Vicente González-Quintanilla, Stefan Evers, Julio Pascual
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引用次数: 0
摘要
乙酰胆碱是一种强效的肌肉收缩抑制剂,通过阻止乙酰胆碱在神经肌肉接头处的释放而发挥作用。在偏头痛等疼痛状态下,其作用机制尚未完全阐明,可能与三叉神经系统内的中枢和外周敏化现象有关。偏头痛是一种常见的致残性疾病,尤其是其变异型慢性偏头痛(CM)与相关症状和社会经济负担有关,预防性治疗的目的是减少偏头痛发作的频率、持续时间或严重程度。通过肌肉注射给药的奥那巴妥妥毒素A已被批准用于预防偏头痛,是偏头痛预防治疗中使用最多的药物之一,也是临床实践的基础。PREEMPT1和PREEMPT2研究验证了奥那保妥适在治疗CM方面的有效性和安全性,随后进行的COMPEL、REPOSE和CM PASS等真实世界研究也证实了这一点。奥那保妥适不仅能减少头痛天数,还能改善患者的功能和生活质量,从而减轻偏头痛的影响。本文回顾并讨论了有关其病理生理学、疗效及其在 CGRP 单克隆抗体时代的 CM 治疗中的地位的数据。
OnabotulinumtoxinA: Discussion of the evidence for effectiveness of OnabotulinumA and its place in chronic migraine treatment.
OnabotulinumtoxinA is a potent inhibitor of muscle contraction that acts by preventing the release of acetylcholine at the neuromuscular junction. In pain states such as migraine, its mechanism of action is not yet fully elucidated and probably relates to the phenomena of central and peripheral sensitization within the trigeminal system. Migraine is a prevalent and disabling disorder and, especially in its variant of chronic migraine (CM), is associated with relevant symptomatic and socioeconomic burden, the objective of preventive treatment being to reduce the frequency, duration, or severity of migraine attacks. OnabotulinumtoxinA, administered by intramuscular injection, is approved for the prevention of CM and is among the most utilized preventive treatments in CM and fundamental to clinical practice. The efficacy and safety of OnabotulinumtoxinA in the treatment of CM have been verified by the PREEMPT 1 and 2 studies and confirmed by the real-world studies that followed, including the COMPEL, REPOSE, and CM PASS. OnabotulinumtoxinA not only reduces headache days but also leads to improvement in functioning and quality of life, thereby reducing migraine impact. Data about its pathophysiology, efficacy, and its place in CM treatment in the era of CGRP monoclonal antibodies are reviewed and discussed here.
期刊介绍:
The Handbook of Clinical Neurology (HCN) was originally conceived and edited by Pierre Vinken and George Bruyn as a prestigious, multivolume reference work that would cover all the disorders encountered by clinicians and researchers engaged in neurology and allied fields. The first series of the Handbook (Volumes 1-44) was published between 1968 and 1982 and was followed by a second series (Volumes 45-78), guided by the same editors, which concluded in 2002. By that time, the Handbook had come to represent one of the largest scientific works ever published. In 2002, Professors Michael J. Aminoff, François Boller, and Dick F. Swaab took on the responsibility of supervising the third (current) series, the first volumes of which published in 2003. They have designed this series to encompass both clinical neurology and also the basic and clinical neurosciences that are its underpinning. Given the enormity and complexity of the accumulating literature, it is almost impossible to keep abreast of developments in the field, thus providing the raison d''être for the series. The series will thus appeal to clinicians and investigators alike, providing to each an added dimension. Now, more than 140 volumes after it began, the Handbook of Clinical Neurology series has an unparalleled reputation for providing the latest information on fundamental research on the operation of the nervous system in health and disease, comprehensive clinical information on neurological and related disorders, and up-to-date treatment protocols.