Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.
IRCCS Neuromed, Pozzilli, IS, Italy.
Neurol Sci. 2019 May;40(5):963-969. doi: 10.1007/s10072-019-03735-4. Epub 2019 Feb 1.
To study the effects of a standard acute medication withdrawal program on short-term cortical plasticity mechanisms in patients with medication overuse headache (MOH).
Thirteen patients with MOH and 16 healthy volunteers underwent repetitive transcranial magnetic stimulation (rTMS) over the left motor cortex; in patients with MOH, recordings were performed before and after a 3-week medication withdrawal program. Ten trains of 10 stimuli each (120% resting motor threshold) were delivered at 1 Hz or 5 Hz in two separate sessions in a randomised order. Motor evoked potential (MEP) amplitudes were measured from the right first dorsal interosseous muscle and the slope of the linear regression line from the first to the tenth stimuli was calculated for each participant.
All subjects exhibited MEP amplitude inhibition in response to 1 Hz rTMS. Alternatively, the 5-Hz trains of rTMS inhibited rather than potentiated MEP amplitudes in patients with MOH. The physiological potentiating effect of 5 Hz rTMS on MEP amplitudes was restored after drug withdrawal and in proportion with the percentage reduction in monthly headache days in patients with MOH.
The results suggest that acute medication withdrawal normalises brain responses in patients with MOH. Clinical improvements after medication withdrawal may reflect the reversal of neurophysiological dysfunction. Accordingly, medication withdrawal should be offered to patients with MOH as early as possible in order to prevent the development of more pronounced alterations in brain plasticity.
研究标准急性药物戒断方案对药物过度使用性头痛（MOH）患者短期皮质可塑性机制的影响。
13 例 MOH 患者和 16 名健康志愿者接受左运动皮质重复经颅磁刺激（rTMS）；在 MOH 患者中，在 3 周药物戒断方案前后进行记录。在两个单独的会话中，以随机顺序分别以 1Hz 或 5Hz 施加 10 个刺激的 10 个训练（120％静息运动阈值）。从右第一背侧间骨肌测量运动诱发电位（MEP）幅度，并为每个参与者计算从第一个到第十个刺激的线性回归线的斜率。
所有受试者在 1Hz rTMS 刺激下均表现出 MEP 幅度抑制。相反，5Hz rTMS 刺激在 MOH 患者中抑制而不是增强 MEP 幅度。在药物戒断后，5Hz rTMS 对 MEP 幅度的生理增强作用得以恢复，并且与 MOH 患者每月头痛天数的百分比降低成正比。
结果表明，急性药物戒断可使 MOH 患者的大脑反应正常化。药物戒断后的临床改善可能反映了神经生理功能障碍的逆转。因此，应尽早为 MOH 患者提供药物戒断治疗，以防止大脑可塑性发生更明显的改变。
