Kronik Migrenli Hastalarda Bir Kliniğin Botulinum toksin A Deneyimi

Year 2021, Volume: 11 Issue: 3, 272 - 276, 24.05.2021

Şükran Çevik Yurtoğulları

https://doi.org/10.16899/jcm.821703

Abstract

Amaç :
Son yıllarda her alanda kullanımı artan Botulinum toksin A (BoNT/A)’nın yapılan son çalışmalarla etkinliği kronik migrende de (KM) gösterilmiştir. Nöroloji kliniklerinde de uzun yıllardır Fokal Distoniler, Distoni olmayan istemsiz hareket bozuklukları, Spastisite, Otonom Sinir Sistemi bozuklukları gibi kullanımlardan sonra KM de kullanımı hızla yayılmaktadır. Bizde bu çalışmamız ile KM tanısıyla takip ettiğimiz BoNT/A uygulanan hastalarımızın tedavi yanıtlarını incelemeyi amaçladık.
Gereç ve Yöntem:
Kronik Migren tanılı, ülkemizdeki ruhsatlı tedavi seçeneklerini kulanmış olmasına rağmen yeterli yanıt alınamayan, 18-65 yaş arası ve ek nörolojik hastalığı olmayan 41 Kronik Migren (KM) hastası çalışmaya dahil edildi. BoNT/A tedavisi alan hastalar enjeksiyon öncesi ilk vizitlerinde demografik bilgiler (yaş,cinsiyet), eğitim durumu, tanı zamanı, migren tetikleyicileri, aldıkları tedaviler açısından sorgulandı ve tedavi sonrası altıncı aylarında analjezik kullanımı, atak sıklığı, VAS (Vizuel Analog Skala) ve MIDAS (Migren Özürlülük Değerlendirmesi) skorları ile birlikte değerlendirildi.
Bulgular:
Hastaların 36 (%87.8) kadın, 5 (%12.2) erkekti. Yaş ortalaması 44.88±10.51 olarak saptandı. Migren hastalık süresi ortalama 15.75 yıl idi. Hastaların 25 (%61)’inde birinci derece akrabalarında aile öyküsü varken 16 (%39) hastada yoktu. Hastaların 20 (%48.8)’i auralı migren kriterlerine sahipken, 21(%51.2)’inde aura saptanmadı. Hastaların BoNT/A tedavisi sonrası MIDAS ve VAS skorlarında anlamlı düşme saptandı (p<0.001).
Sonuç:
KM’nin proflaktik tedavisinde etkin ve güvenilir bulunmuştur. Hastaların migrene bağlı özürlülüğünün azaldığı ve yaşam kalitesinin arttırdığı saptanmıştır. Tüm proflaksi tedavilerini alan KM’li uygun kriterli hastalarda BoNT/A deneyimli nöroloji uzmanlarınca uygulanacak güçlü bir tedavidir.

Keywords

Baş ağrısı, Kronik migren, Botilinum toxin A

Supporting Institution

yok

Project Number

Ankara şehir hastanesi etik kurulundan protocol no: 2019-E-19-083 sayılı etik kurul onamı alınmıştır.

Botulinum toxin A in Patients with Chronic Migraine: A Single-Center Experience;

Abstract

Abstract:
Objective : The Botulinum toxin A (BoNT/A), increasingly used in many fields in recent years, was shown to be effective in chronic migraine (CM) in recent studies. In this study, we aimed to investigate treatment response in our CM patients who underwent BoNT/A therapy.

Methods: The study included 41 CM patients (aged 18-65 years). We questioned patients undergoing BoNT/A therapy regarding demographic characteristics, education level, time of diagnosis, migraine triggers, and previous therapies at first visit prior to injection. The patients were assessed together with analgesic use, visual analog scale (VAS) score and Migraine Disability Assessment Score (MIDAS) rating at month 6 after treatment.

Results: There were 36 women (87.8%) and 5 men (12.2%) in the study group. Mean age was calculated as 44.88±10.51 years. Of the patients, 20 patients (48.8%) fulfilled criteria for migraine with aura while no aura was detected in 21 patients (51.2%). Significant decrease was detected in MIDAS rating and VAS scores after BoNT/A therapy (p<0.001).

Conclusion: The BoNT/A was found to be effective and safe in the prophylactic treatment of chronic migraine. The BoNT/A is a potent treatment that could be performed by experienced neurologists in eligible CM patients regardless of previous prophylactic treatments.

Keywords

Baş ağrısı, Kronik migren, Botilinum Toksin A

Project Number

Ankara şehir hastanesi etik kurulundan protocol no: 2019-E-19-083 sayılı etik kurul onamı alınmıştır.

References

• 1- Headache Classification Committee of the International Headache Society (2013) The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 33: 629–808. DOI: 10.1177/0333102413485658
• 2- Ertas M, Baykan B, Kocasoy Orhan E, et al. One-year prevalence and the impact of migraine and tension-type headache in Turkey: a nation wide home-based study in adults. J Headache Pain 2012; 13:147-157. DOI: 10.1007/s10194-011-0414-5.
• 3- Lipton RB, Bigal ME, Diamond M, et al; AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 2007; 68:343-349. DOI:10.1212/01.wnl.0000252808.97649.21
• 4- Blumenfeld A, Silberstein S, Dodick D, et al. (2010) Method of injection of OnabotulinumtoxinA for chronic migraine: a safe, well-tolerated, and effective treatment paradigm based on the PREEMPT clinical program. Headache 50: 1406–1418. DOI:10.1111/j.1526-4610.2010.01766.x
• 5- Diener H, Dodick D, Aurora S, et al. (2010) OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia 30: 804–814. DOI:10.1177/0333102410364677
• 6- Lipton R, Rosen N, Ailani J, et al. (2016) OnabotulinumtoxinA improves quality of life and reduces impact of chronic migraine over one year of treatment: pooled results from the PREEMPT randomized clinical trial program. Cephalalgia 36: 899–908. DOI: 10.1177/0333102416652092
• 7- Simpson D, Hallett M, Ashman E, et al. (2016) Practice guideline update summary: botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 86: 1818–1826. DOI: 10.1212/WNL.0000000000002560.
• 8- Botulinum Toxin Type A for the Prevention of Headaches in Adults with Chronic Migraine. NICE (2012) Technology appraisal guidance [TA260]. Available at: https://www.nice.org.uk/Guidance/ta260.
• 9- Bigalke H, Botulinum toxin: application, safety, and limitations.Curr Top Microbiol Immunol. 2013;364:307-17. DOI:10.1007/978-3-642-33570-9_14
• 10- Dolly O. Synaptic transmission: inhibition of neurotransmitter release by botulinum toxins. Headache 2003; 43:16-24. DOI:10.1046/j.1526-4610.43.7s.4.x
• 11- Aoki KR. Pharmacology and immunology of botulinum neurotoxins. Int. Ophtalmol Clin 2005; 45:25-37. DOI:10.1097/01.iio.0000167167.10402.74
• 12- Cui M, Khanijou S, Rubino J, Aoki KR. Subcutaneous administration of botulinum toxin A reduces formalin-induced pain. Pain 2004; 107:125-133. DOI:10.1016/j.pain.2003.10.008
• 13- Meng J, Wang J, Lawrence G, Dolly JO. Synaptobrevin I mediates exocytosis of CGRP from sensory neurons and inhibition by botulinum toxins reflects their anti-nociceptive potential. J Cell Sci 2007; 120:2864- 2874. DOI:10.1242/jcs.012211
• 14- Gazerani P, Staahl C, Drewes AM, Arendt-Nielsen L. The effects of Botulinum Toxin type A on capsaicin-evoked pain, flare, and secondary hyperalgesia in an experimental human model of trigeminal sensitization. Pain 2006; 122:315-325. DOI:10.1016/j.pain.2006.04.014
• 15- Gazerani P, Pedersen NS, Staahl C, Drewes AM, Arendt-Nielsen L. Subcutaneous Botulinum toxin type A reduces capsaicin-induced trigeminal pain and vasomotor reactions in human skin. Pain 2009; 141:60- 69. DOI:10.1016/j.pain.2008.10.005
• 16- Durham PL, Cady R, Cady R. Regulation of calcitonin gene-related peptide secretion from trigeminal nerve cells by botulinum toxin type A: implications for migraine therapy. Headache 2004; 44:35-42. DOI:10.1111/j.1526-4610.2004.04007.x
• 17- Welch MJ, Purkiss JR, Foster KA. Sensitivity of embryonic rat dorsal root ganglia neurons to Clostridium botulinum neurotoxins. Toxicon 2000; 38:245-258. DOI:10.1016/s0041-0101(99)00153-1
• 18- Cernuda-Morollón E, Martínez-Camblor P, Ramón C, et al. (2014) CGRP and VIP levels as predictors of efficacy of onabotulinumtoxin type A in Chronic Migraine. Headache 54: 987–995. DOI:10.1111/head.12372
• 19- Dodick DW, Turkel CC, DeGryse RE, et al; PREEMPT Chronic Migraine Study Group. Onabotulinumtoxin A for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache 2010; 50:921-36. DOI:10.1111/j.1526-4610.2010.01678.x
• 20- Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevelance and Burden of Migraine in the United States: Data from the American Migraine Study II. Headache 2001;41:646-657. DOI:10.1046/j.1526-4610.2001.041007646.x
• 21- Russell MB, Fenger K, Olesen J. The family history of migraine. Direct versus indirect information. Cephalalgia 1991;11:156-60. DOI:10.1046/j.1468-2982.1996.1603156.x
• 22- Smetana GW. The Diagnostik Value Of Historical Features in Primary Headache Syndromes A Comprehensive Review. Arch Intern Med. 2000; 160:2729-2737. DOI:10.1001/archinte.160.18.2729
• 23- Freitag FG, Diamond S, Diamond M, Urban G. Botulinum toxin type A in the prophylactic treatment of choronic migraine without mediacation overuse. Headache 2008; 48:201-209. DOI: 10.1111/j.1526-4610.2007.00963.x
• 24- Cernuda-Morollón E, Martínez-Camblor P, Ramón C, et al. (2014) CGRP and VIP levels as predictors of efficacy of onabotulinumtoxin type A in Chronic Migraine. Headache 54: 987–995. DOI:10.1111/head.12372
• 25- Khalil M, Zafar H, Quarshie V, Ahmed F. (2014) Prospective analysis of the use of OnabotulinumtoxinA (BOTOX) in the treatment of chronic migraine; real-life data in 254 patients from Hull, UK J Headache Pain 15: 54. DOI:10.1186/1129-2377-15-54
• 26- Russo M, Manzoni G, Taga A, et al. (2016) The use of onabotulinum toxin A (Botox®) in the treatment of chronic migraine at the Parma Headache Centre: a prospective observational study. Neurol Sci 37: 1127–113120-22. DOI:10.1007/s10072-016-2568-z
• 27- Aydınar EI, Yalınay Dikmen P, Sağduyu Kocaman A. Botulinum Toxin in Migraine Treatment Noropsikiyatri Arşivi 2013; 50 Ozel Sayı 1: 36-40. Doi: 10.4274/npa.y7198
• 28- Tsui J, Eisen A, Stoessl A, Calne S, Calne D. (1986) Double-blind study of botulinum toxin in spasmodic torticollis. Lancet 2: 245–247. DOI:10.1016/s0140-6736(86)92070-2
• 29- Mathew NT. The prophylactic treatment of chronic daily headache. Headache 2006; 46:1552-64. DOI:10.1111/j.1526-4610.2006.00621.x
• 30- Özturan A, Şanlıer N, Coşkun Ö. The Relationship Between Migraine and Nutrition. Turk J Neurol 2016;22:44-50. DOI:10.4274/tnd.37132