Epicrania Fugax: Ten New Cases and Therapeutic Results
Epicrania Fugax: Ten New Cases and Therapeutic Results
复制标题
DOI：
10.1111/j.1526-4610.2009.01607.x
复制
发表时间：
2010-03-01
期刊：
影响因子：
5
通讯作者：
Fernandez, Rosa
中科院分区：
文献类型：
--
作者：
Guerrero, Angel L.;Cuadrado, Maria L.;Fernandez, Rosa
目标。目的：报告10例新发的阴沟癣（EF）病例，分析其临床特点和治疗效果。fugax最近被描述为一种发作性头痛，始于位于颅骨后部的病灶区域，并沿线性或之字形轨迹迅速向前扩散到同侧眼睛或鼻子。有些患者疼痛后伴有眼或鼻自主神经特征。在之前的系列研究中，1例患者通过麻醉阻断获得疼痛缓解，另1例患者使用卡马西平得到改善。自第一次描述EF以来，我们在我们两个中心的神经病学门诊评估了10名具有相同临床表现的患者（8名女性和2名男性）。-平均发病年龄48.5岁（SD: 19.8，范围：23-83）。所有患者均有严格的单侧疼痛发作，从顶部（n = 5）、枕部（n = 4）或顶枕部至枕部（n = 1）开始，并立即沿线性路径向前扩散至同侧前额（n = 3）或同侧眼睛（n = 7），整个过程持续1-10秒。在我们的病人中没有发现任何诱因，而他们中的5人在发作之间的茎干区域有轻微的疼痛。3例患者有同侧流泪，2例患者在发作结束时进行结膜注射。频率从每周一次到每天多次。神经影像学和实验室检查均正常。对乙酰氨基酚对间歇疼痛有反应。在3例中，为了避免发作，考虑了预防措施。加巴喷丁显著改善2例。第三例患者没有从加巴喷丁或阿米替林获得任何益处，但拉莫三嗪略有改善。这一描述强化了EF作为一种新的头痛变体或一种新的头痛综合征的建议。麻醉阻滞、卡马西平、加巴喷丁和拉莫三嗪对个别患者明显有效。需要进一步的观察和治疗试验。
Objective.-We aimed to report 10 new cases of epicrania fugax (EF), showing their clinical features and therapeutic responses.Background.-Epicrania fugax has been recently described as a paroxysmal head pain starting in a focal area located at a posterior cranial region and rapidly spreading forward to the ipsilateral eye or nose along a linear or zigzag trajectory. In some patients the pain is followed by ocular or nasal autonomic features. In the prior series, 1 patient got pain relief with anesthetic blockades, while another patient improved with carbamazepine.Methods.-Since the first description of EF, we have assessed 10 patients with the same clinical picture (8 women and 2 men) at the Neurology outpatient offices of our 2 centers.Results.-The mean age at onset was 48.5 years (SD: 19.8, range: 23-83). All the patients complained of strictly unilateral pain paroxysms starting at parietal (n = 5), occipital (n = 4), or parieto-occipital locations (n = 1), and immediately spreading forward through a linear pathway toward the ipsilateral forehead (n = 3) or the ipsilateral eye (n = 7), the complete sequence lasting 1-10 seconds. No trigger was identified in any of our patients, while 5 of them suffered mild pain in the stemming area between the paroxysms. Three patients had ipsilateral lacrimation, and 2 had conjunctival injection at the end of the attacks. The frequency ranged from 1 attack per week to multiple attacks per day. Neuroimaging and laboratory tests were consistently normal. Interictal pain was responsive to acetaminophen. In 3 cases a preventive was considered in order to avoid the paroxysms. Gabapentin led to significant improvement in 2 cases. The third patient did not obtain any benefit from gabapentin or amitriptyline, but improved slightly with lamotrigine.Conclusions.-This description reinforces the proposal of EF as a new headache variant or a new headache syndrome. Anesthetic blockades, carbamazepine, gabapentin, and lamotrigine have been apparently effective in individual patients. Further observations and therapeutic trials are needed.