Avaliação e tratamento de pacientes com dor facial atípica através da estimulação magnética transcraniana repetitiva

Abstract

RESUMO As características funcionais e morfológicas da face, aliadas à complexidade do fenômeno doloroso, tornam favorável a existência de inúmeras fontes de dor facial, como procuraram demonstrar as várias classificações existentes a respeito. A nucleotratotomia trigeminal consiste na ablação cirúrgica de núcleos trigeminais de segunda ordem e tratos. Dois casos de dor facial atípica refratários ao tratamento medicamentoso ou a outras formas não-operatórias são discutidos. A intensidade da dor pré e pós-operatória foi avaliada pela Escala Visual Analógica. A técnica operatória é descrita. Os resultados imediatos foram satisfatórios em ambos os casos. Um doente teve recidiva da dor, com menor intensidade, dois meses após o procedimento e o outro estava assintomático oito meses depois. Um doente apresentou ataxia transitória que regrediu em dois meses; o outro teve meningite bacteriana no pós-operatório. Aspectos terapêuticos e as bases fisiopatológicas da indicação cirúrgica são apresentados. ABSTRACT Stereotactic trigeminal nucleotractotomy for treatment of atypical facial pain The functional and morphologic peculiarities of the face justify the occurrence of varied sources of pain. The trigeminal nucleotractotomy consists in a surgical lesion of secundary trigeminal nuclei and tracts. Two cases of atypical facial pain refractory to clinical treatments are discussed. The intensity of pain was evaluated by the Visual Analogic Scale. The surgical technique is described. The immediate results were satisfactory. One patient developed recurrent pain two months later, and the other was asymptomatic for eight months. One patient presented transitory ataxia and the other developed bacterial meningitis. The physiopathological basis of this procedure is discussed. KEYWORDS Facial pain. Stereotaxis. Stereotactic trigeminal nucleotractotomy.

The efficacy of transcranial direct current stimulation and transcranial magnetic stimulation for chronic orofacial pain: A systematic review

“…Umezaki et al, 2015 [48] reported the occurrence of headache at the beginning of treatment, which disappeared within two days in seven participants in the active group and in five participants in the sham group. Khedr et al, 2005 [35] reported an absence of adverse effects, while Galhardoni et al, 2014 [30] did not describe any evaluation of side effects in their study. The adverse effects reported in each tDCS /TMS article are summarized in S1 Table.…”

“…Galhardoni et al, 2014 [30]; Khedr et al, 2005 [35]; Lindholm et al, 2015 [34] and Umezaki et al, 2015 [48] evaluated the efficacy of repetitive TMS (rTMS) in the treatment of neuropathic orofacial pain, including BMS, AFP and TN. The stimulation protocols differed in the number of sessions, site of the stimulation, and the intensity and number of pulses per session.…”

“…In the study by Lindholm et al, 2015 [34]; 2016 [33], none of the variables investigated were significantly different, when comparing the study groups. Galhardoni et al, 2014 [30] evaluated the quality of life. In agreement with the results of Lindholm et al, 2015 [34]; 2016 [33], no significant group differences were found.…”

“…Among the rTMS studies included, the longest evaluation periods were used by Galhardoni et al, 2014 [30] and Umezaki et al, 2015 [48]. Galhardoni et al, 2014 [30] evaluated the subjects of their study for up to 60 days, counting from the start of the treatment. Umezaki et al, 2015 [48] performed three follow-ups (at days 15, 30 and 60 from the start of the treatment).…”

“…Only two of the eight studies analyzed the efficacy of M1-rTMS compared to a placebo, with contradictory results. While Khedr et al, 2005 [35] demonstrated a significant improvement of pain with active TMS compared to a placebo, Galhardoni et al, 2014 [30] reported no significant difference between placebo and active treatments in any of the variables evaluated. Such divergences might be related to the use of different protocols/methodological designs and/or to the inclusion of different pain disorders.…”