Brighina Filippo, Palermo Antonio, Aloisio Antonina, Francolini Margherita, Giglia Giuseppe, Fierro Brigida
Neurophysiology Unit, Department of Neurology, University of Palermo, Palermo, Italy.
Clin Neuropharmacol. 2006 Nov-Dec;29(6):338-42. doi: 10.1097/01.WNF.0000236766.08409.03.
To evaluate the efficacy of levetiracetam as prophylactic treatment for migraine with aura with high frequency of attacks.
Migraine with aura with high frequency of attacks could represent a very demanding therapeutic problem. Efficacy of the antiepileptic drug, lamotrigine, has been reported in this form of migraine. Levetiracetam is a new antiepileptic drug with an excellent tolerability profile. Mechanisms of action of this drug remain largely unknown, but recently, it has been shown to exert inhibitory effects on neuronal-type calcium channels.
We performed a small open-label trial treating 16 patients affected by migraine with aura with high frequency of attacks. After a 1-month run-in period, patients were treated with levetiracetam at a dosage of 1000 mg/d for 6 months.
The number of attacks per month was significantly reduced during the first month (compared with run-in; P < 0.001), and it was reduced further during the second (second month vs first month; P < 0.001) and the third months (third month vs second month; P < 0.001) of the treatment. This improvement persisted unchanged for the remaining 3 months of treatment. In 7 (44%) of the 16 patients, the attacks were completely abolished after 3 months of treatment. Severity of headache and duration of headache and aura were also significantly reduced at the third and sixth months of treatment (P < 0.001). Levetiracetam was well tolerated (6 patients complained of slight dizziness, nervousness, and somnolence).
Levetiracetam seems to be a safe and effective treatment for migraine with aura. Controlled trials are needed to confirm the observed results.
评估左乙拉西坦作为预防性治疗发作频繁的伴有先兆偏头痛的疗效。
发作频繁的伴有先兆偏头痛可能是一个极具挑战性的治疗难题。抗癫痫药物拉莫三嗪对这种类型的偏头痛的疗效已有报道。左乙拉西坦是一种耐受性良好的新型抗癫痫药物。该药物的作用机制在很大程度上仍不清楚，但最近已表明它对神经元型钙通道有抑制作用。
我们进行了一项小型开放标签试验，治疗16例发作频繁的伴有先兆偏头痛患者。经过1个月的导入期后，患者接受左乙拉西坦治疗，剂量为1000mg/d，持续6个月。
在治疗的第一个月，每月发作次数显著减少（与导入期相比；P<0.001），在第二个月（第二个月与第一个月相比；P<0.001）和第三个月（第三个月与第二个月相比；P<0.001）进一步减少。这种改善在治疗的其余3个月中持续不变。在16例患者中的7例（44%），治疗3个月后发作完全消失。在治疗的第三个月和第六个月，头痛的严重程度、头痛和先兆的持续时间也显著降低（P<0.001）。左乙拉西坦耐受性良好（6例患者抱怨有轻微头晕、紧张和嗜睡）。
左乙拉西坦似乎是治疗伴有先兆偏头痛的一种安全有效的方法。需要进行对照试验来证实观察到的结果。
