1
|
Roghani M, Ghaedi G, Iranzadeh S, Golezar MH, Afshinmajd S. Efficacy and safety of venlafaxine versus nortriptyline for the preventive treatment of migraine: A double-blind randomized clinical trial. Clin Neurol Neurosurg 2024; 243:108400. [PMID: 38901375 DOI: 10.1016/j.clineuro.2024.108400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/13/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Migraine, as a primary headache disorder, stands as one of the primary causes of disability worldwide. Consequently, prophylactic treatments are highly recommended for individuals experiencing recurrent migraine episodes. Our study aimed to compare the efficacy and safety profiles of venlafaxine and nortriptyline in the prophylactic management of migraine. METHODS In this single-center, randomized, double-blind clinical trial, 210 migraine patients were allocated into two groups in a 1:1 ratio. One group received venlafaxine (37.5 mg, orally twice daily), while the other group administered nortriptyline (25 mg, orally once daily). A neurologist documented (1) headache intensity using the Visual Analog Scale (VAS) and 6-point Behavioral Rating Scale (BRS-6), (2) headache frequency (per month), and (3) headache duration (in hours) of participants on days 0, 45, and 90 of the intervention. RESULTS Following the 90-day intervention, a significant decrease was observed in VAS, BRS-6, frequency, and duration of headaches within both groups (all with p-values <0.001). No difference in VAS, BRS-6, or headache durations was observed between the two groups after 45 and 90 days of treatment (all p-values > 0.05). Although the headache frequency exhibited no difference between the groups after 45 days (p-value = 0.097), a significantly lower frequency in the venlafaxine group was observed at day 90 of the intervention (p-value = 0.011). The reductions in attack parameters in the 0-45- and 0-90-day intervals did not meet statistical significance between the two groups (p-values > 0.05). 77.0 % of the participants in the venlafaxine group and 79.2 % in the nortriptyline group experienced a minimum of 50 % improvement in all attack parameters. Venlafaxine demonstrated a statistically significant lower incidence of adverse reactions in comparison to nortriptyline (p-value = 0.005). A total of 33 adverse drug reactions were documented in the venlafaxine group and 53 in the nortriptyline group, with insomnia observed in the former and xerostomia in the latter as the most prevalent side effects. CONCLUSIONS Venlafaxine and nortriptyline demonstrate clinically significant and comparable therapeutic efficacy for migraine patients in reducing the intensity, frequency, and duration of headache attacks. Venlafaxine may be preferred to nortriptyline in the context of migraine preventive treatment under comparable conditions due to its lower incidence of adverse effects.
Collapse
Affiliation(s)
- Mehrdad Roghani
- Neurophysiology Research Center, Shahed University, Tehran, Iran
| | | | | | | | - Siamak Afshinmajd
- Neurophysiology Research Center, Shahed University, Tehran, Iran; Department of Neurology, Faculty of Medicine, Shahed University, Tehran, Iran.
| |
Collapse
|
2
|
Sheng ZF, Zhang H, Zheng P, Chen S, Gu Z, Zhou JJ, Phaup JG, Chang HM, Yeh ETH, Pan HL, Li DP. Impaired Kv7 channel activity in the central amygdala contributes to elevated sympathetic outflow in hypertension. Cardiovasc Res 2022; 118:585-596. [PMID: 33512443 PMCID: PMC8803073 DOI: 10.1093/cvr/cvab031] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/11/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Elevated sympathetic outflow is associated with primary hypertension. However, the mechanisms involved in heightened sympathetic outflow in hypertension are unclear. The central amygdala (CeA) regulates autonomic components of emotions through projections to the brainstem. The neuronal Kv7 channel is a non-inactivating voltage-dependent K+ channel encoded by KCNQ2/3 genes involved in stabilizing the neuronal membrane potential and regulating neuronal excitability. In this study, we investigated if altered Kv7 channel activity in the CeA contributes to heightened sympathetic outflow in hypertension. METHODS AND RESULTS The mRNA and protein expression levels of Kv7.2/Kv7.3 in the CeA were significantly reduced in spontaneously hypertensive rats (SHRs) compared with Wistar-Kyoto (WKY) rats. Lowering blood pressure with coeliac ganglionectomy in SHRs did not alter Kv7.2 and Kv7.3 channel expression levels in the CeA. Fluospheres were injected into the rostral ventrolateral medulla (RVLM) to retrogradely label CeA neurons projecting to the RVLM (CeA-RVLM neurons). Kv7 channel currents recorded from CeA-RVLM neurons in brain slices were much smaller in SHRs than in WKY rats. Furthermore, the basal firing activity of CeA-RVLM neurons was significantly greater in SHRs than in WKY rats. Bath application of specific Kv7 channel blocker 10, 10-bis (4-pyridinylmethyl)-9(10H)-anthracnose (XE-991) increased the excitability of CeA-RVLM neurons in WKY rats, but not in SHRs. Microinjection of XE-991 into the CeA increased arterial blood pressure (ABP) and renal sympathetic nerve activity (RSNA), while microinjection of Kv7 channel opener QO-58 decreased ABP and RSNA, in anaesthetized WKY rats but not SHRs. CONCLUSIONS Our findings suggest that diminished Kv7 channel activity in the CeA contributes to elevated sympathetic outflow in primary hypertension. This novel information provides new mechanistic insight into the pathogenesis of neurogenic hypertension.
Collapse
Affiliation(s)
- Zhao-Fu Sheng
- Center for Precision Medicine, Department of Medicine, School of Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA
| | - Hua Zhang
- Center for Precision Medicine, Department of Medicine, School of Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA
| | - PeiRu Zheng
- Center for Precision Medicine, Department of Medicine, School of Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA
| | - Shanyan Chen
- Department of Pathology and Anatomical Sciences, School of Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA
| | - Zezong Gu
- Department of Pathology and Anatomical Sciences, School of Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA
| | - Jing-Jing Zhou
- Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Jeffery G Phaup
- Center for Precision Medicine, Department of Medicine, School of Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA
| | - Hui-Ming Chang
- Departments of Pharmacology and Toxicology and Internal Medicine, The University of Arkansas for Medical Sciences, 4301 West Markham St., Little Rock, AR 72205, USA
| | - Edward T H Yeh
- Departments of Pharmacology and Toxicology and Internal Medicine, The University of Arkansas for Medical Sciences, 4301 West Markham St., Little Rock, AR 72205, USA
| | - Hui-Lin Pan
- Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - De-Pei Li
- Center for Precision Medicine, Department of Medicine, School of Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA
| |
Collapse
|
3
|
Zhou JJ, Gao Y, Kosten TA, Zhao Z, Li DP. Acute stress diminishes M-current contributing to elevated activity of hypothalamic-pituitary-adrenal axis. Neuropharmacology 2016; 114:67-76. [PMID: 27908768 DOI: 10.1016/j.neuropharm.2016.11.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/17/2016] [Accepted: 11/26/2016] [Indexed: 11/16/2022]
Abstract
Acute stress stimulates corticotrophin-releasing hormone (CRH)-expressing neurons in the hypothalamic paraventricular nucleus (PVN), which is an essential component of hypothalamic-pituitary-adrenal (HPA) axis. However, the cellular and molecular mechanisms remain unclear. The M-channel is a voltage-dependent K+ channel involved in stabilizing the neuronal membrane potential and regulating neuronal excitability. In this study, we tested our hypothesis that acute stress suppresses expression of Kv7 channels to stimulate PVN-CRH neurons and the HPA axis. Rat PVN-CRH neurons were identified by expressing enhanced green fluorescent protein driven by Crh promoter. Acute restraint stress attenuated the excitatory effect of Kv7 blocker XE-991 on the firing activity of PVN-CRH neurons and blunted the increase in plasma corticosterone (CORT) levels induced by microinjection of XE-991 into the PVN. Furthermore, acute stress significantly decreased the M-currents in PVN-CRH neurons and reduced PVN expression of Kv7.3 subunit in the membrane. In addition, acute stress significantly increased phosphorylated AMP-activated protein kinase (AMPK) levels in the PVN tissue. Intracerebroventricular injection of the AMPK inhibitor dorsomorphin restored acute stress-induced elevation of CORT levels and reduction of membrane Kv7.3 protein level in the PVN. Dorsomorphin treatment increased the M-currents and reduced the firing activity of PVN-CRH neurons in acutely stressed rats. Collectively, these data suggest that acute stress diminishes Kv7 channels to stimulate PVN-CRH neurons and the HPA axis potentially via increased AMPK activity.
Collapse
Affiliation(s)
- Jing-Jing Zhou
- Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Physiology, Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Yonggang Gao
- Department of Preventive Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, PR China
| | - Therese A Kosten
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Zongmao Zhao
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China.
| | - De-Pei Li
- Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
4
|
Reilly JM, Dharmalingam B, Marsh SJ, Thompson V, Goebel A, Brown DA. Effects of serum immunoglobulins from patients with complex regional pain syndrome (CRPS) on depolarisation-induced calcium transients in isolated dorsal root ganglion (DRG) neurons. Exp Neurol 2015; 277:96-102. [PMID: 26708558 DOI: 10.1016/j.expneurol.2015.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 12/10/2015] [Accepted: 12/15/2015] [Indexed: 12/28/2022]
Abstract
Complex regional pain syndrome (CRPS) is thought to have an auto-immune component. One such target recently proposed from the effects of auto-immune IgGs on Ca(2+) transients in cardiac myocytes and cell lines is the α1-adrenoceptor. We have tested whether such IgGs exerted comparable effects on nociceptive sensory neurons isolated from rat dorsal root ganglia. Depolarisation-induced [Ca(2+)]i transients were generated by applying 30 mM KCl for 2 min and monitored by Fura-2 fluorescence imaging. No IgGs tested (including 3 from CRPS patients) had any significant effect on these [Ca(2+)]i transients. However, IgG from one CRPS patient consistently and significantly reduced the K(+)-induced response of cells that had been pre-incubated for 24h with a mixture of inflammatory mediators (1 μM histamine, 5-hydroxytryptamine, bradykinin and PGE2). Since this pre-incubation also appeared to induce a comparable inhibitory response to the α1-agonist phenylephrine, this is compatible with the α1-adrenoceptor as a target for CRPS auto-immunity. A mechanism whereby this might enhance pain is suggested.
Collapse
Affiliation(s)
- Joanne M Reilly
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Backialakshmi Dharmalingam
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London, WC1E 6BT, UK; Pain Research Institute, Department of Translational Medicine, University of Liverpool, Liverpool, L9 7AL, UK
| | - Stephen J Marsh
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Victoria Thompson
- Pain Research Institute, Department of Translational Medicine, University of Liverpool, Liverpool, L9 7AL, UK
| | - Andreas Goebel
- Pain Research Institute, Department of Translational Medicine, University of Liverpool, Liverpool, L9 7AL, UK.
| | - David A Brown
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London, WC1E 6BT, UK
| |
Collapse
|
5
|
Bordas C, Kovacs A, Pal B. The M-current contributes to high threshold membrane potential oscillations in a cell type-specific way in the pedunculopontine nucleus of mice. Front Cell Neurosci 2015; 9:121. [PMID: 25904846 PMCID: PMC4388076 DOI: 10.3389/fncel.2015.00121] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/17/2015] [Indexed: 11/24/2022] Open
Abstract
The pedunculopontine nucleus is known as a cholinergic nucleus of the reticular activating system, participating in regulation of sleep and wakefulness. Besides cholinergic neurons, it consists of GABAergic and glutamatergic neurons as well. According to classical and recent studies, more subgroups of neurons were defined. Groups based on the neurotransmitter released by a neuron are not homogenous, but can be further subdivided. The PPN neurons do not only provide cholinergic and non-cholinergic inputs to several subcortical brain areas but they are also targets of cholinergic and other different neuromodulatory actions. Although cholinergic neuromodulation has been already investigated in the nucleus, one of its characteristic targets, the M-type potassium current has not been described yet. Using slice electrophysiology, we provide evidence in the present work that cholinergic neurons possess M-current, whereas GABAergic neurons lack it. The M-current contributes to certain functional differences of cholinergic and GABAergic neurons, as spike frequency adaptation, action potential firing frequency or the amplitude difference of medium afterhyperpolarizations (AHPs). Furthermore, we showed that high threshold membrane potential oscillation with high power, around 20 Hz frequency is a functional property of almost all cholinergic cells, whereas GABAergic neurons have only low amplitude oscillations. Blockade of the M-current abolished the oscillatory activity at 20 Hz, and largely diminished it at other frequencies. Taken together, the M-current seems to be characteristic for PPN cholinergic neurons. It provides a possibility for modulating gamma band activity of these cells, thus contributing to neuromodulatory regulation of the reticular activating system.
Collapse
Affiliation(s)
- Csilla Bordas
- Faculty of Medicine, Department of Physiology, University of Debrecen Debrecen, Hungary
| | - Adrienn Kovacs
- Faculty of Medicine, Department of Physiology, University of Debrecen Debrecen, Hungary
| | - Balazs Pal
- Faculty of Medicine, Department of Physiology, University of Debrecen Debrecen, Hungary
| |
Collapse
|