Ereigniskorrelierte Potenziale von Patienten mit idiopathischen Kopfschmerzen - Beiträge zur Pathophysiologie und Differenzialdiagnostik

Zusammenfassung

Ereigniskorrelierte Potenziale (EKP) stellen eine Methode zur elektrophysiologischen Untersuchung kognitiver Vorgänge dar. Patienten mit Migräne zeigen in den EKP einen Verlust der Habituation bei der kognitiven Reizverarbeitung, wenn diese zwischen den Migräneattacken untersucht wird. In der Migräneattacke besteht eine normale kognitive Reizverarbeitung. Dieses Phänomen des Habituationsverlustes verstärkt sich in den Tagen vor einer Migräneattacke. Auch bei Kindern und Jugendlichen kann es beobachtet werden, ist dort aber altersabhängig weniger stark ausgeprägt. Patienten mit Kopfschmerz bei sexueller Aktivität zeigen ein ähnliches Verhalten, bei allen anderen idiopathischen Kopfschmerzen liegt keine Störung der kognitiven Habituation vor. Allerdings zeigen Patienten mit Clusterkopfschmerzen während der aktiven Phase eine signifikante Verzögerung der Latenzen in den EKP. Die EKP können bei Migränepatienten mit spezifischen Migränemedikamenten pharmakologisch beeinflusst werden. Dabei führt eine Gabe von Serotonin-1_B/D-Agonisten zu einer kurzfristigen Aufhebung dieses Habituationsverlustes. Lang dauernde Einnahme von Ergotaminen dagegen bewirkt eine nur teilweise reversible Verlängerung der EKP-Latenzen. Zusammenfassend können mit EKP sowohl differenzialdiagnostische als auch pathophysiologische Fragestellungen bei idiopathischen Kopfschmerzen bearbeitet werden.

Abstract

Event-related potentials (ERP) provide an electrophysiological method to investigate cognitive processing. Patients with migraine show a loss of cognitive habituation when ERP are measured between migraine attacks. During a migraine attack, cognitive processing is normal. The loss of cognitive habituation increases in the days before a migraine attack and normalizes just with the beginning of the attack. This phenomenon can also be observed in children and adolescents with migraine. However, it is age-dependent in this group of migraine patients. Patients with headache related to sexual activity demonstrate a similar loss of cognitive habituation. In all other idiopathic headache types, cognitive processing is normal with respect to habituation. Patients with cluster headache exhibit increased latencies of ERP during an active period. The ERP of migraine patients can be influenced by different migraine-specific drugs. After 5-HT-1_B/D-agonists, the loss of cognitive habituation disappears. Chronic intake of ergotamines, however, induces an increase of ERP latencies which is only in part reversible. In conclusion, ERP contribute to a better understanding of the differential diagnosis and the pathophysiology of idiopathic headache disorders.

Key words

Event-related potentials - CNV - migraine - cluster headache

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