Flores-Hernández R, Zermeño-Pohls F, Rodríguez-Alvarez CA, Reyes AR

Idioma: Español
Referencias bibliográficas: 48
Paginas: 178-186
Archivo PDF: 107.48 Kb.

FRAGMENTO

En el Instituto Nacional de Neurología y Neurocirugía (INNN), la cefalea constituye la segunda causa de preconsulta después de la epilepsia. La migraña es un padecimiento que ocupa la sexta causa de ausentismo laboral. Dentro de los medicamentos utilizados en el tratamiento profiláctico de la migraña se encuentran el topiramato y el valproato. Objetivo: comparar la eficacia profiláctica entre valproato y topiramato en los pacientes con diagnóstico de migraña con y sin aura (criterios de acuerdo a la clasificación internacional de cefaleas del 2004). Material y métodos: de enero a octubre de 2005; se estudiaron 90 pacientes consecutivos que acudieron a la preconsulta o al servicio de urgencias del INNN. Los pacientes no se encontraban tomando ningún medicamento profiláctico y aceptaron costear su tratamiento en forma voluntaria. Se asignaron los pacientes en forma alterna consecutiva por una enfermera a uno de dos grupos. Al primero se administró topiramato y al segundo valproato de magnesio. La dosis de topiramato fue de 25 mg y la de valproato de magnesio de 200 mg. Las dosis se incrementaron semanalmente hasta obtener profilaxis de las crisis migrañosas. Los cortes de seguimiento se hicieron al mes y a los 3 y 6 meses. Resultados: se evaluaron 90 pacientes de los cuales 75 completaron el estudio (40 topiramato y 35 valproato). La eficacia profiláctica a los 6 meses fue del 100% para el grupo de topiramato (32 con 25 mg y 8 con 50 mg) y del 85% para el grupo de valproato (17 con 200 mg y 18 con 400 mg), hubo 5 pacientes en quienes no se pudo aumentar la dosis de valproato debido a la presencia de efectos secundarios. Conclusiones: el topiramato tiene mayor eficacia profiláctica respecto del valproato a menores dosis, además de que tiene menor incidencia de efectos adversos y lleva a remisión de las crisis migrañosas en menos tiempo (3 meses).
Nota: este estudio no fue patrocinado por la industria farmacéutica.

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