Mi Ji Lee1, Chungbin Lee1, Hanna Choi1, Chin-Sang Chung2. 1. Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 2. Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: cspaul@naver.com.
Abstract
BACKGROUND: Botulinum toxin A (BTA) responders have elevated levels of calcitonin gene-related and vasoactive intestinal peptides, which are potent vasodilators. We aimed to investigate neurovascular features as a predictor of BTA treatment response in patients with chronic migraine. METHODS: We prospectively recruited South Korean patients who were diagnosed with chronic migraine and underwent BTA injection at a university hospital from December 2013 to January 2015. Interictal transcranial Doppler (TCD) test was performed before BTA treatment when patients did not experience moderate-to-severe headache attacks. Botulinum toxin A was injected per the Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) protocol. Treatment response was determined after 4-6 weeks of follow-up. Pretreatment clinical and neurosonologic features of responders and non-responders were analyzed. RESULTS: Of the 83 enrolled patients, 70 who completed initial and follow-up evaluations were included for this study. Forty-two (60.0%) patients were classified as responders. 50% responders were 31 (44.2%). Longer disease duration was associated with poor treatment outcome (p=0.019). The ratio of the mean velocity of middle cerebral artery to that of ipsilateral internal carotid artery (MCA/ICA index) was significantly higher in responders than non-responders (p=0.027) and remained significant after controlling for covariates (p=0.025). CONCLUSIONS: Shorter disease duration and higher pretreatment MCA/ICA index on TCD are associated with good early outcomes of BTA treatment.
BACKGROUND: Botulinum toxin A (BTA) responders have elevated levels of calcitonin gene-related and vasoactive intestinal peptides, which are potent vasodilators. We aimed to investigate neurovascular features as a predictor of BTA treatment response in patients with chronic migraine. METHODS: We prospectively recruited South Korean patients who were diagnosed with chronic migraine and underwent BTA injection at a university hospital from December 2013 to January 2015. Interictal transcranial Doppler (TCD) test was performed before BTA treatment when patients did not experience moderate-to-severe headache attacks. Botulinum toxin A was injected per the Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) protocol. Treatment response was determined after 4-6 weeks of follow-up. Pretreatment clinical and neurosonologic features of responders and non-responders were analyzed. RESULTS: Of the 83 enrolled patients, 70 who completed initial and follow-up evaluations were included for this study. Forty-two (60.0%) patients were classified as responders. 50% responders were 31 (44.2%). Longer disease duration was associated with poor treatment outcome (p=0.019). The ratio of the mean velocity of middle cerebral artery to that of ipsilateral internal carotid artery (MCA/ICA index) was significantly higher in responders than non-responders (p=0.027) and remained significant after controlling for covariates (p=0.025). CONCLUSIONS: Shorter disease duration and higher pretreatment MCA/ICA index on TCD are associated with good early outcomes of BTA treatment.
Authors: Raffaele Ornello; Carlo Baraldi; Fayyaz Ahmed; Andrea Negro; Anna Maria Miscio; Antonio Santoro; Alicia Alpuente; Antonio Russo; Marcello Silvestro; Sabina Cevoli; Nicoletta Brunelli; Fabrizio Vernieri; Licia Grazzi; Luca Pani; Anna Andreou; Giorgio Lambru; Ilaria Frattale; Katharina Kamm; Ruth Ruscheweyh; Marco Russo; Paola Torelli; Elena Filatova; Nina Latysheva; Anna Gryglas-Dworak; Marcin Straburzyński; Calogera Butera; Bruno Colombo; Massimo Filippi; Patricia Pozo-Rosich; Paolo Martelletti; Simona Guerzoni; Simona Sacco Journal: Int J Environ Res Public Health Date: 2022-09-02 Impact factor: 4.614