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三叉神经痛(第二部分):影响早期药物治疗效果的因素。

Trigeminal neuralgia (part II): Factors affecting early pharmacotherapeutic outcome.

作者信息

Benoliel R, Zini A, Khan J, Almoznino G, Sharav Y, Haviv Y

机构信息

Rutgers School of Dental Medicine, Rutgers State University of New Jersey, USA

Department of Community Dentistry, The Faculty of Dentistry, Hebrew University-Hadassah, Israel.

出版信息

Cephalalgia. 2016 Jul;36(8):747-59. doi: 10.1177/0333102415611406. Epub 2015 Oct 9.

Abstract

AIMS

We conducted a cohort study to examine demographic and clinical features associated with the pharmacotherapeutic outcome in classical trigeminal neuralgia (CTN) patients.

METHODS

Patients with a clinical profile indicating a diagnosis of CTN, as per the International Headache Society's published classification, were enrolled prospectively. Demographic and pain-related characteristics were carefully collected. For the purposes of the study, patients with features such as autonomic signs and longer attack duration were included. All patients were then initiated on a standardised and accepted stepped pharmacotherapeutic protocol for the management of CTN. Initial pain scores and prospectively collected pain scores from pain diaries were used to assess the treatment outcome, with a ≥50% reduction considered significant.

RESULTS

A total of 86 patients were seen, of whom five had an underlying disorder that could account for the pain. The study cohort therefore consisted of 81 patients, and based on attack duration these were divided into short (≤2 minutes, n = 61) and long (>2 minutes, n = 20) groups, for further analysis. The features of these patients and a discussion on the differential diagnosis have been presented in part 1 of this report. Employing an accepted stepped pharmacotherapeutic protocol for the management of CTN, significant improvement was more frequent in the short (74%) than in the long attack group (50%, p = 0.05). In the short attack group there were statistically significant associations between a poor treatment response and longer disease duration, the presence of autonomic signs and atypical pain descriptors for pain quality (p < 0.05).

CONCLUSION

This report supports previous findings that prolonged disease duration and autonomic signs are negative prognostic indicators. The present study now adds long attack duration as a further negative prognostic sign.

摘要

目的

我们进行了一项队列研究,以检查经典三叉神经痛(CTN)患者药物治疗结果相关的人口统计学和临床特征。

方法

根据国际头痛协会发布的分类标准,前瞻性纳入临床特征表明诊断为CTN的患者。仔细收集人口统计学和疼痛相关特征。为了本研究的目的,纳入具有自主神经体征和发作持续时间较长等特征的患者。然后所有患者开始采用标准化且被认可的阶梯式药物治疗方案来管理CTN。使用初始疼痛评分和从疼痛日记中前瞻性收集的疼痛评分来评估治疗结果,疼痛减轻≥50%被认为具有显著意义。

结果

共诊治了86例患者,其中5例有可解释疼痛的潜在疾病。因此,研究队列由81例患者组成,并根据发作持续时间将其分为短发作组(≤2分钟,n = 61)和长发作组(>2分钟,n = 20),以进行进一步分析。这些患者的特征以及关于鉴别诊断的讨论已在本报告的第1部分中呈现。采用公认的阶梯式药物治疗方案管理CTN,短发作组(74%)的显著改善比长发作组(50%,p = 0.05)更常见。在短发作组中,治疗反应不佳与病程较长、存在自主神经体征以及疼痛性质的非典型疼痛描述词之间存在统计学上的显著关联(p < 0.05)。

结论

本报告支持先前的研究结果,即病程延长和自主神经体征是不良预后指标。本研究现在增加了长发作持续时间作为另一个不良预后标志。

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