功能性神经障碍阳性症状与头痛严重程度的相关性:一项前瞻性横断面研究。

IF 2.4 4区 医学 Q2 CLINICAL NEUROLOGY
Eric Morel, Antonia Klein, Adrian Scutelnic, Janine Bühler, Selma Aybek, Christoph Schankin
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引用次数: 0

摘要

目的:阳性体征是不能用结构性神经病变解释的临床体征,被认为是功能性神经障碍(FND)的标志。在文献和临床经验中,在没有FND的患者中观察到阳性体征。本研究的目的是检验头痛患者中阳性体征的意义。方法:这项前瞻性研究的作者招募了瑞士伯尔尼大学医院Inselspital的头痛会诊患者。纳入标准为过去3个月头痛或面部疼痛,年龄≥18岁。排除标准为已知的FND诊断。所有患者均检查了14个经证实的阳性体征:退让性无力、共收缩、胸锁乳突肌征、斜方肌抬高试验、头屈曲试验、无旋前漂移、Hoover I和II、脊柱损伤试验、手臂下垂试验、拉唇征、中线分裂、前部振动分裂征、表达性行为征。结果:共纳入101例患者(69%为女性;平均±SD年龄=40.8±16.3岁),其中43%为阳性症状。振动分裂是最常见的症状(27%);其他征象较少(≤10%)。有阳性症状的患者比无此类症状的患者年龄更大,检查时每月头痛天数和加重次数更多,头痛强度更大。多变量logistic回归显示阳性体征与每月加重天数显著相关(OR=1.08, 95% CI=1.01-1.14,每加重天数;p = 0.019)。结论:阳性症状在头痛患者中是常见的,并指向更严重的头痛状况。这一发现提示头痛和FND的重叠机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Correlation of Positive Signs of Functional Neurological Disorder With Headache Severity: A Prospective Cross-Sectional Study.

Objective: Positive signs are clinical signs that are not explained by a structural neurological lesion and are considered the hallmark of functional neurological disorder (FND). In the literature and in clinical experience, positive signs are observed among patients without FND. The aim of the study was to examine the significance of positive signs among headache patients.

Methods: The authors of this prospective study recruited patients in headache consultation at the University Hospital Inselspital, Bern, Switzerland. Inclusion criteria were headache or facial pain in the past 3 months and age ≥18 years. The exclusion criterion was a known diagnosis of FND. All patients were examined for 14 validated positive signs: give-way weakness, co-contraction, sternocleidomastoid sign, trapezius elevation test, head flexion test, drift without pronation, Hoover I and II, spinal injury test, arm drop test, lip-pulling sign, midline splitting, splitting of vibration sign at the front, and expressive behavior sign.

Results: In total, 101 patients were recruited (69% female; mean±SD age=40.8±16.3 years), of whom 43% showed positive signs. Splitting of vibration was the most common sign (27%); the other signs were less frequent (≤10%). Patients with positive signs were older than patients without such signs and had more monthly headache days and exacerbations as well as more intense headache at examination. Multivariable logistic regression revealed a significant association between positive signs and exacerbation days per month (OR=1.08, 95% CI=1.01-1.14, per exacerbation day; p=0.019).

Conclusions: Positive signs are frequent among headache patients and point toward a more severe headache condition. This finding suggests overlapping mechanisms in headache and FND.

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来源期刊
CiteScore
5.30
自引率
3.40%
发文量
67
审稿时长
6-12 weeks
期刊介绍: As the official Journal of the American Neuropsychiatric Association, the premier North American organization of clinicians, scientists, and educators specializing in behavioral neurology & neuropsychiatry, neuropsychology, and the clinical neurosciences, the Journal of Neuropsychiatry and Clinical Neurosciences (JNCN) aims to publish works that advance the science of brain-behavior relationships, the care of persons and families affected by neurodevelopmental, acquired neurological, and neurodegenerative conditions, and education and training in behavioral neurology & neuropsychiatry. JNCN publishes peer-reviewed articles on the cognitive, emotional, and behavioral manifestations of neurological conditions, the structural and functional neuroanatomy of idiopathic psychiatric disorders, and the clinical and educational applications and public health implications of scientific advances in these areas. The Journal features systematic reviews and meta-analyses, narrative reviews, original research articles, scholarly considerations of treatment and educational challenges in behavioral neurology & neuropsychiatry, analyses and commentaries on advances and emerging trends in the field, international perspectives on neuropsychiatry, opinions and introspections, case reports that inform on the structural and functional bases of neuropsychiatric conditions, and classic pieces from the field’s rich history.
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