托吡酯片对偏头痛患者脑血管病变和神经元放电的影响分析

目的:探讨托吡酯片治疗偏头痛对脑血管病变及神经元放电的影响分析.方法:回顾2015年4月～2017年4月就诊的82例偏头痛病例,根据治疗方式不同分组分析,对照组使用普萘洛尔,观察组给予托吡酯片治疗,比较两组治疗前后头痛发作频率、每次发作持续时间及疼痛(VAS)评分,观察治疗后脑电图变化以及治疗前后脑部动脉血流变化,对比治疗后不良反应.结果:与治疗前相比,两组治疗后疼痛持续时间、发作率及疼痛评分均明显下降(P<0.05);与对照组相比,治疗后观察组疗效更为显著(P<0.05).观察组用药后脑电图变化情况明显优于对照组(P<0.05).与治疗前相比,观察组于治疗后大脑各部位血流情况明显改善(P<0.05),但对照组于治疗后大脑各部位血流情况无明显改善(P>0.05),无统计学意义;与对照组相比,治疗后观察组大脑各部位动脉血流变化更为明显(P<0.05).讨论:偏头痛采用托吡酯片进行治疗,有效改善脑动脉血流速度,调节神经元放电,缓解疼痛,降低发病率及发作时间.     

托吡酯治疗偏头痛的临床疗效及其对脑血管病变和神经元放电的影响

目的 分析托吡酯治疗偏头痛的临床效果及其对脑血管病变和神经元放电的影响.方法 选取本院2012年3月至2014年7月收治的100例偏头痛患者作为研究对象,根据随机原则分成对照组和试验组.对照组普萘洛尔治疗,试验组托吡酯治疗.对比两组脑电图改善率、血流速度异常发生率,并对治疗后发作频率、发作持续时间和头痛等级的差异性进行对比.结果 与对照组相比,试验组脑电图改善率明显更高,数据间经x 2检验,差异有统计学意义(P＜0.05).试验组治疗后发作频率、发作持续时间和头痛等级明显优于对照组,数据间经f检验,差异统计学意义(P＜0.05).两组血流速度异常发生率差异有统计学意义(P＜0.05).结论 托吡酯治疗偏头痛的临床效果确切,可改善患者临床症状,减少发作频率和时间,改善脑血管病变和神经元放电情况,值得推广.     

探讨托吡酯治疗偏头痛的临床疗效及对患者脑血管病变与神经元放电指标的影响

目的研究对偏头痛患者进行托吡酯治疗的效果,以及对患者脑血管病变与神经元放电指标的影响。方法选取2018年3月至2019年3月到我院就诊的偏头痛患者50例,采用随机分为实验组和对照组各25例。对照组患者行常规药物治疗,实验组患者行托吡酯治疗,对比两组患者的治疗有效率以及脑电图和脑白质变性情况。结果实验组患者治疗效果明显优于对照组,且患者脑电图改善情况要优于对照组,差异显著P<0.05,存在统计学意义。结论对偏头痛患者进行托吡酯治疗的效果明显,对于脑血管无明显的不良影响,优化了患者脑电图异常放电,具体临床应用的价值。     

托吡酯预防性治疗偏头痛的临床疗效观察

目的观察托吡酯预防性治疗偏头痛的临床疗效,为偏头痛患者提供有效预防方法。方法以2010年9月至2012年9月我院收治的118例偏头痛患者为研究对象,随机分为治疗组和对照组;观察组采用托吡酯治疗,对照组采用安慰剂治疗,对比两组患者1年后的效果。结果从12个月后的随访发现,观察组疗效优于对照组,其中观察组优42例,良11例,优良率为76.81%;对照组优26例,良7例,优良率为47.83%,P〈0.05,差异具有统计学意义。结论托吡酯预防性治疗偏头痛有着良好疗效。     

托吡酯治疗慢性偏头痛的临床疗效观察

目的观察托吡酯治疗慢性偏头痛的临床疗效。方法选取我院2009年10月至2013年2月诊治的慢性偏头痛患者120例,随机分为两组,每组60例,治疗组予托吡酯治疗,对照组予氟桂利嗪治疗,治疗3个月,统计两组的治疗总有效率。结果两组的总有效率分别为78.33%和70.00%。托吡酯治疗组优于氟桂利嗪治疗组(P<0.05)。结论托吡酯治疗慢性偏头痛安全有效。     

川芎清脑颗粒联合托吡酯治疗偏头痛的疗效观察

目的探讨川芎清脑颗粒联合托吡酯片治疗偏头痛的临床疗效。方法选取2016年5月—2018年5月重庆市梁平区人民医院收治的182例偏头痛患者作为研究对象,随机将患者分为对照组和治疗组,每组各91例。对照组口服托吡酯片,25 mg/d,维持1周;第2周25 mg/次,2次/d;第3周早上25 mg,晚上50 mg;第4周50 mg/次,2次/d。治疗组在对照组治疗的基础上冲服川芎清脑颗粒,10 g/次,3次/d。两组患者均连续治疗8周。观察两组患者的临床疗效,比较两组治疗前后的临床症状改善情况、神经元放电情况和血液流变学指标。结果治疗后,对照组和治疗组的总有效率分别为76.9%、95.6%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者偏头痛发作频率和持续时间均明显下降(P0.05);治疗后,治疗组发作频率、持续时间均显著短于对照组(P0.05)。治疗后,治疗组α波频率变慢、δ波增多和θ波增多比例均显著高于对照组(P0.05)。治疗后,两组患者血浆黏度(PV)、全血高切黏度(WBHSV)、全血低切黏度(WBLSV)、红细胞压积(HCT)和纤维蛋白原(FIB)水平均明显下降(P0.05);治疗后,治疗组血液流变学指标均显著低于对照组(P0.05)。结论川芎清脑颗粒联合托吡酯片治疗偏头痛具有较好的临床疗效,可有效改善患者的神经元放电和血液流变学指标,具有一定的临床推广应用价值。     

托吡酯预防治疗偏头痛的研究进展

偏头痛是神经内科门、急诊的常见症状之一。循证医学表明 ,一些抗癫药物在偏头痛的预防用药方面具有一定的疗效。托吡酯是一种新的抗癫药物 ,两项新近的多中心、有安慰药对照、随机、大样本临床试验报道 ,托吡酯 10 0和 2 0 0mg·d 1 作为偏头痛的预防用药是有效的。托吡酯可减少偏头痛的发作频度、持续时间 ,偏头痛急性发作时使用托吡酯的有效率优于使用安慰药 ,并且患者对该药有良好的耐受性。     

托吡酯对原代培养海马神经元癫痫样放电的抑制效应

目的:探讨托吡酯对原代培养海马神经元癫痫样放电的抑制作用及其特点。方法:分离原代培养 1日龄SD大鼠海马神经元,d9~15采用膜片钳全细胞模式记录托吡酯 ( 20, 100μmol·L-1 )和苯妥英 (10μmol·L-1 )对电流刺激及谷氨酸诱导神经元癫痫样放电的抑制效应。结果:苯妥英(10μmol·L-1 )、托吡酯(20, 100μmol·L-1 )抑制电流刺激诱导神经元动作电位,分别减少 100 %,(38±25) %和 ( 70±19 ) %。苯妥英 ( 10μmol·L-1 )及托吡酯(100μmol·L-1 )分别完全或部分抑制谷氨酸诱导海马神经元的癫痫样放电。结论:托吡酯抑制原代培养海马神经元的癫痫样放电,并与其浓度及作用时间有关。     

托吡酯治疗普通型偏头痛62例

目的：探讨托吡酯治疗普通型偏头痛的临床效果。方法：将普通型偏头痛患者124例随机分成治疗组和对照组各62例。治疗组给予托吡酯25mg，bid；对照组给予氟桂利嗪10mg，qd。治疗8周，随防6个月。结果：治疗组60例完成治疗，对照组57例完成治疗，治疗组头痛指数及1个月内头痛总天数都比对照组有显著降低。结论：托吡酯治疗普通型偏头痛疗效较好。     

托吡酯预防性治疗偏头痛的临床疗效观察

目的：评价托吡酯预防性治疗偏头痛的远期疗效。方法：96例偏头痛患者双盲随机分为治疗组与对照组，分别予托吡酯和安慰剂治疗3个月，随访观察治疗前及治疗后1年内2组患者偏头痛发作变化。结果：治疗组头痛发作频率、头痛发作天数、头痛发作严重程度减少明显，2组比较差异有显著性（P〈0．01）。结论：托吡酯预防性治疗偏头痛的疗效明显优于安慰剂，且远期疗效仍然达50％。     

Clinical pharmacology of topiramate in migraine prevention

INTRODUCTION: Migraine is a widespread disorder. Migraine patients experience worse health-related quality of life than the general population. The availability of effective and tolerable treatments for this disorder is an important medical need. This narrative review focuses on the clinical pharmacology of topiramate, an antiepileptic drug that was approved for the prophylaxis of migraine where it should act as a neuromodulator. AREAS COVERED: A PubMed database search (from 2000 to 24 January 2011) and a review of the human studies published on topiramate and migraine was conducted. EXPERT OPINION: Topiramate is an important option for the prophylaxis of migraine and is of proven efficacy and tolerability. It has also been studied in chronic migraine with encouraging results, even in patients with medication overuse. However, in migraine prevention its efficacy is comparable to the other first-line drugs and there are no published trials with a superiority design which can establish topiramate's role in the available therapeutic armamentarium.     

Effect of topiramate on choroidal thickness and anterior chamber parameters in the treatment of patients with migraine

Objective: To investigate the effects of topiramate on choroidal thickness and anterior chamber parameters using optical coherence tomography in the treatment of patients with migraine.

Methods: A total of 22 eyes of 22 adults (12 females, 10 males) diagnosed with migraine and scheduled to topiramate treatment for pain control were recruited in this prospective study. Choroidal thickness (CT), anterior chamber depth (ACD), anterior chamber angle (ACA), spherical refractive equivalent (SphEq) and intraocular pressure (IOP) measurements were recorded at baseline (prior the topiramate therapy), first and second month visits for the statistical analysis. One-way ANOVA with repeated measures test was used for the statistical evaluation.

Results: Mean age of the patients was 40.2?±?6.5?years. Mean CT at central fovea was 324?±?47?μm initially, 341?±?45?μm in the first month and 344?±?46?μm in the second month, thus first and second month measures were significantly higher than base values (p?p?=?0.001). Baseline ACD (3.66?±?0.22?mm) measures significantly decreased at the first month (3.63?±?0.22?mm) and second month (3.62?±?0.22?mm, p?=?0.009). Also, a significant reduction was detected in the first (36.2?±?4.9°) and second month (35.9?±?5.1°) ACA measures comparing with baseline (39.1?±?5.1°, p?=?0.05). A significant myopic shift was determined in the first and second month SphEq values (?0.08?±?0.6, ?0.10?±?0.6, respectively, p?=?0.05).

Conclusions: The study revealed increased CT and altered anterior chamber parameters and IOP due to topiramate therapy. Therefore, the patients using topiramate should be carefully monitored by an ophthalmologist considering the possible side effects.     

染料木黄酮对大鼠下丘脑脑片室旁核神经元放电的影响(英文)

目的研究染料木黄酮(GST)在心血管中枢神经系统的作用。方法应用细胞外记录单位放电技术,在下丘脑脑片上观察GST对静息状态下的室旁核神经元放电的影响。结果①26个脑片分别灌流GST 10,50,100μmol·L~(-1)2 min,有25个脑片放电频率明显降低,且呈浓度依赖性;②用0.2 mmol·L~(-1) L-谷氨酸灌流脑片,7/7个脑片放电频率明显增加,表现为癫痫样放电,在此基础上加灌GST 50μmol·L~(-1)2 min,其癫痫样放电被抑制;③用G蛋白激活的内向整流型钾通道阻断剂四乙胺1 mmol·L~(-1)灌流脑片,约10 min后加入GST 50μmol·L~(-1),8/8个脑片的放电抑制效应被完全阻断;④用一氧化氮合酶抑制剂左旋硝基精氨酸甲酯50μmol·L~(-1)灌流脑片,7/7个脑片的放电频率增加,在此基础上加灌GST 50μmol·L~(-1)2 min,放电被抑制。结论GST可抑制下丘脑室旁核神经元自发放电,并抑制L-谷氨酸诱发的神经元癫痫样放电。这种抑制作用可能与激活G蛋白激活的内向整流型钾通道,促进K~+外流,从而引起细胞膜超极化有关;而与NO释放无关。GST可能通过降低心血管中枢的活动性而产生一定的心血管系统保护作用。     

New drugs for the prevention and treatment of migraine: topiramate and BIBN 4096 BS

Migraine is one of the leading causes of disability. Topiramate has multiple mechanisms and may reduce neurotransmission through the trigeminocervical complex to prevent migraine. In clinical trials for the prevention of migraine, the mean monthly migraine frequency decreased from 5.6 to 4.5 in the placebo group and larger decreases were observed with topiramate (100 mg/day, 5.8 to 3.5; 200 mg/day, 5.1 to 3.0). However, topiramate use is associated with a high incidence of adverse events (paraesthesia, fatigue, anorexia, diarrhoea), which may limit the willingness of patients to use topiramate for the prevention of migraine. BIBN 4096 BS is a non-peptide calcitonin gene-related peptide-receptor antagonist that has recently been trialled in migraine attacks. The primary efficacy end point was the reduction of severe or moderate headache prior to treatment to mild or no headache at 2 h. This endpoint was achieved in 21 of 32 (66%) patients with BIBN 4096 BS 2.5 mg, compared to 27% of patients given placebo. Although BIBN 4096 BS is a non-peptide, it is still administered intravenously, which will probably limit its use to medical centres.     

New drugs for the prevention and treatment of migraine: topiramate and BIBN 4096 BS

Migraine is one of the leading causes of disability. Topiramate has multiple mechanisms and may reduce neurotransmission through the trigeminocervical complex to prevent migraine. In clinical trials for the prevention of migraine, the mean monthly migraine frequency decreased from 5.6 to 4.5 in the placebo group and larger decreases were observed with topiramate (100 mg/day, 5.8 to 3.5; 200 mg/day, 5.1 to 3.0). However, topiramate use is associated with a high incidence of adverse events (paraesthesia, fatigue, anorexia, diarrhoea), which may limit the willingness of patients to use topiramate for the prevention of migraine. BIBN 4096 BS is a non-peptide calcitonin gene-related peptide-receptor antagonist that has recently been trialled in migraine attacks. The primary efficacy end point was the reduction of severe or moderate headache prior to treatment to mild or no headache at 2 h. This endpoint was achieved in 21 of 32 (66%) patients with BIBN 4096 BS 2.5 mg, compared to 27% of patients given placebo. Although BIBN 4096 BS is a non-peptide, it is still administered intravenously, which will probably limit its use to medical centres.     

维拉帕米缓释片与普萘洛尔防治偏头痛的比较

目的：比较维拉帕米缓释片与普萘洛尔对偏头痛的防治效果。方法：治疗组２６例（男性８例，女性１８例，年龄３３±ｓ５ａ），采用维拉帕米缓释片１２０ｍｇ，ｐｏ，ｑｄ，治疗６ｍｏ。对照组２６例（男性９例，女性１７例，年龄３３±７ａ），采用普萘洛尔片１０ｍｇ，ｐｏ，ｔｉｄ，递增至３０ｍｇ，ｔｉｄ，治疗６ｍｏ。结果：治疗组总有效率９２％，对照组总有效率６９％，经Ｒｉｄｉｔ分析统计，Ｐ＜０．０５。结论：维拉帕米缓释片防治偏头痛疗效优于普萘洛尔，不良反应轻微。