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PFO-Operation bessert Migräne gleich welchen Typs [Pharma]
23 Dez 05

Verbesserung unabhängig von Alter, Migränetyp, Schlaganfallrisiko

In dieser italienischen Studie wurden 23 Patienten mit Schlaganfallproblematik, PFO und Migräne (= Gruppe1) und 27 Patienten ohne Schlaganfallproblematik, aber mit PFO und Migräne (= Gruppe2) einer PFO-Operation unterzogen (Schließung des Lochs in der Herzscheidewand). 27 Personen einer Kontrollgruppe (= Gruppe3) litten ebenfalls unter PFO und Migräne, wurden aber keiner Operation unterzogen, sondern lediglich medikamentös behandelt. Alle 3 Gruppen waren bzgl. Alter, Geschlecht, Häufigkeit und Schwere der Migräne ähnlich ausgestattet.

In allen 3 Gruppen wurde die Migräneschwere über die Variablen: Häufigkeit, Dauer, Schwere und Vorhandensein einer Aura über einen Zeitraum von 6 Monaten ermittelt.

Vor Operation war in den Gruppen die durchschnittliche Migräneschwere wie folgt:

  • Gruppe1: 6,3
  • Gruppe2: 6,1
  • Gruppe3: 6,7

Für das 6-monatige Intervall nach dem Operationszeitpunkt ergaben sich die folgenden durchschnittlichen Migräneschweren:

  • Gruppe1: 2,6 (mit Operation)
  • Gruppe2: 3,3 (mit Operation)
  • Gruppe3: 6,8 (ohne Operation)

Vor der Operation litten 21 der 27 Patienten der Gruppe3 unter Aura-Migräne und dies änderte sich auch 6 Monate später nicht, während sich die Zahl der Patienten mit Aura-Migräne nach der Operation in der Gruppe1 von 19 auf 4 und in der Gruppe2 von 14 auf 3 verringerte.

Die Autoren schließen daraus, dass die Schließung eines PFOs für alle Migränepatienten mit PFO gleich welchen Migränetyps wirksamer ist, als eine rein medikamentöse Behandlung.

Abstract:
Shunt-Associated Migraine Responds Favorably to Atrial Septal Repair. A Case-Control Study
Gian P. Anzola MD; Giovanni B. Frisoni MD; Eva Morandi MD; Francesco Casilli MD; and Eustaquio Onorato MD, FSCAI
From the Servizio di Neurologia (G.P.A.), Ospedale S. Orsola FBF, AFaR, Associazione Fatebenefratelli per la Ricerca, Brescia, Italy; Laboratory of Epidemiology Neuroimaging and Telemedicine (G.B.F.), IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Clinica Neurologica Università di Brescia (E.M.), Italy; and Divisione di Cardiologia I (F.C., E.O.), Humanitas Gavazzeni, Bergamo, Italy.

Background and Purpose--Transcatheter closure of patent foramen ovale (PFO) has been reported to improve migraine in patients with cerebrovascular disorders in noncontrolled studies. The aim of the study was to compare the course of migraine assessed prospectively over a 12-month period in symptomatic (for cerebrovascular disease) and asymptomatic patients undergoing PFO closure and in patients with PFO treated medically.

Methods--Twenty-three stroke symptomatic (SS; 39±10 years of age; males/females [M/F] 5/18) and 27 stroke asymptomatic (SA; 40±12 years of age; M/F 5/22) patients with migraine underwent PFO closure. Twenty-seven patients with migraine and PFO (controls [CTRLS]; 36±11 years of age; M/F 4/23) were followed up medically. Migraine severity was assessed at baseline with a scale that takes into account the frequency, duration, and intensity of the attacks and the occurrence of aura (score range 0 to 10). Six months later, the patients were given a structured diary to annotate monthly with the same scale the characteristics of the attacks for the next 6 months. By the end of 1 year, the migraine score was averaged for the last 6 months.

Results--Baseline severity of migraine did not differ between groups (6.3 to 6.1 and 6.7 in SS, SA, and CTRLS groups, respectively). At the 1-year assessment, the overall migraine score had significantly improved by 3.7 and 2.8 points in SS and SA, respectively (P<0.001 on repeated-measure ANOVA), whereas it had nonsignificantly worsened by 0.1 points in CTRLS. Multiple linear regression analysis showed that the improvement in SS and SA was independent of migraine type, age, and cerebrovascular risk factors. Twenty-one of 21 patients with migraine with aura in the CTRLS group still had aura at the end of follow-up, whereas only 3 of 14 among SA and 4 of 19 among SS continued to have migraine preceded by aura (P<0.0001 on Fisher exact test).

Conclusions--Compared with medical treatment, closure of PFO brings about a significant overall improvement in migraine. This seems to occur irrespective of migraine type and of previous cerebrovascular disease. In addition to the overall improvement, in migraine with aura, the occurrence of aura is dramatically reduced.


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