Multipl sklerozlu bir hastada trigeminal nevralji: Rastlantısal? Bir atak? Teriflunomid kaynaklı?

Multipl skleroza bağlı trigeminal nevralji (TNMS), multipl skleroz (MS) hastalarının %2–5’inde görülür. Tedavi stratejileri klasik trigeminal nevralji ile benzer olsa da, TNMS medikal tedaviye dirençli hale gelebilir ve çoklu tedavi ihtiyacı doğabilir. Kritik bölgelerdeki demiyelinizan lezyonlar en sık etiyolojidir. Ancak MS tedavisinde kullanılan terapiler, migren ya da günlük başağrısı benzeri diğer ağrı bozuklukları gibi trigeminal nevraljiyi de tetikleyebilmektedir. Burada relaps- remisyonlar ile giden MS için onaylanmış bir oral immunmodulatuvar ilaç olan ‘teriflunomid’e geçtikten beş ay sonra trigeminal nevralji gelişmiş bir MS vakası bildirilmiştir. Vakada trigeminal nevralji için olası etiyolojiler tartışılmıştır.

Trigeminal neuralgia in a patient with multiple sclerosis: Coincidental? An attack? Teriflunomide-induced?

Trigeminal neuralgia attributed to multiple sclerosis (TNMS) occurs in 2% to 5% of patients with multiple sclerosis (MS). Although treatment strategies are similar to those for classic trigeminal neuralgia, TNMS tends to become medically resistantand require polytherapy. Demyelinating lesions in critical regions are the most common etiology. However, therapies used totreat MS may trigger trigeminal neuralgia, as well as other pain disorders, like migraines or daily headaches. Presently reportedis the case of a patient with MS who suffered severe trigeminal neuralgia 5 months after switching to teriflunomide, an oralimmunomodulator drug approved for relapsing-remitting MS, and a discussion of possible etiological factors for the development of trigeminal neuralgia.

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