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소아청소년 두통의 예방적 치료로 flunarizine의 효과와 안전성

Efficacy and Safety of Flunarizine in Treatment of Pediatric Headaches

노영일|주민아
대한소아신경학회 (the Korean Child Neurology Society)|2013.09|대한소아신경학회지 (Journal of the korean child neurology society)|제21권 제3호|pp. 120-129

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초록

목 적 : 국내에서 소아청소년 두통의 예방적 치료로 flunarizine의 효과와 안전성을 알아보고, 각 두통의 형태에 따른 flunarizine의 예방효과를 알아보고자 하였다. 방 법: 2006년 3월부터 2012년 12월까지 두통으로 조선대학교병원 소아신경클리닉에 방문한 환자총 543명 중 예방적 약물 치료를 받은 환자는 212 명(39.04%)이었고 이중에서 flunarizine을 복용한환자 85명(40.09%)의 의무기록을 후향적으로 조사하였다. 기록이 미비한 23명은 대상에서 제외하였다. Flunarizine의 효과와 안전성을 평가하기 위해약물 투여 전과 투여 1, 3, 6개월 후 두통의 빈도, 두통의 지속시간, 심한 정도, 장애 정도 및 급성 약물의 월 사용 횟수를 비교하였고 약물의 부작용과약물을 중단한 경우, 중단한 이유를 알아보았다. 약물의 효과는 빈도가 50% 이상 감소했을 때 효과가있는 것으로 판정하였다. 결 과 : 소아청소년 두통의 예방치료로 flunari- zine의 효과는 치료 후 1개월에 54.8%, 3개월에70.4%, 6개월 80.8%로 효과가 있었다. 두통 형태에 따른 효과는 편두통은 1개월, 3개월, 6개월 점차효과가 있었고 긴장형 두통은 1개월에 효과가 좋았으며 이후에는 차이가 없었다. 치료 후 두통의 빈도, 심한 정도, 장애 정도가 의미 있게 감소하였다. 부작용은 두통의 악화, 졸림, 체중 증가 등이 있었다. 약물의 중단은 9.1%에서 있었고 중단 이유는 두통의악화, 의식 저하, 근육 통증이었다. 결 론:본 연구에서 flunarizine은 소아청소년의편두통을 포함한 여러 형태의 두통에서 예방치료로효과가 있었고, 부작용은 경미하였다. 편두통 예방약으로 효과가 좋다고 알려진 flunarizine은 다른 형태의 두통에도 효과적이고 비교적 안전하게 사용할 수있을 것으로 생각된다.

Abstract

Purpose : The aim of this study was to estimate the efficacy and safety of flunarizine in the treatment of pediatric headaches. Methods : We conducted a retrospective analysis of clinical records of children aged between 4 and 19 years who were treated with flunarizine for headache at the Chosun university hospital between April 2006 and December 2012. Flunarizine was initially prescribed to patients 5 mg daily and was then escalated once in 7 patients because of the unresponsiveness to the initial dose. We evaluated the frequency, duration, severity, and disability of headache before and after the treatment of flunarizine. Effective treatment was defined as a reduction in the frequency of individual attacks by at the least 50%. Results : Eighty five patients were identified, but 23 were excluded due to missing records. Sixty two children were included in the study: 18 boys and 44 girls with a mean age of 11 years. The diagnostic categories included migraine (27), tension type headache (7), others (28). The mean frequency of attack was 15.1±8.9 per month. Good outcome was observed 54.8% (34/62) in 1 month, 70.4% (38/54) in 3 month, and 80.8% (42/52) in 6 month. Adverse effects were seen in 15 (24.2%): worsening of headache (4), sedation (3), weight gain/increased appetite (2), dizziness (1), drowsiness (1) and others (4). Flunarizine was discontinued due to adverse effects in 6 patients, which includes worsening of headache (4), muscle ache (1), and tremor (1). In addition, it was discontinued due to lack of efficacy in seven patients. Conclusion : Flunarizine appears to be effective and safe in pediatric headache in our study. However, further studies are needed.

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