
Schmerztherapie:
Migräne-Behandlung mit transkranialer Magnetfeldstimulation
Die
transkraniale Magnetfeldstimulation hilft oft jenen Migränepatienten
bei denen die derzeit verfügbaren Schmerzmittel wie Aspirin (ASS)
entweder nicht helfen, oder aber aufgrund starker Nebenwirkungungen
oder Kontraindikationen nicht eingesetzt werden können.
Die
Behandlung einer chronischen Migräne stellt die Geduld und Leidensfähigkeit
der betroffenen Patienten, gelegentlich auch jene der behandelnden
Ärzte, auf eine harte Probe. Bis heute gibt es nämlich keine
zuverlässig wirkende Therapie, die bei allen Migränepatienten
erfolgreich eingesetzt werden kann. Oft sind auch die Nebenwirkungen
der Medikamente mehr als nur lästig. Manche Patienten leider
so stark unter den typischerweise einseitigen Kopfschmerzen, dass
sie ernsthaft über eine Selbsttötung nachdenken.
Nun
gibt es eine neue, nahezu nebenwirkungsfreie Therapiemethode,
die zumindest einem Teil der Migränepatienten helfen kann.
Erfolgreich behandelt wurden Migränepatienten, deren Erkrankung
mit einer sog. Aura einhergeht - also neurologischen Symptomen
wie Sehstörungen, die meist schon vor dem Einsetzen der Schmerzen
auftreten.
WIKIPEDIA
zum Thema transkranielle Magnetstimulation
hier
zum Thema Migräneaura
hier und
zum Thema Migräne
hier
Die
Uniklinik Ulm forscht auf dem Gebiet der
transkraniellen Magnetstimulation
mehr
|
|
Bei
der kontrollierten Studie wußten die Patienten nicht, ob sie mit
einem tatsächlich wirkenden Gerät, oder einer identisch
aussehenden Attrappe ohne Magnet-Wirkung behandelt wurden.
In beiden Gruppen gingen 80% der Patienten davon aus, dass sie
tatsächlich mit Magnetpulsen behandelt wurden.
Wie
das renommierte Fachblatt The Lancet Neurology berichtete,
wurde die Studie am Albert Einstein College of Medicine, New York,
USA, durchgeführt. Richard B Lipton und seine Kollegen setzten
ein einfaches Therapiegerät ein, das die relativ schwachen
sog. Einfach-Puls-Magnetfelder erzeugt (engl.
single-pulse transcranial magnetic stimulation (sTMS)) die offenbar
trotzdem in der Lage sind, den Schädelknochen zu durchdringen.
Im Gehirn beeinflussen die pulsierenden Magnetwellen offenbar
jene elektrischen Phänomene positiv, die für die Entstehung der
Migräne-Aura verantwortlich sind.
In der Gruppe jener Patienten, die zumindest einen Migräneanfall
mit dem medizintechnischen Grät behandelten, waren 39% zwei Stunden
nach Beginn der Therapie schmerzfrei. In der Placebogruppe waren
es nur 22%. Die Schmerzfreiheit bestand of über 48-Stunden fort
und auch die Rückfallfreiheit war nach der magnetfeld-Therapie
größer. Da die Behandlung nahezu nebenwirkungsfrei ist, lohnt
sich also ein Therapieversuch in jedem Einzelfall.
Professor
Hans-Christoph Diener von
der Universitätsklinik Essen kommentierte die Studie und bezeichnete
die Anwendung der pulsierenden Magnetfelder als großen Schritt
vorwärts - insbesondere für jene Migränepatienten mit Aura,
bei denen die übliche medikamentöse Therapie nicht hilft, nicht
gut vertragen wird oder aufgrund anderer Krankheiten kontraindiziert
ist.

THE LANCET NEUROLOGY
MAGNETIC
STIMULATION OFFERS POTENTIAL NON-DRUG TREATMENT OPTION FOR MIGRAINE
PATIENTS
A
new hand-held device that delivers a magnetic pulse to the back
of the head could be a promising non-invasive, non-drug treatment
option for patients with migraine. The device offers effective
pain relief for up to 48 hours after treatment in some
patients with migraine with aura*, without any serious side-effects,
when given at the onset of symptoms, finds an Article published
Online First and in the April edition of The Lancet Neurology.
Evidence
suggests that single-pulse transcranial magnetic stimulation
(sTMS)** might disrupt the electrical events in the brain that
underpin migraine aura. Previous small studies suggest that sTMS
reduces migraine pain and that it is well tolerated. However,
previous trials used large and expensive devices not suitable
for use outside a clinic, and patients were not masked to treatment
making it difficult to confirm if the effect of TMS was real.
To
address these limitations, Richard B Lipton from the Albert Einstein
College of Medicine, New York, USA, and colleagues did a randomised,
sham-controlled trial*** to assess the safety and effectiveness
of a new, hand-held sTMS device suitable for home use, in the
treatment of migraine with aura.
201
patients were randomly assigned to sham stimulation (99) or sTMS
(102) and instructed to treat up to three attacks over 3 months
while experiencing aura, and to record pain and associated symptoms
before and at regular intervals after treatment. Findings
showed that sTMS was significantly more effective than placebo
for the treatment of migraine with aura.
More
patients were pain free at follow-up intervals of 2, 24, and 48
hours, were free of headache recurrence, and did not require rescue
medication, compared with sham stimulation. Of the 164
patients who treated at least one attack, 39% in the
sTMS group were pain free 2 hours after treatment compared with
22% in the sham group, a therapeutic gain of 17%.
Additionally,
sTMS treatment did not exacerbate associated symptoms, and was
non-inferior to sham stimulation for the improvement of nausea,
photophobia (excessive sensitivity to light), and phonophobia
(heightened sensitivity to sounds). Importantly, sTMS treatment
was well tolerated and no device-related serious adverse events
were reported, while incidence and severity of side-effects was
low and similar between the two groups. Furthermore, patients
rarely experienced errors when using the device and rated it an
average 8 out of 10 for user-friendliness.
The
authors comment: “Although the exact mechanisms of migraine
remain under study, administration of sTMS in people with migraine
with aura decreases progression of the attack in some
individuals…and could be a promising acute treatment.”
They
conclude by saying that more research is needed to examine the
range of sTMS doses and to establish the optimum timing of treatment
and cost effectiveness.
In
an accompanying Comment, Hans-Christoph Diener from University
Hospital Essen in Germany says that these findings show
that: “the use of TMS could be a major step forward in the
treatment of migraine with aura, particularly in patients in whom
presently available drug treatment is ineffective, poorly tolerated,
or contraindicated.”
Contact:
Dr Richard B Lipton, the Albert Einstein College of Medicine,
New York, USA. T) +1 718 430 3101 (Deirdre Branley, Albert Einstein
Department of Communications and Public Affairs) E)
rlipton@aecom.yu.edu
Dr Hans-Christoph Diener University Hospital Essen, Essen, Germany.
T) +49 201 723 2460 E)
h.diener@uni-essen.de
For
full Article and Comment, see:
http://press.thelancet.com/migraine.pdf
Notes
to Editors:
*There
are two major types of migraine: migraine without aura,
and migraine with aura. In migraine with aura, a variety
of focal neurological features occur in association with the headache,
usually beginning before the onset of pain. These include visual
symptoms such as spots of light, zigzag lines, and regions of
visual loss, as well as non-visual symptoms including tingling
and numbness, and weakness and difficulties with language.
**There
are two types of TMS: single pulse (sTMS), and repetitive TMS
(rTMS). In sTMS, used in the present study, individual magnetic
pulses are applied. In rTMS a series of pulses is used. rTMS has
been approved by regulatory bodies for use in diagnostic testing
and for the treatment of depression. There is therefore a large
body of data supporting the safety of TMS with much higher exposures
than used in the present study. The device used in this study
is portable and suitable for self-treatment outside medical settings.
***
The trial involved an identical device designed to deliver an
inactive (sham) impulse to ensure patients and investigators were
masked to treatment. Both active and sham treatment was associated
with a clicking sound and vibration of the device to maintain
blinding. Blinding was successful as demonstrated by the fact
that 80% of patients in both groups thought they received active
sTMS.
|