Background

NSAIDs (nonsteroidal anti-inflammatory drugs) were administered to patients with ischemic onset-type moyamoya disease who experience headaches, but their therapeutic effect was very poor and resulted in a drop in quality of life (QOL). On the other hand, patients who were administered aspirin initially to prevent transient ischemic attacks (TIA) were observed to have a better QOL with the absence of headaches. Here, we report on patients with ischemic onset-type moyamoya disease experiencing headaches who received aspirin in order to verify its safety and effectiveness.

Methods

From October 2012 to July 2014, 35 patients (male: 19, female: 16 average age: 10.5 ± 3.9) with ischemic onset-type pediatric moyamoya disease and who were admitted or commuted to hospital and had surgical treatment were evaluated for background, moyamoya staging (Suzuki), presence/absence of TIA, and platelet aggregation activity by adenosine diphosphate (ADP)/collagen turbidity test. The patients were divided into four groups depending on the intensity of headache prior to being administered aspirin, and the Kruskal-Wallis test was carried out for platelet aggregation activity and moyamoya staging. Also, the 4 × 2 χ² test was carried out for the presence/absence of TIA. Next, the items which were significant in these tests were used as independent variables to analyze the risk of headache onset, using logistic regression analysis.

Results

One item with statistical significance was the platelet aggregation test(PAT) value (on collagen) (P < 0.0001). A logistic regression analysis was carried out, using this value as an independent variable and headache intensity—as a dependent variable. As a result, an increase in PAT value by 1 translated into 4.43 times higher risk of the onset of intractable headache, and the onset of intractable headaches was predicted at 58.8% with collagen. The risk of developing a headache decreased as a result of aspirin administration, and the decrease was dependent on the collagen-induced aggregation suppression effect of aspirin. Aspirin was administered in the range of 1.6~9.5 mg/kg/day, and the PAT value decreasing rate was 42.9% on average. One case alone experienced nasal bleeding, and all cases showed an improvement in the intractable headaches.

Conclusions

In patients with ischemic onset-type pediatric moyamoya disease who experience headaches, the platelet aggregation activity is accelerated, and aspirin administration is effective in alleviating headaches by inhibiting platelet activation, detected by the collagen PAT.

中文翻译：

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患有顽固性头痛（moya-ache）的缺血性发作型儿科烟雾病患者中阿司匹林的使用和血小板聚集

背景

对出现头痛的缺血性发作型烟雾病患者给予NSAIDs（非甾体抗炎药），但治疗效果很差，导致生活质量（QOL）下降。另一方面，观察到最初服用阿司匹林以预防短暂性脑缺血发作 (TIA) 的患者具有更好的 QOL，并且没有头痛。在这里，我们报告了接受阿司匹林治疗的出现头痛的缺血性发作型烟雾病患者，以验证其安全性和有效性。

方法

2012年10月至2014年7月，35例（男：19岁，女：16岁，平均年龄：10.5±3.9岁）入院或转院接受手术治疗的缺血性发作型小儿烟雾病患者进行背景、烟雾病评估通过二磷酸腺苷 (ADP)/胶原浊度测试确定分期 (Suzuki)、TIA 的存在/不存在和血小板聚集活性。根据服用阿司匹林前的头痛强度将患者分为四组，并对血小板聚集活性和烟雾分期进行 Kruskal-Wallis 试验。此外，4 × 2 χ ²测试是否存在 TIA。接下来，将在这些测试中显着的项目用作自变量，使用逻辑回归分析来分析头痛发作的风险。

结果

具有统计学意义的一项是血小板聚集试验（PAT）值（对胶原蛋白）（P < 0.0001)。进行逻辑回归分析，使用该值作为自变量和头痛强度作为因变量。结果，PAT 值增加 1 转化为 4.43 倍的顽固性头痛发作的风险，而胶原蛋白预测顽固性头痛的发作率为 58.8%。服用阿司匹林后，发生头痛的风险降低，而且这种降低取决于阿司匹林对胶原蛋白诱导的聚集抑制作用。阿司匹林在1.6~9.5 mg/kg/天范围内给药，PAT值平均下降率为42.9%。仅1例出现鼻出血，所有病例均显示顽固性头痛有所改善。

结论

在出现头痛的缺血性发作型小儿烟雾病患者中，血小板聚集活动加速，阿司匹林通过抑制血小板活化（由胶原蛋白 PAT 检测）可有效缓解头痛。