NEUROMODULACIÓN DEL NERVIO OCCIPITAL COMO ALTERNATIVA DE MANEJO PARA LA NEURALGIA OCCIPITAL

Oscar Andrés Escobar Vidarte

Resumen


RESUMEN
INTRODUCCIÓN: La neuralgia occipital es un síndrome doloroso severo de alta complejidad que puede deteriorar la calidad de vida y comprometer la funcionalidad de quien lo sufre. Existen casos refractarios al manejo médico que pueden ser tratados con cirugía ablativa con el riesgo de empeoramiento del dolor. En la actualidad la estimulación eléctrica continua del nervio occipital mayor se convierte en opción terapéutica para este tipo de pacientes. MATERIALES Y MÉTODOS: Presentamos el caso de una mujer de 65 años con neuralgia occipital izquierda severa e intolerable, resistente al manejo médico, quien fue llevada a cirugía para la implantación de un estimulador del nervio occipital mayor, con un año de seguimiento post operatorio, durante el cual ha logrado control casi completo de los síntomas, recobrando su calidad de vida y funcionalidad. DISCUSIÓN: La neuralgia occipital severa y refractaria al manejo médico puede ser tratada con técnicas quirúrgicas ablativas, sin embargo estas ofrecen dificultades en términos de control del dolor y por sus posibles efectos adversos. La estimulación eléctrica continua del nervio occipital es una técnica quirúrgica que modula el influjo doloroso desde el sistema nervioso periférico hacia el central, que ha demostrado en series de casos publicadas ser una alternativa para el paciente severamente comprometido que en otras circunstancias no tendrían otra opción terapéutica. El caso descrito en este artículo fortalece la evidencia para recomendar el uso de esta alternativa.
PALABRAS CLAVE: Neuralgia occipital, estimulación eléctrica, nervio occipital mayor.

Palabras clave


Neuralgia occipital, estimulación eléctrica, nervio occipital mayor.

Referencias


BIBLIOGRAFIA

Cohen D OM, Whiting D. Occipital Neuralgia. In: Springer B, ed. Textbook of Stereotactic and Functional Neurosurgery. Lozano A, Gildenberg P, Tasker R (eds) 2009:2507-2515.

Burchiel KJ. A new classification for facial pain. Neurosurgery. 2003;53(5):1164-1166; discussion 1166-1167.

Buyten JP, Department of Anesthesia and Pain Management AN, Sint Niklaas, Belgium, Linderoth B, Department of Neurosurgery KUHaKI, Stockholm, Sweden. Invasive neurostimulation in facial pain and headache syndromes. European Journal of Pain Supplements. 2015;5(S2):409-421.

Bovim G, Fredriksen TA, Stolt-Nielsen A, Sjaastad O. Neurolysis of the greater occipital nerve in cervicogenic headache. A follow up study. Headache. 1992;32(4):175-179.

Gawel MJ, Rothbart PJ. Occipital nerve block in the management of headache and cervical pain. Cephalalgia. 1992;12(1):9-13.

Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. The Cervicogenic Headache International Study Group. Headache. 1998;38(6):442-445.

Sjaastad O, Saunte C, Hovdahl H, Breivik H, Gronbaek E. "Cervicogenic" headache. An hypothesis. Cephalalgia. 1983;3(4):249-256.

Slavin KV, Nersesyan H, Wess C. Peripheral neurostimulation for treatment of intractable occipital neuralgia. Neurosurgery. 2006;58(1):112-119; discussion 112-119.

Slavin KV. Peripheral nerve stimulation for neuropathic pain. Neurotherapeutics. 2008;5(1):100-106.

Brewer AC, Trentman TL, Ivancic MG, et al. Long-term outcome in occipital nerve stimulation patients with medically intractable primary headache disorders. Neuromodulation. 2013;16(6):557-562; discussion 563-554.

Dodick DW, Silberstein SD, Reed KL, et al. Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: long-term results from a randomized, multicenter, double-blinded, controlled study. Cephalalgia. 2015;35(4):344-358.

Silberstein SD, Dodick DW, Saper J, et al. Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: results from a randomized, multicenter, double-blinded, controlled study. Cephalalgia. 2012;32(16):1165-1179.

Young WB, Silberstein SD. Occipital nerve stimulation for primary headaches. J Neurosurg Sci. 2012;56(4):307-312.

Gobel A, Gobel CH, Heinze A, et al. Imaging sensory effects of occipital nerve stimulation: a new computer-based method in neuromodulation. Brain Stimul. 2015;8(2):295-298.

Shealy CN, Mortimer JT, Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg. 1967;46(4):489-491.

Rafolt D, Gallasch E, Fend M, Bijak M, Lanmuller H, Mayr W. Functional electrical stimulation-induced surface muscle stiffness captured by computer-controlled tonometry. Artif Organs. 2002;26(3):244-247.

Wall PD. The gate control theory of pain mechanisms. A re-examination and re-statement. Brain. 1978;101(1):1-18.

Rodrigo MD, Quero J, Cía P, et al. Estimulación eléctrica invasiva de C2-C3 en el tratamiento del dolor cefálico y facial: Neuralgia occipital. Migraña transformada. Cefalea en racimos. Algias faciales. Revista de la Sociedad Española del Dolor. 2008;15(6):382-391.

Rodrigo-Royo MD, Azcona JM, Quero J, Lorente MC, Acin P, Azcona J. Peripheral neurostimulation in the management of cervicogenic headache: four case reports. Neuromodulation. 2005;8(4):241-248.

Weiner RL, Reed KL. Peripheral neurostimulation for control of intractable occipital neuralgia. Neuromodulation. 1999;2(3):217-221.

Oh MY, Ortega J, Bellotte JB, Whiting DM, Alo K. Peripheral nerve stimulation for the treatment of occipital neuralgia and transformed migraine using a c1-2-3 subcutaneous paddle style electrode: a technical report. Neuromodulation. 2004;7(2):103-112.

Schwedt TJ, Dodick DW, Trentman TL, Zimmerman RS. Occipital nerve stimulation for chronic cluster headache and hemicrania continua: pain relief and persistence of autonomic features. Cephalalgia. 2006;26(8):1025-1027.

The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629-808.

Burns B, Watkins L, Goadsby PJ. Treatment of intractable chronic cluster headache by occipital nerve stimulation in 14 patients. Neurology. 2009;72(4):341-345.

Bartsch T, Paemeleire K, Goadsby PJ. Neurostimulation approaches to primary headache disorders. Curr Opin Neurol. 2009;22(3):262-268.

Rodrigo MD, Quero J, Cía P. Estimulación occipital: Experiencia de la unidad del dolor del Hospital Clínico de Zaragoza. Revista de la Sociedad Española del Dolor. 2007;14(8):579-582.

Mueller O, Diener HC, Dammann P, et al. Occipital nerve stimulation for intractable chronic cluster headache or migraine: a critical analysis of direct treatment costs and complications. Cephalalgia. 2013;33(16):1283-1291.

Magis D, Jensen R, Schoenen J. Neurostimulation therapies for primary headache disorders: present and future. Curr Opin Neurol. 2012;25(3):269-276.

Ignelzi RJ, Nyquist JK. Excitability changes in peripheral nerve fibers after repetitive electrical stimulation. Implications in pain modulation. J Neurosurg. 1979;51(6):824-833.

Chung JM, Lee KH, Hori Y, Endo K, Willis WD. Factors influencing peripheral nerve stimulation produced inhibition of primate spinothalamic tract cells. Pain. 1984;19(3):277-293.

Garrison DW, Foreman RD. Effects of transcutaneous electrical nerve stimulation (TENS) on spontaneous and noxiously evoked dorsal horn cell activity in cats with transected spinal cords. Neurosci Lett. 1996;216(2):125-128.

Woolf CJ. Transcutaneous electrical nerve stimulation and the reaction to experimental pain in human subjects. Pain. 1979;7(2):115-127.

Lindblom U, Tapper DN, Wiesenfeld Z. The effect of dorsal column stimulation on the nociceptive response of dorsal horn cells and its relevance for pain suppression. Pain. 1977;4(2):133-144.

Stiller CO, Cui JG, O'Connor WT, Brodin E, Meyerson BA, Linderoth B. Release of gamma-aminobutyric acid in the dorsal horn and suppression of tactile allodynia by spinal cord stimulation in mononeuropathic rats. Neurosurgery. 1996;39(2):367-374; discussion 374-365.

Goadsby PJ. Neurostimulation in primary headache syndromes. Expert Rev Neurother. 2007;7(12):1785-1789.

Bartsch T, Goadsby PJ. Stimulation of the greater occipital nerve induces increased central excitability of dural afferent input. Brain. 2002;125(Pt 7):1496-1509.

Goadsby PJ, Bartsch T, Dodick DW. Occipital nerve stimulation for headache: mechanisms and efficacy. Headache. 2008;48(2):313-318.

Becser N, Bovim G, Sjaastad O. Extracranial nerves in the posterior part of the head. Anatomic variations and their possible clinical significance. Spine (Phila Pa 1976). 1998;23(13):1435-1441.

Bovim G, Bonamico L, Fredriksen TA, Lindboe CF, Stolt-Nielsen A, Sjaastad O. Topographic variations in the peripheral course of the greater occipital nerve. Autopsy study with clinical correlations. Spine (Phila Pa 1976). 1991;16(4):475-478.

Matharu MS, Bartsch T, Ward N, Frackowiak RS, Weiner R, Goadsby PJ. Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study. Brain. 2004;127(Pt 1):220-230.

Mayanagi Y, Bouchard G. Evaluation of stereotactic thalamotomies for pain relief with reference to pulvinar intervention. Appl Neurophysiol. 1976;39(3-4):154-157.

Choi CR, Umbach W. Combined stereotaxic surgery for relief of intractable pain. Neurochirurgia (Stuttg). 1977;20(3):84-87.

Sweet JA, Mitchell LS, Narouze S, et al. Occipital Nerve Stimulation for the Treatment of Patients With Medically Refractory Occipital Neuralgia: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline. Neurosurgery. 2015;77(3):332-341.

Melvin EA, Jr., Jordan FR, Weiner RL, Primm D. Using peripheral stimulation to reduce the pain of C2-mediated occipital headaches: a preliminary report. Pain Physician. 2007;10(3):453-460.




Copyright (c) 2017 Revista Colombiana Salud Libre