소아청소년 편두통환자들의 임상경과와 예후
Clinical Course and Prognosis of Migraine Headache in Childhood and Adolescence
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목 적:소아 청소년 편두통 환자의 임상경과 및 예후를 알아보았고 특히 소아 편두통 환자에 대한 적극적인 예방적 치료가 편두통의 임상경과 및 예후에 어떠한 영향을 주는지 알아보고자 하였다. 방 법:2006년 1월 1일부터 2008년 6월 30일까지 본 병원 소아청소년과에서 편두통으로 처음 진단되었던 환자 110명을 대상으로 하여 진료 종료 후 1년간의 임상경과와 그 이후의 임상경과를 전화문의를 통해 조사하였다. 편두통의 임상경과는 치료 종료 후 1년간의 단기간의 경과와 그 이후의 장기간의 경과를 조사하였다. 단기간의 경과는 호전, 부분호전, 호전 없음으로 구분하였고 장기간의 경과는 치료, 감소, 지속으로 구분하였다. 결 과:전체 조사대상에서 41.8%가 호전되었고 63.6%가 치료되었다. 이중 무전조 편두통은 38.3%가 호전을 보였고, 59.6%가 치료되었으며 전조 편두통은 58.5%이 호전되었고 70.7%가 치료되었으며 그리고 개연적 편두통은 18.2%가 호전되었고 59.1%가 치료되었다. 이상에서 환자 전체로 보면 편두통의 형태별 임상경과의 차이는 없었다. 한편 편두통 예방적 치료를 한 경우 80%에서 호전이 있었으며 85%가 치료된 것으로 조사되어 예방적 치료를 한 경우에서 호전 및 치료된 경우가 많았다. 이를 편두통 형태별로 분석하면 예방적 치료를 하였던 경우 무전조 편두통에서 66.7%가 호전되었고 80%가 치료되었으며 전조 편두통에서는 88.0%가 호전되었고 88.0%가 치료되었으며 개연적 편두통의 경우는 예방적 치료사례가 없었다. 결 론:소아신경 전문의의 진료를 받았던 편두통 환자들의 전반적인 치료경과 및 예후는 매우 좋았으며 적극적인 예방적 치료를 시행한 경우는 그렇지 않은 경우에 비해 치료경과가 현저히 좋으며 특히 전조 편두통의 예방적 치료의 효과가 가장 좋았고 동시에 예방적 치료를 받았던 전조 편두통 환자들의 장기간의 예후가 가장 좋았던 것으로 판단된다.
Abstract
Purpose:The purpose of this study was to evaluate the clinical course and prognosis of migraines in childhood and adolescence, and the influence of preventive therapy on them. Methods:We recruited 110 children and adolescents with migraines who had been newly diagnosed and treated. Treatment was composed of observation after consultation, acute symptomatic treatment, and preventive therapy. We prescribed topiramate for preventive therapy. The recipients of preventive therapy were those patients who complained of disturbance in daily life due to severe headache. The clinical course was evaluated on the basis of changes in the frequency of migraine attack and was divided into three groups: complete recovery, partial recovery, and non-recovery. The prognosis of migraine was classified into those free from migraine attack, decreased, and persistant. Results:Forty-six (41.8%) of 110 patients completely recovered, and 70 (63.6 %) were free from migraine attack. In those suffering from migraines without aura, 38.3% of the patients completely recovered and 59.6% were free from migraine attack. Regarding migraines with aura, 58.5% of the patients completely recovered and 70.7% were free from migraine attack. With respect to cases of probable migraine, 18.2% completely recovered and 59.6% were free from migraine attack. In those receiving preventive treatment, 80.0% of all patients completely recovered and 85.0% were free from migraine. According to migraine type, 66.7% of patients with migraine without aura completely recovered and 80% were free from migraine. In those with migraine and aura, 88.8% of patients completely recovered and 88.8% were free from migraine attack. Conclusion:It was estimated that the clinical course and prognosis of migraine patients who were treated by pediatric neurologists were generally good. The clinical course was better in the preventive therapy group. In particular, the effect of preventive treatment and prognosis were optimal in patients with migraine with aura.
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