El síndrome de Tolosa-Hunt se presenta como oftalmoplejía dolorosa. La corticoterapia es el tratamiento de primera línea establecido, pero un subgrupo de pacientes no alcanza la respuesta esperada, lo que requiere un protocolo de segunda línea definido.
La corticoterapia de primera línea — metilprednisolona, prednisolona o dexametasona, administrada por vía oral o intravenosa — se considera que ha fracasado cuando no logra la resolución del dolor orbitario y periorbitario y la oftalmoplejía (paresia) en 48 horas. En ese momento, está indicada la escalada a este protocolo.
DOI: 10.4236/ym.2020.42014
Infusion with 300 mg of a tumor necrosis factor-alpha antibody (infliximab) has been reported to result into dramatic and tenacious recovery in patients who previously reported recurrence of headache and diplopia on tapering prednisone to beneath 50 mg and cushingoid hallmarks, edematous legs, acne and hyperglycemia on maintanance 50 mg daily, hence, controlled researches should be conducted to systematize the usage of infliximab in THS, other alternative therapies include azathioprine and methotrexate which irregularly demands to be supplemented to sustain the primary response to glucocorticoids.
Nonetheless, acupuncture has been widely utilized for management of ophthalmological conditions particularly ophthalmoplegia in China, Multiple clinical trials show that acupuncture may improve the recovery of extra-ocular muscles in ophthalmoplegia cases farther researches are warranted to appraise the effectiveness and safety of acupuncture for THS ophthalmoplegia.
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