Neuromodulation:经颅直流电刺激预防发作性偏头痛的长期疗效:一项随机对照试验的结果

2021-07-24 MedSci原创 MedSci原创

偏头痛患者对感觉信息的处理方式不同。照片恐惧症和声音恐惧症在发作期间和发作之间都很常见。发作间期,许多偏头痛患者不习惯反复的躯体感觉、视觉、听觉和疼痛刺激。一些研究调查了大脑皮层的反应性,以阐明潜在的

偏头痛患者对感觉信息的处理方式不同。照片恐惧症和声音恐惧症在发作期间和发作之间都很常见。发作间期,许多偏头痛患者不习惯反复的躯体感觉、视觉、听觉和疼痛刺激。一些研究调查了大脑皮层的反应性,以阐明潜在的机制。在发作性偏头痛(EM)中,视皮层的异常处理被认为反映了由于丘脑-皮层驱动力不足导致的预激活水平下降。然而,在慢性偏头痛(CM)中,一些研究表明视觉和体感皮层的高兴奋性。经颅直流电刺激(tDCS)可能通过神经元的超极化或阈下去极化(取决于电流方向)来改变皮层的兴奋性。因此,tDCS似乎有助于治疗以脑兴奋性改变为特征的功能性疾病,如偏头痛。这似乎更具吸引力,因为这种方法没有严重的副作用,而大多数预防性偏头痛药物治疗有不利的疗效/不良反应概况。

在这项研究中,决定通过的刺激阳极TDC治疗EM患者(可能激活)枕叶皮层上,使刺激模式适应参与者视觉皮层的假定皮层预激活水平。分析了28天的治疗期对偏头痛/头痛天数和残疾的影响,同时也对通常与偏头痛共病的焦虑和抑郁的影响。评估了治疗后4个月内刺激效应的持续性。到目前为止,大多数研究没有评估偏头痛临床tDCS效应的持续时间,只有一项研究发现在刺激结束后8周内偏头痛发作显著减少。与假刺激相比,阳极tDCS可导致EM患者偏头痛天数的长期减少。尚未有随机、假对照研究(纵向设计)解决这一研究问题。

image

活动电极在视觉皮层上的位置

这项研究是单盲、随机。纳入标准为18-80岁 。满足发作性偏头痛的ICHD-3诊断。排除标准为妊娠、存在神经退行性疾病、MRI检查禁忌症和28天基线期内偏头痛少于2天。排除基线期提示慢性偏头痛的患者。基线检查后,参与者每天使用verum(阳极-1毫安至20毫安) 最小)或假tDCS(阳极-1 mA至30 mA )在Oz(参考Cz电极)下刺激28 天。在刺激期间,以及在随后的四个28天期间。记录头痛临床情况。

image

T1为28天的刺激期,T2、T3、T4、T5为随后4个28天的随访期;与基线检查时相比,T4时的平均变化有显著性差异(p=0.033),T3时有显著性趋势(p=0.081),但刺激期间两组偏头痛天数的变化无显著性差异(T1;p=0.944)、T2(p=0.497)和T5(p=0.631)

对枕叶皮质进行阳极tDCS预防性治疗,可显著减少28天刺激期后偏头痛的天数。两组之间的差异为1.9% ± 0.7 天。尽管verum-tDCS组50%应答者的比例高于sham组;差异不显著。然而,将平均每月5天的偏头痛天数减少2天是有临床意义的。纳入23例患者。与假tDCS(n=12)相比,verum tDCS(n=11)在所有随访期间导致偏头痛天数减少(p=0.010)。发现总头痛天数(p=0.165)、焦虑(p=0.884)或抑郁评分(p=0.535)没有显著变化。无严重不良事件发生;两组的副作用相似。

总之,在未来的研究中探讨长时间的刺激是否能够提供更持久的治疗益处是有意义的。本文的数据表明,tDCS对偏头痛以外的头痛或共病焦虑或抑郁症状没有影响。

Pohl, H., Moisa, M., Jung, H.-H., Brenner, K., Aschmann, J., Riederer, F., Ruff, C.C., Schoenen, J., Luechinger, R., Widmer, L., Petersen, J.A., Gantenbein, A.R., Sandor, P.S. and Michels, L. (2021), Long-Term Effects of Self-Administered Transcranial Direct Current Stimulation in Episodic Migraine Prevention: Results of a Randomized Controlled Trial. Neuromodulation: Technology at the Neural Interface

 

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    2022-03-23 光明骑士

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    2021-11-17 amyloid
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    2021-07-24 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1940547, encodeId=eb86194054e7a, content=<a href='/topic/show?id=9a29e8497ac' target=_blank style='color:#2F92EE;'>#经颅直流电刺激#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78497, encryptionId=9a29e8497ac, topicName=经颅直流电刺激)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=947269, createdName=lvygwyt2781, createdTime=Wed Jan 12 00:32:51 CST 2022, time=2022-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1205216, encodeId=c214120521655, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4d585243593, createdName=光明骑士, createdTime=Wed Mar 23 13:24:10 CST 2022, time=2022-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1775570, encodeId=f92e1e7557027, content=<a href='/topic/show?id=937d46650bf' target=_blank style='color:#2F92EE;'>#对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46650, encryptionId=937d46650bf, topicName=对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8ae138776909, createdName=amyloid, createdTime=Wed Nov 17 17:32:51 CST 2021, time=2021-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1987302, encodeId=d832198e3027b, content=<a href='/topic/show?id=bac5466546c' target=_blank style='color:#2F92EE;'>#对照试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46654, encryptionId=bac5466546c, topicName=对照试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, createdName=般若傻瓜, createdTime=Mon Jan 10 06:32:51 CST 2022, time=2022-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1296267, encodeId=b0a9129626ef7, content=<a href='/topic/show?id=7591984530b' target=_blank style='color:#2F92EE;'>#随机对照试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98453, encryptionId=7591984530b, topicName=随机对照试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=373b263, createdName=lisa438, createdTime=Mon Jul 26 11:32:51 CST 2021, time=2021-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1394038, encodeId=f8be1394038e3, content=<a href='/topic/show?id=a054e00031c' target=_blank style='color:#2F92EE;'>#电刺激#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70003, encryptionId=a054e00031c, topicName=电刺激)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqTLTjicBiccpdUyHMGZV43nOBI6QIQqxVcy2EzXz67E390Q5j0R7QWjym391HxsyiaYt7NzbrcojRDw/132, createdBy=64462500151, createdName=ms705947299214030, createdTime=Mon Jul 26 11:32:51 CST 2021, time=2021-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1553518, encodeId=7d6e155351856, content=<a href='/topic/show?id=3b409e02804' target=_blank style='color:#2F92EE;'>#长期疗效#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97028, encryptionId=3b409e02804, topicName=长期疗效)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fe2a14383573, createdName=gjsgj, createdTime=Mon Jul 26 11:32:51 CST 2021, time=2021-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1033054, encodeId=06fe10330545c, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Sat Jul 24 23:32:51 CST 2021, time=2021-07-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1039042, encodeId=2b56103904292, content=高质量研究,读起来真爽,谢谢梅斯, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Sat Jul 24 23:32:51 CST 2021, time=2021-07-24, status=1, ipAttribution=)]
    2021-07-24 肿瘤克星

    高质量研究,读起来真爽,谢谢梅斯

    0

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