微栓子及托吡酯对偏头痛患者运动皮层兴奋性及头痛严重程度的影响  

Effect of microemboli and topiramate on motor cortex excitability and headache severity of patients with migraine

作　　者：李思燃 武晓昱 黄昊[3] 宋鹏辉[1] 林华[1] LI Siran;WU Xiaoyu;HUANG Hao(Department of Neurology,Xuanwu Hospital of Capital Medical University,Beijing(100053),Beijing,China)

机构地区：[1]首都医科大学宣武医院神经内科 [2]北京大学人民医院心血管内科 [3]首都医科大学宣武医院病案统计科

出　　处：《癫痫与神经电生理学杂志》2023年第1期19-24,共6页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：目的 观察偏头痛患者微栓子对运动皮层兴奋性及头痛严重程度的影响,探讨偏头痛患者口服托吡酯治疗前后的运动皮层兴奋性及头痛严重程度的变化。方法 选取2020年7月至2022年3月首都医科大学宣武医院偏头痛患者发泡实验阳性19例作为阳性组,发泡实验阴性23例作为阴性对照组。采用经颅磁刺激双上肢运动诱发电位(MEP)、皮层静息期(CSP)作为观察指标,比较两组患者的静息运动阈值(RMT)、CSP及头痛严重程度的差异。共17例偏头痛患者服用托吡酯治疗(不区分发泡实验结果),分析患者服药前后的RMT、CSP及头痛严重程度的差异。结果 发泡实验阳性组和阴性组患者的视觉模拟评分(VAS)、RMT及CSP比较差异均无统计学意义(P>0.05)。患者服用托吡酯治疗后,其右侧RMT提高,右侧CSP延长,VAS评分明显改善(P<0.05)。结论 卵圆孔未闭导致的微栓子对偏头痛患者的运动皮层兴奋性及头痛严重程度无明显影响。口服托吡酯治疗可降低患者的皮层兴奋性,恢复其皮层抑制功能,显著改善偏头痛患者的头痛严重程度。Objective To observe the effect of microemboli on motor cortex excitability and headache severity of patients with migraine and explore the changes of motor cortex excitability and headache severity in patients with migraine before and after oral treatment with topiramate. Methods From July 2020 to March 2022, 19 migraine patients with positive foaming test in Xuanwu Hospital of Capital Medical University were selected as positive group, and 23 patients with negative foaming test were selected as negative group. Transcranial magnetic stimulation-inducedmotor evoked potential(MEP) and cortical silent period(CSP) of both upper limbs were used as observation indexes to compare the differences in resting motor threshold(RMT), CSP and headache severity between two groups.A total of 17 patients with migraine were treated with topiramate regardless of the foaming test results. The differences in RMT, CSP and headache severity before and after treatment were analyzed.Results There were no significant differences in visual analogue score(VAS), RMT and CSP between positive and negative groups(P>0.05). After topiramate treatment, the patients exhibited increased right RMT, prolonged right CSP and improved VAS score(P<0.05). Conclusion Microemboli caused by patent foramen ovale has no significant effect on motor cortex excitability and headache severity of the patients with migraine. Oral topiramate treatment can reduce the cortical excitability of the patients, restore their cortical inhibitory function and significantly improve the headache severity of the patients with migraine.

关 键 词：偏头痛 卵圆孔未闭 发泡实验 运动诱发电位 静息运动阈值 皮层静息期 

分 类 号：R747.[医药卫生—神经病学与精神病学]