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Terapia anticonvulsiva en la neuralgia trigeminal: una revisión sistemática orientada a la clase
Miguel Pinto Moreira1, Bruno Daniel Carneiro1,2, Carlos Silva Faria3
1Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal.
Medicines (Basel, Switzerland)
|February 20, 2026
Resumen
Los anticonvulsivos son clave para el dolor de la neuralgia trigeminal (NT). Los bloqueadores de los canales de sodio son eficaces pero tienen efectos secundarios, mientras que otras opciones ofrecen una mejor tolerabilidad para el manejo de este dolor facial crónico.
Área de la Ciencia:
- Neurología
- Farmacología
- Medicina Clínica
Sus antecedentes:
- La neuralgia del trigémino (NT) es una afección neuropática crónica debilitante que causa dolor facial severo.
- Los anticonvulsivos son el principal tratamiento farmacológico para la NT.
- La evidencia comparativa sobre la eficacia y seguridad de los anticonvulsivos por mecanismo de acción es limitada.
Objetivo del estudio:
- Revisar y evaluar sistemáticamente la eficacia y seguridad de los anticonvulsivos para la NT.
- Estratificar los hallazgos según los mecanismos de acción de los anticonvulsivos.
Principales métodos:
- Búsqueda sistemática de literatura en PubMed, Scopus y Web of Science (directrices PRISMA 2020).
- Inclusión de estudios sobre pacientes humanos con NT que utilizan tratamientos farmacológicos, publicados en inglés desde 2000.
- Evaluación del riesgo de sesgo utilizando las herramientas Cochrane RoB 2, ROBINS-I y ROBINS-E.
Principales resultados:
- Doce estudios cumplieron los criterios de elegibilidad de 922 registros iniciales.
- Los inhibidores de los canales de sodio demostraron alta eficacia pero efectos adversos frecuentes (p. ej., hiponatremia, síntomas del SNC).
- Los moduladores de los canales de calcio presentaron un mejor perfil de seguridad; la levetiracetam y el topiramato mostraron eficacia moderada y buena tolerabilidad.
- Los bloqueadores de los canales de sodio son eficaces pero menos tolerables que las alternativas.
Conclusiones:
- La selección de fármacos para la NT debe considerar el mecanismo de acción.
- Adaptar la terapia a las características individuales del paciente y al fenotipo del dolor es crucial para equilibrar la eficacia y la tolerabilidad.
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