Cho Soohyun, Lee Mi Ji, Chung Chin-Sang
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Neuroscience Center, Samsung Medical Center, Seoul, South Korea.
Front Neurol. 2019 Jun 18;10:644. doi: 10.3389/fneur.2019.00644. eCollection 2019.
In reversible cerebral vasoconstriction syndrome (RCVS), nimodipine is currently used for the treatment, although no evidence is available to support its disease-modifying effect. In this prospective observational study, we investigated whether earlier nimodipine treatment can modify the clinical course of reversible cerebral vasoconstriction syndrome. We prospectively observed patients with angiogram-proven RCVS within 1 month after onset in the Samsung Medical Center between October 2015 and January 2018. Nimodipine was started in all patients immediately after diagnosis. Time from onset to the first nimodipine treatment was categorized as tertiles. We analyzed Kaplan-Meier curve and Cox proportional hazard model to test if the timing of nimodipine treatment can affect the clinical course of thunderclap headaches (TCHs) defined as the duration from onset to remission of thunderclap headaches. In 82 patients included in this study, 71 (86.6%) patients showed remission of TCHs after starting nimodipine treatment. When categorized into earliest (<6 days), early (6-13 days), and late (≥14 days) treatment groups, earlier treatment was significantly associated with shorter clinical courses (median, 2 days [interquartile range 1-3] vs. 7 days [4-10] vs. 10 days [5-15]; log-rank < 0.001). Univariable and multivariable Cox regression analyses also demonstrated an independent effect of earlier nimodipine treatment on earlier remission of TCHs (adjusted hazard ratio, 0.75 per 1-day delay in treatment; 95% CI, 0.693-0.802, < 0.001). The clinical course of RCVS differed according to the timing of nimodipine treatment, suggesting the effect of earlier nimodipine treatment. In addition to preventing TCHs, beneficial effects of earlier nimodipine treatment on the progression of vasoconstriction and development of neurological complications should be investigated in future studies.
在可逆性脑血管收缩综合征（RCVS）中，目前使用尼莫地平进行治疗，尽管尚无证据支持其改善病情的效果。在这项前瞻性观察研究中，我们调查了早期使用尼莫地平治疗是否能改变可逆性脑血管收缩综合征的临床病程。我们对2015年10月至2018年1月期间在三星医疗中心发病1个月内血管造影证实为RCVS的患者进行了前瞻性观察。所有患者在诊断后立即开始使用尼莫地平。从发病到首次使用尼莫地平治疗的时间分为三分位数。我们分析了Kaplan-Meier曲线和Cox比例风险模型，以检验尼莫地平治疗的时机是否会影响霹雳样头痛（TCHs）的临床病程，TCHs定义为从发病到缓解的持续时间。在本研究纳入的82例患者中，71例（86.6%）患者在开始使用尼莫地平治疗后TCHs缓解。当分为最早（<6天）、早期（6-13天）和晚期（≥14天）治疗组时，早期治疗与较短的临床病程显著相关（中位数，2天[四分位间距1-3]对7天[4-10]对10天[5-15]；对数秩<0.001）。单变量和多变量Cox回归分析也表明，早期使用尼莫地平治疗对TCHs的早期缓解具有独立作用（调整后的风险比，治疗延迟1天为0.75；95%CI，0.693-0.802，<0.001）。RCVS的临床病程因尼莫地平治疗的时机而异，提示早期使用尼莫地平治疗的效果。除了预防TCHs外，早期使用尼莫地平治疗对血管收缩进展和神经并发症发生的有益作用应在未来研究中进行调查。
