自下而上的方法:治疗偏头痛的非侵入性周围神经刺激方法:从儿童神经病学家的角度进行的范围综述。

The bottom-up approach: Non-invasive peripheral neurostimulation methods to treat migraine: A scoping review from the child neurologist's perspective.

机构信息

LMU Hospital, Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Munich, Germany.

Biomechanical and Neurophysiological Research Lab in neuro-musculo-skelettal Rehabilitation (BioNR Lab), Université du Québec à Chicoutimi, Chicoutimi, Canada.

出版信息

Eur J Paediatr Neurol. 2021 May;32:16-28. doi: 10.1016/j.ejpn.2021.02.008. Epub 2021 Mar 1.

Abstract

Migraine is a common and invalidating disorder worldwide. Patients of all ages experience the disorder as very impairing regarding their personal and occupational lives. The current approach in migraine therapy is multimodal including lifestyle management, psychoeducation and, if available, psychotherapeutic interventions, and pharmacotherapy. The lack of non-pharmacological and non-invasive treatment options call for new and innovative therapeutic approaches. Peripheral neurostimulation is a relatively new method in migraine management offering a painless and non-pharmacological way of targeting specific mechanisms involved in migraine. This review summarizes 15 recent randomized clinical trials to provide an overview of non-invasive peripheral neurostimulation methods currently available for the treatment of migraine. Efficacy, tolerability, and safety of the different interventions and their feasibility in the pediatric setting are evaluated. Vagal nerve stimulation (VNS), remote electrical neuromodulation (REN) and supraorbital nerve stimulation (SNS) are considered effective in treating acute migraine attacks, the latter being more pronounced in migraine without aura. Regarding migraine prevention, occipital nerve stimulation (ONS) and supraorbital nerve stimulation (SNS) demonstrated efficacy, whereas repetitive neuromuscular magnetic stimulation (rNMS) may represent a further effective option in episodic migraine. REN and rNMS were found to be well-accepted with fewer patients discontinuing treatment than those receiving direct cranial nerve stimulation. In summary, peripheral neurostimulation represents a promising option to complement the multimodal therapy concept for pediatric migraine. In particular, rNMS opens a new field for research and treatment fitting the requirements of "non-invasiveness" for children. Given the reported efficacy, safety, and feasibility, the therapy decision should be made on an individual level.

摘要

偏头痛是一种常见且使人丧失能力的疾病,全球范围内各年龄段的患者都深受其扰,其对个人生活和职业生活造成的损害都十分严重。偏头痛的治疗方法目前采用的是多模式治疗,包括生活方式管理、心理教育,如果可行,还包括心理治疗干预和药物治疗。由于缺乏非药物和非侵入性的治疗选择,因此需要新的创新治疗方法。周围神经刺激是偏头痛管理的一种相对较新的方法,它提供了一种无痛且非药物的方式来针对偏头痛中涉及的特定机制。这篇综述总结了 15 项最近的随机临床试验,为目前可用于偏头痛治疗的非侵入性周围神经刺激方法提供了概述。评估了不同干预措施的疗效、耐受性和安全性及其在儿科环境中的可行性。迷走神经刺激 (VNS)、远程电神经调节 (REN) 和眶上神经刺激 (SNS) 被认为在治疗急性偏头痛发作方面有效,后者在无先兆偏头痛中更为明显。关于偏头痛预防,枕神经刺激 (ONS) 和眶上神经刺激 (SNS) 显示出疗效,而重复神经肌肉磁刺激 (rNMS) 可能是发作性偏头痛的另一种有效选择。REN 和 rNMS 被认为是可接受的,与接受直接颅神经刺激的患者相比,停止治疗的患者较少。总之,周围神经刺激为补充儿科偏头痛的多模式治疗概念提供了一种很有前途的选择。特别是 rNMS 为研究和治疗开辟了一个新领域,符合儿童“非侵入性”的要求。鉴于报告的疗效、安全性和可行性,应根据个人情况做出治疗决策。

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