Untersuchung der Wirkung einer prophylaktischen Therapie der episodischen Migräne mit CGRP-/Rezeptor-Antikörpern auf die dysfunktionelle Schmerzverarbeitung im Hirnstamm

Media type: E-Book; Thesis

Title: Untersuchung der Wirkung einer prophylaktischen Therapie der episodischen Migräne mit CGRP-/Rezeptor-Antikörpern auf die dysfunktionelle Schmerzverarbeitung im Hirnstamm

Contributor: Thiele, Anne [VerfasserIn]; Flöel, Agnes [AkademischeR BetreuerIn]; Holle-Lee, Dagny [AkademischeR BetreuerIn]

Corporation: Universität Greifswald

imprint: Greifswald, 2022

Extent: 1 Online-Ressource (PDF-Datei: 58 Seiten, 6971 Kilobyte); Diagramme (teilweise farbig)

Language: German; English

Identifier:

Keywords: Migräne > Kopfschmerz > Hirnstamm > Elektrophysiologie > Reizverarbeitung > Calcitonin gene-related peptide > Antikörper

Origination:

University thesis: Dissertation, Universitätsmedizin der Universität Greifswald, 2024

Footnote: Literaturverzeichnis: Seite 27-28. - Literaturangaben
Text deutsch, Publikationen englisch

Description: Migräne, Kopfschmerz, Hirnstamm, Elektrophysiologie, Reizverarbeitung, Antikörper, CGRP

Background: Migraine is a highly prevalent neurological disease, which causes severe headache for the affected patients and interferes with their social and work life. Therapy consists of acute treatment of the pain and a prophylactical treatment, which should reduce the headache frequency and severity. Antibodies against the calcitonin-gene-related peptide (CGRP) and his receptor are therefore the first pharmaceuticals, which were specifically developed for this purpose. This raises the question, if CGRP-antibodies are solely a symptomatic therapy acting in the periphery of the trigemino-vascular system or if they interfere with the underlying central nervous pathomechanisms of the disease and are therefore disease-modifying. This study aims to weigh the null hypothesis of a symptomatic therapy against the alternative hypothesis of central disease modifying activity by examining the nociceptive blink reflex on patients suffering from episodic migraine before and after the treatment with CGRP-antibodies. Methods: 22 patients with episodic migraine (21 female, 46.2 ± 13.8 years old) and 22 age and gender matched controls were examined for this prospective observational study. The patients were given a questionnaire to examine demographic as well as the headache characteristics. For the investigation they underwent an analysis of the supraorbital blink reflex (10 blocks à 6 stimuli) prior and 3 months after the application of CGRP-antibodies (controls were examined once). Therefore, painful stimuli were applied, which allowed to investigate the central excitability of the brain stem as an essential mechanism of the underlying pathophysiology of migraine. The area-under-the-curve (AUC), calculated from the R2 component of the summarized muscle action potential and the habituation (regression coefficient over the blocks) for the stimulated and non-stimulated site for ten blocks were analysed as the primary endpoint. Results: All patients showed a significant reduction of headaches days per month (V0: 12.4±3.3, V3: 6.6 ± 4.9) after the beginning of a treatment with CGRP-antibodies. The AUC was significantly reduced in the blocks one, two and eight on the stimulated site (Fglobal=5.86, p<0.001; block 1: R2a_s: -28%, p<0.001) and in the blocks one, two, three, eight and ten on the non-stimulated site (Fglobal=8.22, p<0.001, block 1: R2a_ns: -22%, p=0.003). The change in habituation was significant in the blocks six, seven, eight and ten on the non-stimulated site (Fglobal=3.07, p<0.001; block 6: R2h_ns: r=-1.36, p=0.007). None of the parameters could be used as a baseline predictor for the treatment response (binary logistic regression; all predictors p>0.05). Discussion & Summary: The findings of this study show that a three-month therapy with CGRP-antibodies restores the brain stem excitability as an answer to repeated painful stimuli in patients with episodic migraine and provide evidence for a disease-modifying potential. The changes of the habituation correlated with a lower headache frequency; however, further studies should evaluate if the blink reflex can be used as a predictor for the treatment response and the risk of relapse after the treatment cessation.

Access State: Open Access

Search in field:

Recently searched for: