Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942009000400010
Brazilian Journal of Anesthesiology
Clinical Information

Neuralgia do trigêmeo bilateral: relato de caso

Bilateral trigeminal neuralgia: case report

Caio Marcio Barros de Oliveira; Luis Gustavo Baaklini; Adriana Machado Issy; Rioko Kimiko Sakata

http://dx.doi.org/10.1590/S0034-70942009000400010 Braz J Anesthesiol, vol.59, n4, p.476-480, 2009
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Resumo

JUSTIFICATIVA E OBJETIVOS: A neuralgia do nervo trigêmeo é uma condição intensamente dolorosa, caracterizada por surtos de dor lancinante e súbita, tipo choque, com duração de poucos segundos a dois minutos e geralmente unilateral. Sua incidência anual é de cerca de 4,3 em 100.000 na população geral, tendo manifestação bilateral em apenas 3% desses casos. O objetivo deste artigo foi descrever um caso raro de neuralgia do trigêmeo primário bilateral. RELATO DO CASO: Paciente de 61 anos, maranhense, casada, do lar, com antecedente de hipertensão arterial e há seis anos com queixa de dor intensa em V2-V3 à esquerda, com duração de 5 a 10 segundos, em região lateral do nariz e mandibular, com piora ao falar, mastigar e com diminuição da temperatura. Já havia utilizado clorpromazina (3 mg a cada oito horas) e carbamazepina (200 mg a cada oito horas) durante seis meses sem alívio da dor. Ao exame físico apresentava alodinia térmica e mecânica em regiões de V2-V3. Estava em uso de gabapentina (1.200 mg ao dia) com alívio parcial da dor. Foi então aumentada a gabapentina para 1500 mg ao dia e introduzida amitriptilina 12,5 mg à noite. Evoluiu com dor leve e esporádica com diminuição da intensidade da dor ao longo de 10 meses de tratamento, sendo reduzida progressivamente a gabapentina para 600 mg ao dia e mantida a amitriptilina 12,5 mg ao dia. Após um ano, começou a apresentar dor de característica semelhante em região mandibular à direita, tendo melhorado com aumento de gabapentina para 900 mg ao dia. Não apresentava exames alterados de tomografia ou ressonância magnética de encéfalo. CONCLUSÕES: A carbamazepina é o fármaco de primeira escolha para tratamento de neuralgia trigeminal, porém a gabapentina tem sido cada vez mais utilizada como primeira medida farmacológica ou em casos refratários à terapia convencional.

Palavras-chave

DOR, Crônica, DROGAS, Anticonvulsivante, DROGAS, Anticonvulsivante

Abstract

BACKGROUND AND OBJECTIVES: Trigeminal neuralgia is an extremely painful condition characterized by recurrent episodes of sudden, lancinating, shock-like pain lasting from a few seconds to two minutes usually unilateral. It has an annual incidence of approximately 4.3 in 100,000 in the general population and only 3% of those cases present bilateral manifestation. The objective of this report was to describe a rare case of bilateral trigeminal neuralgia. CASE REPORT: A 61 years old housewife from Maranhão, Brazil, married, with a history of hypertension, presented with a six-year history of severe pain in the left V2-V3 regions, lasting 5 to 10 seconds, in the lateral aspect of the nose and mandible, worsening by talking, chewing, and with a decrease in temperature. She had been treated with chlorpromazine (3 mg every eight hours) and carbamazepine (200 mg every eight hours) during six months without improvement. On physical exam, the patient presented thermal and mechanical allodynia in the V2-V3 regions. She was using gabapentin (1,200 mg/day) with partial relief of the pain. The dose of gabapentin was increased to 1,500 mg/day and amitriptyline 12.5 mg at night was added to the therapeutic regimen. The patient evolved with mild and sporadical pain and a reduction in pain severity during 10 months; the dose of gabapentin was progressively reduced to 600 mg/day, and amitriptyline was maintained at 12.5 mg/day. After one year, the patient developed similar pain in the region of the right mandible, which improved with an increase in the dose of gabapentin to 900 mg/day. Head CT and MRI did not show any abnormalities. CONCLUSIONS: Carbamazepine is the first choice for the treatment of trigeminal neuralgia; however, the use of gabapentin as the first pharmacological choice or in cases refractory to conventional therapy has been increasing.

Keywords

DRUGS, Anticonvulsants, DRUGS, Anticonvulsants, PAIN, Chronic

Referências

Bennetto L, Patel NK, Fuller G. Trigeminal neuralgia and its management. BMJ. 2007;334:201-205.

Krafft RM. Trigeminal neuralgia. Am Fam Physician. 2008;77:1291-1296.

Neto HS, Camilli JA, Marques MJ. Trigeminal neuralgia is caused by maxillary and mandibular nerve entrapment: greater incidence of right-sided facial symptoms is due to the foramen rotundum and foramen ovale being narrower on the right side of the cranium. Med Hypotheses. 2005;65:1179-1182.

Manzoni GC, Torelli P. Epidemiology of typical and atypical craniofacial neuralgias. Neurol Sci. 2005;26(^s2):s65-67.

Nurmikko TJ, Eldridge PR. Trigeminal neuralgia: pathophysiology, diagnosis and current treatment. Br J Anaesth. 2001;87:117-132.

Osterberg A, Boivie J, Thuomas KA. Central pain in multiple sclerosis: prevalence and clinical characteristics. Eur J Pain. 2005;9:531-542.

Love S, Coakham HB. Trigeminal neuralgia: pathology and pathogenesis. Brain. 2001;124:2347-2360.

The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(^s1):9-160.

Lindena G, Diener HC, Hildebrandt J. Leitlinien zur schmerztherapie: methodische qualitat von leitlinien zur therapie von patienten mit schmerzen. Schmerz. 2002;16:194-204.

Zakrzewska JM. Diagnosis and differential diagnosis of trigeminal neuralgia. Clin J Pain. 2002;18:14-21.

Wiffen PJ, McQuay HJ, Moore RA. Carbamazepine for acute and chronic pain. Cochrane Database Syst Rev. 2005:CD005451.

Canavero S, Bonicalzi V. Drug therapy of trigeminal neuralgia. Expert Rev Neurotherap. 2006;6:429-440.

Wiffen PJ, McQuay HJ, Edwards JE. Gabapentin for acute and chronic pain. Cochrane Database Syst Rev. 2005:CD005452.

Cheshire Jr WP. Defining the role for gabapentin in the treatment of trigeminal neuralgia: a retrospective study. J Pain. 2002;3:137-42.

Lemos L, Flores S, Oliveira P. 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;24:64-75.

Ong KS, Keng SB. Evaluation of surgical procedures for trigeminal neuralgia. Anesth Prog. 2003;50:181-188.

Hall GC, Carroll D, McQuay HJ. Primary care incidence and treatment of four neuropathic pain conditions: a descriptive study, 2002-2005. BMC Fam Pract. 2008;9:26.

Kalkanis SN, Eskandar EN, Carter BS. Microvascular decompression surgery in the United States: 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery. 2003;52:1251-1262.

Lim M, Villavicencio AT, Burneikiene S. CyberKnife radiosurgery for idiopathic trigeminal neuralgia. Neurosurg Focus. 2005;18:E9.

Massager N, Lorenzoni J, Devriendt D. Radiosurgery for trigeminal neuralgia. Prog Neurol Surg. 2007;20:235-243.

Massager N, Murata N, Tamura M. Influence of nerve radiation dose in the incidence of trigeminal dysfunction after trigeminal neuralgia radiosurgery. Neurosurgery. 2007;60:681-688.

Hai J, Li ST, Pan QG. Treatment of atypical trigeminal neuralgia with microvascular decompression. Neurol India. 2006;54:53-57.

Tomasello F, Alafaci C, Angileri FF. Clinical presentation of trigeminal neuralgia and the rationale of microvascular decompression. Neurol Sci. 2008;29(^s1):s191-195.

Tronnier VM, Rasche D, Hamer J. Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. Neurosurgery. 2001;48:1261-1268.

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