Studije praćenja kliničkih karakteristika, toka, onesposobljenosti, kvaliteta života i psiholoških poteškoća kod dece i adolescenata sa migrenom

Abstract

Migrena je hronično neurološko oboljenje koje se karakteriše ponavljanim, epizodičnim glavoboljama, često udruženim sa mučninom, povraćanjem, foto i/ili fonofobijom. Pokazano je da migrena može značajno uticati na fizičke, emocionalne i socijalne aspekte svakodnevnog funkcionisanja. Procena težine bolesti samo na osnovu učestalosti i intenziteta glavobolja ne pruža dovoljan uvid o uticaju migrene na kvalitet života. Korišćenje specifičnih upitnika daje mogućnost praćenja onesposobljenosti, efekata terapije i kvaliteta života obolelih kako u toku tako i između migrenskih ataka. Cilj: Cilj rada je utvrđivanje povezanosti relevantnih varijabli bolesti (učestalost glavobolja, težina napada i toka) sa onesposobljenošću i kvalitetom života, kao i utvrđivanje nivoa anksioznih i depresivnih simptoma i poteškoća u ponašanju kod dece sa migrenom. Metodologija: Multicentričnom studijom praćenja su obuhvaćeni deca i adolescenati sa migrenom koji su dijagnostikovani i lečeni u tri tercijarna centra, koji se bave neurologijom dečjeg i adolescentnog doba na teritoriji Beograda. U studiju je uključeno 52 ispitanika uzrasta 7-17,5 godina, dva ispitanika su izgubljena tokom praćenja. Ispitivanje onesposobljenosti dece sa migrenom je procenjeno PedMIDAS testom (engl. „Pediatric Migraine Disability Assessment“). Kvalitet života bolesnika sa migrenom je procenjen Upitnikom o Zdravlju za decu i mlade ljude KIDSCREEN-27 (engl.“Kidscreen-27 Health Questionnaire for Children and Young People“). Revidirana skala za anksioznost i depresiju dece - (RCADS) je korišćena za procenu nivoa anksioznih i depresivnih simptoma, Nisonger upitnik za procenu ponašanja dece urednog razvoja (engl. NCBRF) je korišćen da bi se procenile poteškoće u ponašanju. Rezultati: U ovoj studiji je kod oko trećine ispitanika utvrđen umeren do težak stepen onesposobljenosti usled migrene. Uočeno je da PedMIDAS skor visoko korelira sa brojem glavobolja u poslednjih mesec dana pre procene (p < 0,01)...

Migraine is a chronic neurological condition characterized by recurrent, episodic headaches often associated with nausea, vomiting, photophobia and/or phonophobia. Evidence suggests that migraine attacks significantly limit daily activities and adversely affect quality of life (QOL). The evaluation of the severity of the disease based solely on the frequency and intensity of the headache does not provide sufficient insight into the impacts of migraine on QOL. The use of specific questionnaires provides the ability to monitor the effects of therapy, disability, and QOL of patients during the course and between migraine attacks. Objective: The aim of the study was to determine the association between the relevant variables of the disease (headache frequency and severity and the course of disease) with disability and QOL, as well as determining levels of anxiety, depressive symptoms and behavioral disorders in children with migraine. Methods: This was a follow-up study of children and adolescents with migraine, diagnosed and treated at three pediatric/child neurology clinics in Belgrade. Fifty two patients age 7-17,5 years were enrolled and two patients were lost to follow-up. Disability due to migraine was assessed by the Pediatric Migraine Disability Assessment tool – PedMIDAS (Pediatric Migraine Disability Assessment). The KIDSCREEN-27 was used to assess QOL. Depressive and anxiety symptoms were assessed by the Revised Child Anxiety and Depression Scale (RCADS), while the Nisonger questionnaire for assessing the behavior of children with normal development (NCBRF) was used to assess symptoms of behavioral disorders. Results: In this study, about one-third of respondents identified a moderate to severe disability due to migraine. It was noticed that the PedMIDAS score was highly correlated with the number of headaches in the month before the assessment (p <0.01). In the six-month follow-up period, PedMIDAS scores statistically significant decrease (x;ˉ (SD)početak = 22,72 (23,39), x;ˉ (SD)3 meseci = 14,60 (17,63), x;ˉ (SD)6 meseci = 9,58 (12,48); F (df) = 11,81 (1,6), p < 0,01)...