescribed oral lacosamide after first-line treatment failure. The primary endpoints were pain relief and adverse effects. We secondarily analyzed clinical outcomes and compared responders versus nonresponders in the search for potential predictors of response.Results: Eighty-six patients were included (mean age: 62 [SD 15.6] years; 54/86 [63%] female). The TN etiology was secondary in 16/86 (19%) patients. Concomitant continuous pain was present in 29/86 (34%) patients. The mean number of previous treatments was 2.7 [SD 1.5]. Pain relief was achieved in 57/86 (66%) cases, with 28/86 (33%) patients presenting adverse effects, all of which were mild. No statistically significant differences were observed between responders and nonresponders, but subtle clinical differences suggested potential predictors of response. Conclusion:Lacosamide may be an effective and relatively safe treatment for refractory pain in TN patients after first-line treatment failure.

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“…11 Although much work has focused on the processing of peripheral pain signals in neuropathic pain conditions, less is known about the mechanisms by which trigeminal neuropathies lead to a dysregulation of signaling in the trigeminal pathway, leading to a paucity of therapeutic avenues to combat trigeminal neuralgia. 15 Anticonvulsants, such as carbamazepine and oxcarbazepine, that target voltage-gated sodium channels are first-line treatment options, 3,14 indicating that sodium channels may be potential targets for trigeminal pain. In this current issue of PAIN, Loya-Lopez et al 16 present new evidence that selectively targeting Na v 1.7 channel expression offered protection from trigeminal pain in preclinical models.…”

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confidence: 99%