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JNNP:SUNCT和SUNA的药物治疗：一项前瞻性开放标签研究，包括单臂meta分析

2020-12-28 MedSci原创 MedSci原创

单臂meta单侧神经样头痛SUNCT和SUNA
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结膜注射和撕裂（SUNCT）和颅脑自主症状（SUNA）引起的持续性单侧神经样头痛发作仍然缺乏临床数据,鉴于SUNCT和SUNA的罕见性，关于其临床表现、潜在病理生理机制和治疗反应的文献很少。SUNCT

结膜注射和撕裂（SUNCT）和颅脑自主症状（SUNA）引起的持续性单侧神经样头痛发作仍然缺乏临床数据,鉴于SUNCT和SUNA的罕见性，关于其临床表现、潜在病理生理机制和治疗反应的文献很少。SUNCT和SUNA发作被认为是三叉神经自主性头痛（TACs）中的短时单侧神经痛样头痛发作”（SUNHA）。鉴于临床和病理生理学的相似性，SUNCT和SUNA尝试了几种已知对其他TAC有效的治疗方法。但是，目前的证据仅限于小病例组和一个小的随机安慰剂对照试验，这阻碍了临床治疗研究。本研究的目的是描述口服和肠外治疗用于治疗大量SUNCT和SUNA患者的疗效结果。此外，本文将研究结果与现有的已发表数据集中在单臂meta分析中。

这是一项单中心、非随机、前瞻性的开放标签研究，在2007年至2014年间，由头痛研究小组用SUNCT和SUNA对连续患者进行诊断。临床资料由两位作者（MM和GL）在治疗开始时直接从患者那里收集，采用半结构化标准化问卷。调查问卷旨在记录：头痛特征，包括基线检查时和随访时评估治疗结果时的发作频率、严重程度和持续时间、治疗名称、达到的最大剂量、治疗持续时间、治疗结果、副作用和停药原因。对于口服治疗试验，计划在3个月进行面对面或电话随访评估，以确定治疗效果和耐受性，随后在6个月和12个月进行，以确定反应的一致性。对于注射剂治疗试验，在治疗或患者出院后6周安排电话随访，以确定疗效和耐受性；随后组织3个月、6个月和12个月的随访，以建立反应的一致性。

本研究中评估的口服药物包括有初步疗效证据的治疗，即拉莫三嗪、卡马西平、奥卡西平、托吡酯、加巴喷丁和普瑞巴林，以及没有报告疗效证据的治疗，即度洛西汀、拉科萨胺和美西律。在SUNCT和SUNA中测试这些药物的基本原理来自于其他神经病变和神经痛样疾病的疗效证据。对所有患者使用标准化药物滴定协议，以确保数据的一致性。本研究评估的注射剂治疗为枕大神经阻滞（GONB）和静脉注射利多卡因。本研究中使用的GONB方案包括在枕下区域注射80毫克甲基强的松龙和2毫升2%利多卡因的混合物。头痛改善定义为每日发作频率和/或强度和/或持续时间的减少。治疗改善分为：轻度（<50%）改善、良好（50%-90%）和优秀（91%-100%）改善。
 
拉莫三嗪是SUNCT和SUNA的首选治疗药物。76%的患者（n=97/128）（SUNCT:73%；SUNA 72%，p=0.935）报告说拉莫三嗪在一定程度上改善了头痛。其中56%（n=71/128）被认为有疗效（SUNCT:54%；SUNA:58%，p=0.620）。82%的患者对拉莫三嗪有耐受性。6名SUNCT患者和3名SUNA患者需要超过英国国家处方集（BNF）推荐的每日400毫克剂量才能获得有益效果。与卡马西平相比，奥卡西平是一种更有效的药物。事实上，本文的证据支持这样的观点，即奥卡西平应被视为对拉莫三嗪无反应或耐受性的患者的第二选择，或作为拉莫三嗪的补充治疗。SUNCT和SUNA的慢性亚型可能是一种特别难以治疗的头痛疾病，可能需要高剂量才能见效。在SUNCT和SUNA状态下，静脉注射利多卡因应该是首选的治疗方法。，SUNCT和SUNA之间的口服和肠外治疗的比较没有出现显著差异。在合并分析中也观察到两种情况下的相似治疗结果，其中拉莫三嗪和奥卡西平被证实是最有效的口服治疗，静脉注射利多卡因是最有效的静脉注射治疗。
 
总之，SUNCT和SUNA在治疗上的相似性进一步支持了这样一个假设，即这些疾病可能是同一疾病的变体。
 
Lambru G, Stubberud A, Rantell K, et al Medical treatment of SUNCT and SUNA: a prospective open-label study including single-arm meta-analysis Journal of Neurology, Neurosurgery & Psychiatry Published Online First: 24 December 2020. doi:10.1136/jnnp-2020-323999
 

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    2021-01-01 1508842480_96220437

    #前瞻性#

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    2021-03-27 一闲

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    2021-01-23 guojianrong

    #Meta#

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    2020-12-28 ms3000001511989661

    孤寡孤寡个哈哈哈

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    2020-12-28 ms3000001511989661

    哈哈哈

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2006509, encodeId=be55200650953, content=<a href='/topic/show?id=924a3264381' target=_blank style='color:#2F92EE;'>#前瞻性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32643, encryptionId=924a3264381, topicName=前瞻性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5cb32500112, createdName=1508842480_96220437, createdTime=Fri Jan 01 18:58:52 CST 2021, time=2021-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1896793, encodeId=52971896e93c1, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Sat Mar 27 16:58:52 CST 2021, time=2021-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1888257, encodeId=e546188825ee0, content=<a href='/topic/show?id=d56611584ec' target=_blank style='color:#2F92EE;'>#Meta#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11584, encryptionId=d56611584ec, topicName=Meta)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Sat Jan 23 22:58:52 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=911505, encodeId=edd89115051c, content=孤寡孤寡个哈哈哈, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74745441193, createdName=ms3000001511989661, createdTime=Mon Dec 28 02:14:18 CST 2020, time=2020-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=911504, encodeId=944691150406, content=哈哈哈, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74745441193, createdName=ms3000001511989661, createdTime=Mon Dec 28 01:56:52 CST 2020, time=2020-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=911503, encodeId=dfae911503a4, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74745441193, createdName=ms3000001511989661, createdTime=Mon Dec 28 01:56:00 CST 2020, time=2020-12-28, status=1, ipAttribution=)]
    2020-12-28 ms3000001511989661

    好

    0