The efficacy of topiramate and flunarizine hydrochloride for prophylactic treatment of vestibular migraine
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摘要: 目的 探讨托吡酯、盐酸氟桂利嗪预防性治疗前庭性偏头痛(VM)的疗效和安全性。方法 回顾2020年8月—2021年4月接受神经内科眩晕门诊治疗的47例确诊或可能的VM患者，最终纳入42例，分为托吡酯组22例和盐酸氟桂利嗪组20例。两组分别给予托吡酯50 mg/d和盐酸氟桂利嗪10 mg/d治疗，比较治疗前和治疗后3个月VM患者的眩晕强度视觉模拟量表、眩晕持续时间、眩晕频率、眩晕残障程度评定量表(DHI)评分。记录焦虑症筛查量表(GAD-7)、抑郁症筛查量表(PHQ-9)评分以评估患者焦虑、抑郁情绪的改善情况，并评估不良事件的发生。结果 托吡酯和盐酸氟桂利嗪可以有效地减少VM患者的眩晕强度、眩晕持续时间、眩晕频率(P < 0.05)，同时DHI总评分、DHI-P、DHI-E、DHI-F、PHQ-9、GAD-7均有显著下降(P < 0.05)。且托吡酯在减少眩晕强度、眩晕持续时间、眩晕频率、DHI-P、DHI-F优于盐酸氟桂利嗪，而两种药物在改善患者情绪方面无显著差异(P>0.05)。两组均未报告严重的不良事件。结论 托吡酯和盐酸氟桂利嗪对VM的预防安全有效，且托吡酯50 mg/d优于盐酸氟桂利嗪10 mg/d治疗。两种药物在情绪改善方面无明显差异。Abstract: Objective To evaluate the efficacy and safety of topiramate and flunarizine hydrochloride in the prophylactic treatment of vestibular migraine prophylaxis.Methods 47 patients with confirmed or probable vestibular migraine(VM) treated at the vertigo clinic of our neurology department from August 2020 to April 2021 were reviewed, and 42 patients were finally included. They were divided into topiramate group (n=22) and flunarizine hydrochloride group (n=20). The two groups were treated with topiramate 50 mg daily and flunarizine hydrochloride 10 mg daily, respectively. The visual analogue scale, vertigo duration, vertigo frequency, and Dizziness Handicap Inventory (DHI) scores of patients with VM before and 3 months after treatment were compared. The anxiety screening scale (GAD-7) and depression screening scale (PHQ-9) were recorded to assess the improvement of patients' anxiety and depression, and the occurrence of adverse events.Results Topiramate and flunarizine hydrochloride effectively reduced vertigo intensity, vertigo duration, and vertigo frequency in VM patients (P < 0.05). Meanwhile, total DHI score, DHI physical (DHI-P), DHI emotional (DHI-E), DHI functional (DHI-F), PHQ-9 and GAD-7 were significantly decreased(P < 0.05). Furthermore, topiramate was superior to flunarizine hydrochloride in reducing vertigo intensity, vertigo duration, vertigo frequency, DHI-P, and DHI-F, while there was no significant difference between two drugs in improving patients' mood(P>0.05). No serious adverse events were reported in either group.Conclusion This study suggests that topiramate and flunarizine hydrochloride are safe and effective in the prevention of VM, and the daily dose of topiramate 50 mg is superior to the daily dose of flunarizine hydrochloride 10 mg. However, there was no significant difference between the two drugs in terms of mood improvement.
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Key words:
- vestibular migraine /
- prophylactic treatment /
- topiramate /
- flunarizine hydrochloride
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表 1 纳入的47例VM患者的临床特征
临床特征 例数(%) 临床特征 例数(%) 眩晕症状 耳蜗症状 自发性眩晕 40(85.1) 耳鸣 16(34.0) 位置性眩晕 23(48.9) 耳胀满感 10(21.3) 伴随症状 主观性听力损失 17(36.2) 头晕 43(91.5) 诱发因素 振动幻视 2(4.3) 曾在月经期 16(34.0) 头运动诱发的头晕/眩晕 41(87.2) 睡眠不规律 25(53.2) 恶心 32(68.1) 压力 38(80.9) 呕吐 19(40.4) 亮/闪烁光 5(10.6) 至少50%眩晕发作伴有偏头痛症状 饮食 3(6.4) 头痛 22(46.8) 情绪波动 15(31.9) 畏光 24(51.1) 冷热环境等刺激 10(21.3) 畏声 28(59.6) 咖啡摄入 6(12.8) 视觉先兆 8(17.0) 
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表 2 VM患者治疗前后眩晕相关情况比较
x±s 氟桂利嗪组(n=20) 托吡酯组(n=22) χ2/t P VAS 基线 7.85±1.348 7.50±1.371 0.833 0.410 4周 5.55±1.234 4.59±1.368 2.376 0.022 8周 3.80±2.567 1.68±1.862 3.082 0.004 12周 1.90±2.292 0.64±1.399 2.131 0.041 眩晕持续时间(小时/月) 基线 10.30±6.174 9.18±4.490 0.676 0.503 4周 5.40±2.703 3.77±1.950 2.253 0.030 8周 3.45±3.748 1.36±2.216 2.169 0.038 12周 2.10±2.954 0.55±1.438 2.135 0.042 眩晕频率(次/月) 基线 4.05±1.572 4.18±1.402 -0.287 0.775 4周 1.70±0.733 1.27±0.631 2.030 0.049 8周 1.40±1.142 0.95±0.950 1.379 0.176 12周 0.65±0.745 0.23±0.528 2.102 0.043
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表 3 VM患者治疗前后DHI评分比较
x±s 氟桂利嗪组(n=20) 托吡酯组(n=22) χ2/t P DHI 基线 68.40±8.172 67.18±7.475 0.505 0.617 12周 41.40±9.383 36.09±7.341 2.052 0.047 DHI-P 基线 23.40±2.761 22.55±3.035 0.951 0.347 12周 14.20±3.172 11.82±2.383 2.767 0.009 DHI-E 基线 18.40±6.541 19.36±4.875 -0.545 0.589 12周 11.80±4.584 11.45±3.218 0.285 0.777 DHI-F 基线 26.60±3.050 25.27±3.239 1.363 0.180 12周 15.40±3.844 12.82±2.872 2.480 0.017
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表 4 VM患者治疗前后PHQ-9、GAD-7评分比较
氟桂利嗪组(n=20) 托吡酯组(n=22) χ2/t P PHQ-9 基线 6.60±3.218 6.45±3.035 0.151 0.881 12周 3.00±2.695 3.09±2.428 -0.115 0.909 GAD-7 基线 5.00±2.555 5.14±2.315 -0.181 0.857 12周 2.75±2.447 2.09±2.045 0.950 0.348
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