Mechanism of Levetiracetam Monotherapy on Neurotransmitters in the Brain Regions of Migraine Patients

OBJECTIVE To investigate the mechanism of levetiracetam monotherapy on neurotransmitters in the brain regions of migraine patients. METHODS A total of 157 migraine patients in the First People's Hospital of Wenling from June 2017 to December 2019 were enrolled. Patients were divided into two groups by random number methods:sodium valproate group(n=64) and levetiracetam group(n=93), sodium valproate and levetiracetam were given orally. The frequency, duration and degree of migraine attack, Migraine Disability Assessment(MIDAS) Questionnaire scores, serum 5-hydroxytryptamine(5-HT), dopamine(DA) and norepinephrine(NE) levels were compared between groups. The healthy people with age ±3 years who passed the physical examination in the hospital during the same period were selected as the control group. The contents of γ-aminobutyric acid(GABA) in anterior cingulate gyrus and posterior cingulate gyrus were measured by Magnetic Resonance Spectroscopy. RESULTS Compared with before treatment, the frequency of migraine attack, duration and visual analogue scale(VAS) score of the two groups were significantly reduced after 1, 2 and 3 months of treatment, and the effect of levetiracetam group was better than that of sodium valproate group(P<0.05). Compared with before treatment, MIDAS scores of the two groups were significantly lower after 3 months of treatment, and the effect of levetiracetam group was better than that of sodium valproate group(P<0.05). Compared with the control group, the levels of GABA in the anterior cingulate gyrus and posterior cingulate gyrus of the two groups were significantly increased before treatment, and the levels of GABA in the anterior cingulate gyrus and posterior cingulate gyrus of the sodium valproate group were significantly increased 3 months after treatment (P<0.05). Compared with before treatment, the content of GABA in cingulate gyrus and posterior cingulate gyrus of sodium valproate group was significantly increased after 3 months of treatment, while the content of GABA in cingulate gyrus of levetiracetam group was significantly decreased(P<0.05). The content of GABA in anterior cingulate gyrus and posterior cingulate gyrus of levetiracetam group was significantly lower than that of sodium valproate group(P<0.05). Compared with before treatment, the serum levels of 5-HT, DA and NE in the two groups were significantly increased after 1 month, 2 months and 3 months of treatment, and the effect of levetiracetam group was better than that of sodium valproate group(P<0.05). CONCLUSION Compared with traditional antiepileptic drugs, levetiracetam is effective in treating migraines. The mechanism may not be related to GABA content increase in brain but the increase in secretion of serum γ-amine neurotransmitters, but GABA may be an indicator to predict the efficacy of levetiracetam in treating migraines.