Resumen
INTRODUCCIÓN:La neuralgia del trigémino produce una gran limitación en la calidad de vida de los pacientes que sufren esta condición. Es necesario un adecuado conocimiento de sus características clínicas para diferenciarla de otras causas de dolor facial que son más frecuentes y evitar tratamientos innecesarios e irreversibles como las extracciones dentales.
OBJETIVO:describir los aspectos más importantes en el diagnóstico y tratamiento de los pacientes con neuralgia del trigémino.
METODOLOGÍA:Revisión narrativa.
DESARROLLO:La neuralgia del trigémino se caracteriza por presentar episodios recurrentes de dolor facial unilateral, severo, breve y penetrante que sigue la distribución del nervio trigémino. Existe una forma clásica en la que se reconoce contacto vascular sobre el nervio trigémino, una forma idiopática sin etiología conocida y una forma secundaria debido a condiciones como la esclerosis múltiple, tumores, malformaciones arteriovenosas, entre otras. El diagnóstico se basa principalmente en las características clínicas, aunque la resonancia magnética es una ayuda en casos seleccionados. La carbamazepina y la oxcarbazepina son la primera línea del tratamiento, mientras que otros medicamentos con menor nivel de evidencia hacen parte de la segunda línea de tratamiento. Para los casos refractarios existen alternativas quirúrgicas, entras las que se encuentra la descompresión microvascular, la rizotomía percutánea por radiofrecuencia, la rizotomía percutánea con glicerol, la compresión percutánea con balón y la radiocirugía estereotáxica.
CONCLUSIONES:El abordaje de la neuralgia del trigémino requiere conocer sus características clínicas y elegir el tratamiento más adecuado para el paciente mediante un trabajo multidisciplinario.
Citas
Cole CD, Liu JK, Apfelbaum RI. Historical perspectives on the diagnosis and treatment of trigeminal neuralgia. Neurosurg Focus. 2005;18(5):1-10.
Merskey H, Bogduk N. Classification of chronic pain. Descriptors of chronic pain syndromes and definitions of pain terms, 2.a ed. Seattle: IASP Press; 1994.
Zakrzewska JM. Insights: facts and stories behind trigeminal neuralgia. Gainesville: Trigeminal Neuralgia Association; 2006.
Tölle T, Dukes E, Sadosky A. Patient burden of trigeminal neuralgia: results from a cros-sectional survey of health state impairment and treatment patterns in six European countries. Pain Pract. 2006;6(3):153-60.
Drangsholt M, Truelove EL, Yamuguchi G. The case of a 52-year-old woman with chronic tooth pain unresolved by multiple traditional dental procedures: an evidence-based review of the diagnosis of trigeminal neuropathic pain. J Evid Based Dent Pract. 2005;5(1):1-10.
Katusic S, Beard CM, Bergstralth E, Kurland LT. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. Ann Neurol. 1990;27(1):89-95.
Hall GC, Carroll D, Parry D, McQuay HJ. Epidemiology and treatment of neuropathic pain: the UK primary care perspective. Pain. 2006;122(1-2):156-62.
Dieleman JP, Kerklaan J, Huygen FJPM, Bouma PAD, Sturken-boom MCJM. Incidence rates and treatment of neuropathic pain conditions in the general population. Pain. 2008;137(3):681-8.
Maarbjerg S, Gozalov A, Olesen J, Bendtsen L. Trigeminal neuralgia - a prospective systematic study of clinical characteristics in 158 patients. Headache J Head Face Pain. 2014;54(10):1574-82.
Mueller D, Obermann M, Yoon M-S, Poitz F, Hansen N, Slomke M-A, et al. Prevalence of trigeminal neuralgia and persistent idiopathic facial pain: a population-based study. Cephalalgia. 2011;31(15):1542-8.
Sjaastad O, Bakketeig LS. The rare, unilateral headaches. Vâgâ study of headache epidemiology. J Headache Pain. 2007;8(1):19-27.
Macfarlane T V, Beasley M, Macfarlane GJ. Self-reported facial pain in UK Biobank study: prevalence and associated factors. J Oral Maxillofac Res. 2014;5(3):e2.
McDermott AM, Toelle TR, Rowbotham DJ, Schaefer CP, Dukes EM. The burden of neuropathic pain: results from a cross-sectional survey. Eur J Pain. 2006;10(2):127-35.
Giraldo HJU, Zuluaga CDH. Propedéutica de examen neurológico del adulto normal [recurso electrónico]. Universidad Tecnológica de Pereira; 2016.
Monkhouse S. The trigeminal nerve. En: Monkhouse S, editor. Cranial nerves functional anatomy. Cambridge: Cambridge University Press; 2006. p. 50-65.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3.a ed. Cephalalgia. 2018;38(1):1-211.
Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G. Trigeminal neuralgia - diagnosis and treatment. Cephalalgia. 2017;37(7):648-57.
Antonini G, Di Pasquale A, Cruccu G, Truini A, Morino S, Saltelli G, et al. Magnetic resonance imaging contribution for diagnosing symptomatic neurovascular contact in classical trigeminal neuralgia: a blinded case-control study and meta-analysis. Pain. 2014;155(8):1464-71.
Lee A, McCartney S, Burbidge C, Raslan AM, Burchiel KJ. Trigeminal neuralgia occurs and recurs in the absence of neuro-vascular compression. J Neurosurg. 2014;120(5):1048-54.
Peker S, Kurtkaya O, Üzün I, Pamir MN. Microanatomy of the central myelin-peripheral myelin transition zone of the trigeminal nerve. Neurosurgery. 2006;59(2):354-9.
Boto GR. Neuralgia del trigémino. Neurocirugía. 2010;21(5):361-72.
Hernández MGG, Rodríguez JPS, Villegas ST. Neuralgia del trigémino. En: Anales Médicos. 2012;39-47.
Cruccu G. Trigeminal neuralgia. Contin Lifelong Learn Neurol. 2017;23(2):396-420.
Solaro C, Brichetto G, Amato MP, Cocco E, Colombo B, D'aleo G, et al. The prevalence of pain in multiple sclerosis A multicenter cross-sectional study. Neurology. 2004;63(5):919-21.
Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, et al. Trigeminal neuralgia. New classification and diagnostic grading for practice and research. Neurology. 2016;87(2):220-8.
Zakrzewska JM, McMillan R. Trigeminal neuralgia: the diagnosis and management of this excruciating and poorly understood facial pain. Postgrad Med J. 2011;87(1028):410-6.
Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ. 2014;348(9):g474.
Di Stefano G, Maarbjerg S, Nurmikko T, Truini A, Cruccu G. Triggering trigeminal neuralgia. Cephalalgia. 2017;38(6):1049-56.
Simms HN, Honey CR. The importance of autonomic symptoms in trigeminal neuralgia. J Neurosurg. 2011;115(2):210-6.
Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008;15(10):1013-28.
Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008;71(15):1183-90.
Wiffen PJ, Derry S, Moore RA, McQuay HJ. Carbamazepine for acute and chronic pain in adults. Cochrane Database Syst Rev. 2011;(1):CD005451.
Dong X, Leppik IE, White J, Rarick J. Hyponatremia from oxcar-bazepine and carbamazepine. Neurology. 2005;65(12):1976-8.
Berghuis B, van der Palen J, de Haan G, Lindhout D, Koeleman BPC, Sander JW, et al. Carbamazepine and oxcarbazepine-induced hyponatremia in people with epilepsy. Epilepsia. 2017;58(7):1227-33.
Zakrzewska JM, Chaudhry Z, Nurmikko TJ, Patton DW, Mullens EL. Lamotrigine (lamictal) in refractory trigeminal neuralgia: results from a double-blind placebo controlled crossover trial. Pain. 1997;73(2):223-30.
Wiffen PJ, Derry S, Moore RA. Lamotrigine for acute and chronic pain. Cochrane Database Syst Rev 2011;(2):CD006044.
Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019;26(6):831-39
Fromm GH, Terrence CF, Chattha AS. Baclofen in the treatment of trigeminal neuralgia: Double-blind study and long-term follow-up. Ann Neurol Off J Am Neurol Assoc Child Neurol Soc. 1984;15(3):240-4.
Obermann M, Yoon MS, Sensen K, Maschke M, Diener HC, Katsarava Z. Efficacy of pregabalin in the treatment of trigeminal neuralgia. Cephalalgia. 2008;28(2):174-81.
Solaro CM, Ferriero G. Refactory trigeminal neuralgia successfully treated by combination therapy (pregabalin plus lamotrigine). Mult Scler Relat Disord. 2018;25:165-6.
Di Stefano G, Truini A, Cruccu G. Current and innovative pharmacological options to treat typical and atypical trigeminal neuralgia. Drugs. 2018;78(14):1433-42.
Wu C-J, Lian Y-J, Zheng Y-K, Zhang H-F, Chen Y, Xie N-C, et al. Botulinum toxin type A for the treatment of trigeminal neuralgia: results from a randomized, double-blind, placebo-controlled trial. Cephalalgia. 2012;32(6):443-50.
Zhang H, Lian Y, Ma Y, Chen Y, He C, Xie N, et al. Two doses of botulinum toxin type A for the treatment of trigeminal neuralgia: observation of therapeutic effect from a randomized, double-blind, placebo-controlled trial. J Headache Pain. 2014;15(1):65.
Moore D, Chong MS, Shetty A, Zakrzewska JM. A systematic review of rescue analgesic strategies in acute exacerbations of primary trigeminal neuralgia. Br J Anaesth. 2019;123(2):e385-96.
Kanai A, Suzuki A, Kobayashi M, Hoka S. Intranasal lidocaine 8 % spray for second-division trigeminal neuralgia. BJA Br J Anaesth. 2006;97(4):559-63.
Lemos L, Flores S, Oliveira P, Almeida A. Gabapentin supplemented with ropivacain block of trigger points improves pain control and quality of life in trigeminal neuralgia patients when compared with gabapentin alone. Clin J Pain. 2008;24(1):64-75.
Tate R, Rubin LM, Krajewski KC. Treatment of refractory trigeminal neuralgia with intravenous phenytoin. Am J Heal Pharm. 2011;68(21):2059-61.
Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective longterm outcomes. Acta Neurochir (Wien). 2008;150(3):243-55.
Bick SKB, Eskandar EN. Surgical treatment of trigeminal neuralgia. Neurosurg Clin. 2017;28(3):429-38.
Pamir MN, Peker S. Microvascular decompression for trigeminal neuralgia: a long-term follow-up study. Minim Invasive Neuro surg. 2006;49(06):342-6.
Ko AL, Ozpinar A, Lee A, Raslan AM, McCartney S, Burchiel KJ. Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression. J Neurosurg. 2015;122(5):1048-57.
Sindou M, Leston J, Decullier E, Chapuis F. Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg. 2007;107(6):1144-53.
Barker FG, Jannetta PJ, Bissonette DJ, Larkins M V, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334(17):1077-84.
Degn J, Brennum J. Surgical treatment of trigeminal neuralgia. Results from the use of glycerol injection, microvascular decompression, and rhizotomia. Acta Neurochir (Wien). 2010;152(12):2125-32.
Sandell T, Eide PK. Effect of microvascular decompression in trigeminal neuralgia patients with or without constant pain. Neurosurgery. 2008;63(1):93-100.
Bederson JB, Wilson CB. Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg. 1989;71(3):359-67.
Zakrzewska JM, Lopez BC, Kim SE, Coakham HB. Patient reports of satisfaction after microvascular decompression and partial sensory rhizotomy for trigeminal neuralgia. Neurosurgery. 2005;56(6):1304-12.
Kanpolat Y, Savas A, Bekar A, Berk C. Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1600 patients. Neurosurgery. 2001;48(3):524-34.
Fraioli B, Esposito V, Guidetti B, Cruccu G, Manfredi M. Treatment of trigeminal neuralgia by thermocoagulation, glycerolization, and percutaneous compression of the gasserian ganglion and/or retrogasserian rootlets: long-term results and therapeutic protocol. Neurosurgery. 1989;24(2):239-45.
Chen L, Xu M, Zou Y. Treatment of trigeminal neuralgia with percutaneous glycerol injection into Meckel's cavity: experience in 4012 patients. Cell Biochem Biophys. 2010;58(2):85-9.
Noorani I, Lodge A, Vajramani G, Sparrow O. Comparing Percutaneous Treatments Of Trigeminal Neuralgia: 19 Years Of Experience In A Single Centre. Stereotact Funct Neurosurg. 2016;94(2):75-85.
Burchiel KJ. Percutaneous retrogasserian glycerol rhizolysis in the management of trigeminal neuralgia. J Neurosurg. 1988;69(3):361-6.
Tuleasca C, Carron R, Resseguier N, Donnet A, Roussel P, Gaudart J, et al. Repeat Gamma Knife surgery for recurrent trigeminal neuralgia: longterm outcomes and systematic review. J Neurosurg. 2014;121(Supl. 2):210-21.
Zakrzewska JM, Akram H. Neurosurgical interventions for the treatment of classical trigeminal neuralgia. Cochrane Database Syst Rev. 2011;(9):CD007312.
Chivukula S, Yong NA, Jafari M, Pouratian N. Radiosurgical Management of Trigeminal Neuralgia BT - stereotactic radiosurgery and stereotactic body radiation therapy: a comprehensive guide. En: Trifiletti DM, Chao ST, Sahgal A, Sheehan JP, editores. Cham: Springer International Publishing; 2019. p. 141-50.
Barba D, Alksne JF. Success of microvascular decompression with and without prior surgical therapy for trigeminal neuralgia. J Neurosurg. 1984;60(1):104-7.
Nurmikko T, Obermann M. Neuromodulation in classical trigeminal neuralgia and painful trigeminal neuropathy. En: Neuromodulation in headache and facial pain management. Springer; 2020. p. 213-24.
Zakrzewska JM. Diagnosis and differential diagnosis of trigeminal neuralgia. Clin J Pain. 2002;18(1):14-21.
Zakrzewska JM. Differential diagnosis of facial pain and guidelines for management. Br J Anaesth. 2013;111(1):95-104.
Al-Quliti KW. Update on neuropathic pain treatment for tri-geminal neuralgia. The pharmacological and surgical options. Neurosciences (Riyadh). 2015;20(2):107-14.
Tai AX, Nayar VV. Update on trigeminal neuralgia. Curr Treat Options Neurol. 2019;21(9):42.
Isaza C, Isaza G, Fuentes J, Marulanda T, Buriticá O, Machado J, et al. Fundamentos de farmacología en terapéutica, 6.a ed. Editorial Médica Celsus; 2014.
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.