שלח לחבר תודה לך על המלצתך על e-Med לחבר

	15/06/2021

08/04/2021

טיפול נוירומודולציה חדשני שאינו תרופתי בהתקפי מיגרנה/מאת ד''ר ברוך אלעד

22<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>מיגרנה היא מחלה שכיחה (כ-15% באוכלוסייה)</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=ltr></SPAN><SPAN dir=ltr></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr><SPAN dir=ltr></SPAN><SPAN dir=ltr></SPAN> </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>שגורמת לכאב ראש אופייני מנטרל בתדירות משתנה. כאב הראש מלווה<SPAN style="mso-spacerun: yes">  </SPAN>לעתים קרובות בתסמינים מטרידים נוספים, כגון רגישות לאור ולרעש, בחילה או הקאה, מניעה מפעילות גופנית שגרתית כמו הליכה או טיפוס מדרגות. התקף מיגרנה יכול להימשך שעות עד ימים. הנטל הבריאותי של מיגרנה מדורג במקום השני בין 328 המחלות המנוטרות ע"י ארגון בריאות העולמי.<?xml:namespace prefix = "o" ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p> </o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>הטיפול בהתקף מיגרנה חד הוא בעיקר תרופתי. הוא כולל משככי כאבים ללא מרשם או במרשם, ותרופות מרשם יעודיות למיגרנה (טריפטאנים); האחרונים נחשבים ליעילים יותר ממשככי כאבים אחרים. <o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>לתרופות השונות קיימות מגבלות של יעילות וסבילות. משככי כאבים הם בעלי פרופיל בטיחות סביר בד"כ, אך לעתים קרובות אינם יעילים מספיק. לטריפטאנים יש פרופיל יעילות גבוה יותר, אך תופעות לוואי מונעות לעתים את השימוש בהם, ויש גם הוריות נגד השימוש בתכשירים אלה. <o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>כל התרופות לטיפול בהתקפים חדים של מיגרנה הם בעלי פוטנציאל לגרום לתופעה של </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>medication overuse headache</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN>, שמתאפיינת בעליה בתדירות ההתקפים ובחומרתם ככל שכמות ימי טיפול בחודש ממוצע גדלה. התופעה עלולה להתפתח אחרי כמה חודשי שימוש בתדירות של 10 ימי טיפול בחודש או יותר. הטיפול בתופעה זו מורכב ותובעני.</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr><o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p> </o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>Nerivio</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN> הוא אביזר חדשני במרשם לטיפול שאינו פרמקולוגי בהתקפי מיגרנה (<B>לא למניעת מיגרנה)</B>.<o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>אביזר זה הוא ראשון מסוגו שמשתמש בטכנולוגיה של </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>Remote Electrical Neuromodulation – REN</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN>. </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>REN</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN> מפעיל מנגנון אנדוגני "יורד" של בקרת כאב </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>CPM - Conditioned Pain Modulation</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN>. בתמצית, </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>CPM</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN> מופעל ע"י גירוי חשמלי מתחת לסף הכאב במקום מרוחק מהכאב בו רוצים לטפל (במקרה של </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=ltr></SPAN><SPAN dir=ltr></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr><SPAN dir=ltr></SPAN><SPAN dir=ltr></SPAN><SPAN style="mso-spacerun: yes"> </SPAN></SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>Nerivio</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN> הגירוי הוא בזרוע, וכאב בו רוצים לטפל הוא במערכת עצב טריגמינלי - בראש). </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr><o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>REN</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN> במקרה זה מיושם ע"י מתן פולסים חשמליים לזרוע בתדר קבוע מראש ובעוצמה הניתנת לשליטה ע"י המשתמש באמצעות יישומון יעודי לסמארטפון (אנדרואיד ו-</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>iOS</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN>), למשך 45 דקות). <B>סוללת המכשיר מספקת 12 טיפולים כאלה, ואז יש להחליפו</B>.<o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>המערכת פרי פיתוח של חברה ישראלית </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>Theranica</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN>. היא נבדקה במחקר פיילוט על 86 נסיינים (</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=ltr></SPAN><SPAN dir=ltr></SPAN><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr><SPAN dir=ltr></SPAN><SPAN dir=ltr></SPAN>1</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN>); במחקר מפתח אקראי מבוקר ע"י </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>sham stimulation</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN> על 252 נסיינים (</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=ltr></SPAN><SPAN dir=ltr></SPAN><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr><SPAN dir=ltr></SPAN><SPAN dir=ltr></SPAN>2</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN>) שבעקבותיו קיבל אישור </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>FDA</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN>; מחקר המשך פתוח (3). <o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p> <IMG src="https://www.e-med.co.il/emed/new/UserSite/images/medisonmigrain.JPG"></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p></o:p></SPAN></SPAN> </P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><B><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"; mso-no-proof: yes' dir=ltr><?xml:namespace prefix = "v" ns = "urn:schemas-microsoft-com:vml" /><v:shapetype id=_x0000_t75 stroked="f" filled="f" path="m@4@5l@4@11@9@11@9@5xe" o:preferrelative="t" o:spt="75" coordsize="21600,21600"><v:stroke joinstyle="miter"></v:stroke><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"></v:f><v:f eqn="sum @0 1 0"></v:f><v:f eqn="sum 0 0 @1"></v:f><v:f eqn="prod @2 1 2"></v:f><v:f eqn="prod @3 21600 pixelWidth"></v:f><v:f eqn="prod @3 21600 pixelHeight"></v:f><v:f eqn="sum @0 0 1"></v:f><v:f eqn="prod @6 1 2"></v:f><v:f eqn="prod @7 21600 pixelWidth"></v:f><v:f eqn="sum @8 21600 0"></v:f><v:f eqn="prod @7 21600 pixelHeight"></v:f><v:f eqn="sum @10 21600 0"></v:f></v:formulas><v:path o:connecttype="rect" gradientshapeok="t" o:extrusionok="f"></v:path><o:lock aspectratio="t" v:ext="edit"></o:lock></v:shapetype></SPAN></B></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"; mso-no-proof: yes' dir=ltr><B></B></SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p></o:p></SPAN></SPAN> </P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><B><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>ממצאי יעילות עיקריים במחקר מפתח:</SPAN></B></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p></o:p></SPAN></SPAN></P> <UL type=disc> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l5 level1 lfo1; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>הפחתה משמעותית של הכאב שעתיים מתחילת הטיפול - 28% יותר נסיינים בקבוצת טיפול פעיל חוו הפחתה משמעותית בכאב בהשוואה לטיפול שאינו פעיל (67% לעומת 39%, בהתאמה)<o:p></o:p></SPAN></SPAN></LI> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l5 level1 lfo1; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>הפחתה משמעותית של הכאב 48 ש' מתחילת הטיפול - 22% יותר נסיינים בקבוצת טיפול פעיל חוו הפחתה משמעותית בכאב בהשוואה לטיפול שאינו פעיל (39% לעומת 17%, בהתאמה)<o:p></o:p></SPAN></SPAN></LI> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l5 level1 lfo1; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>העלמות של הכאב שעתיים מתחילת הטיפול - 19% יותר נסיינים בקבוצת טיפול פעיל חוו העלמות הכאב בהשוואה לטיפול שאינו פעיל (37% לעומת 18%, בהתאמה)<o:p></o:p></SPAN></SPAN></LI> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l5 level1 lfo1; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>העלמות של הכאב 48ש' מתחילת הטיפול - 13% יותר נסיינים בקבוצת טיפול פעיל חוו העלמות הכאב בהשוואה לטיפול שאינו פעיל (21% לעומת 8%, בהתאמה)<o:p></o:p></SPAN></SPAN></LI></UL> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; tab-stops: 335.6pt" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><B><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>תוצאות יעילות אלה דומות לתוצאות שפורסמו בעבר לגבי התרופות היעודיות לטיפול בהתקפי מיגרנה מקבוצת טריפטאנים. </SPAN></B></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>תוצאות דומות התקבלו במחקר פיילוט פתוח לטיפול בהתקפים במיגרנה כרונית (4). מחקר ראשי לטיפול בהתקפים במיגרנה כרונית טרם פורסם, אך הניב תוצאות דומות. גם מחקר פתוח לטיפול במתבגרים הסובלים ממיגרנה הניב תוצאות דומות (5)<o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><B><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr><o:p> </o:p></SPAN></B></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><B><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>ממצאי בטיחות:</SPAN></B></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p></o:p></SPAN></SPAN></P> <UL type=disc> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l2 level1 lfo2; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>תופעות לוואי היו מעטות וקלות (15% בקבוצת טיפול פעיל, 12% בקבוצת טיפול </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>sham</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN>) וכללו בעיקר תחושת חום, נמלול, כאב קל ואודם - כולם מקומיים וחולפים. <o:p></o:p></SPAN></SPAN></LI></UL> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><B><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>הפרופיל הבטיחותי של האביזר טוב יותר מאשר</SPAN></B></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'> <B>התרופות היעודיות לטיפול בהתקפי מיגרנה מקבוצת טריפטאנים.</B><o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr><o:p> </o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>במחקר המשך פתוח (3</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=ltr></SPAN><SPAN dir=ltr></SPAN><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr><SPAN dir=ltr></SPAN><SPAN dir=ltr></SPAN>(</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN>, כמעט 90% מ-117 נסיינים בחרו להשתמש לכל התקפיהם המדווחים רק באביזר ולא השתמשו בתרופות לטיפול אקוטי במיגרנה. בשקלול הכללי, בכ-74%  מהנסיינים היתה ירידה של יותר מ-50% בהתקפים בהם נעשה שימוש בתרופות, ובכ-43% ירידה של 100% בשימוש בתרופות<B>. </B>לא היו אינדיקציות לבעיות בטיחות אחרות מאלה שדווחו במחקרי מפתח. </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr><o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>במחקר מן "העולם האמיתי" נחקרו יותר מאלף חולי מיגרנה; יותר מ-60% מהמטופלים חוו שיפור משמעותי בכאב תוך שעתים מתחילת הטיפול. יותר מ-20% היו ללא כאב תוך שעתיים. יותר מ-50% מהמטופלים ויתרו על תרופה לטיפול בהתקף, עובדה שעשויה להפחית את התופעה של </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>medication overuse headache</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN> (6).<o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p> </o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><B><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>היתרונות של האביזר:</SPAN></B></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p></o:p></SPAN></SPAN></P> <UL type=disc> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l0 level1 lfo3; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>יעילות דומה לטריפטאנים ולדור חדש של תרופות לטיפול אקוטי במיגרנה (</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>gepants</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN>, טרם נרשמו בארץ)<o:p></o:p></SPAN></SPAN></LI> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l0 level1 lfo3; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>פרופיל בטיחות משופר, ועל כן סיכוי גבוה לאימוץ הטיפול ע"י מטופלים<o:p></o:p></SPAN></SPAN></LI> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l0 level1 lfo3; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>הסיכוי להפחתה של </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>Medication Overuse Headache</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p></o:p></SPAN></SPAN></LI></UL> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><B><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>חסרונות האביזר או פערי ידע:</SPAN></B></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p></o:p></SPAN></SPAN></P> <UL type=disc> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l6 level1 lfo4; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>לא נבדק בנשים בהריון<o:p></o:p></SPAN></SPAN></LI> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l6 level1 lfo4; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>נבדק בשימוש תוך שעה בלבד מתחילת ההתקף<o:p></o:p></SPAN></SPAN></LI></UL> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p> </o:p></SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><B><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>למי מיועד האביזר?</SPAN></B></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p></o:p></SPAN></SPAN></P> <UL style="MARGIN-TOP: 0cm" type=disc> <LI class=MsoNormalCxSpMiddle style="COLOR: black; LINE-HEIGHT: 150%; mso-list: l4 level1 lfo6" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>לטיפול אקוטי בהתקפים בחולים במיגרנה אפיזודית או כרונית עם אאורה או בלעדיה בני 12 ומעלה<B>, </B>גם בכאלה הנוטלים טיפול מניעה למיגרנה.<o:p></o:p></SPAN></SPAN></LI> <LI class=MsoNormalCxSpMiddle style="COLOR: black; LINE-HEIGHT: 150%; mso-list: l4 level1 lfo6" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>ניתן להשתמש בטיפול תרופתי אקוטי להתקפי מיגרנה אם הטיפול בהתקף מסוים באמצעות האביזר נכשל.<o:p></o:p></SPAN></SPAN></LI></UL> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p> </o:p></SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><B><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>למי לא מיועד הטיפול באביזר?</SPAN></B></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p></o:p></SPAN></SPAN></P> <UL type=disc> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l1 level1 lfo5; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>חולים באי-ספיקת לב<o:p></o:p></SPAN></SPAN></LI> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l1 level1 lfo5; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>חולים במחלות משמעותיות של כלי הדם הכליליים או המוחיים<o:p></o:p></SPAN></SPAN></LI> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l1 level1 lfo5; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>חולים באפילפסיה לא מאוזנת<o:p></o:p></SPAN></SPAN></LI> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l1 level1 lfo5; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>חולים בעלי אביזר אלקטרומגנטי מושתל (קוצב לב, שתל שבלול, קוצבי מח וכדו')<o:p></o:p></SPAN></SPAN></LI> <LI class=MsoNormal style="COLOR: black; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-list: l1 level1 lfo5; tab-stops: list 36.0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>חולים שאינם מסוגלים להשתמש בסמארטפון או ביישומון יעודי</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr><o:p></o:p></SPAN></SPAN></LI></UL> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>לסיכום, הטיפול במיגרנה אקוטית התרכז עד היום במענה תרופתי בלבד ולא ידע חידושים מזה שנים רבות.</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=ltr></SPAN><SPAN dir=ltr></SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr><SPAN dir=ltr></SPAN><SPAN dir=ltr></SPAN> </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>מכשיר </SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr>Nerivio</SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><SPAN dir=rtl></SPAN><SPAN dir=rtl></SPAN> <SPAN lang=HE>מהווה חידוש טכנולוגי יעיל ובטוח לשימוש לטיפול בהתקפים בחולי מיגרנה ומאפשר חלופה נוחה ובטוחה לטיפול תרופתי במגוון מטופלי מיגרנה בשלבי המחלה השונים..<o:p></o:p></SPAN></SPAN></SPAN></P> <P class=MsoNormal style="TEXT-ALIGN: center; MARGIN: 0cm 0cm 6pt; LINE-HEIGHT: 150%" dir=rtl align=center><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi'>- <B>הכותב הוא ד"ר ברוך אלעד, נוירולוג מומחה העוסק בין היתר בכאבי ראש </B></SPAN></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>הכתבה בחסות חברת מדיסון </SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'></SPAN></SPAN> </P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; COLOR: black; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><A style="BOX-SIZING: border-box; FONT-SIZE: 20px; TEXT-DECORATION: none; FONT-FAMILY: Assistant, Arial, Helvetica, sans-serif; WHITE-SPACE: normal; WORD-SPACING: 0px; TEXT-TRANSFORM: none; FONT-WEIGHT: 600; COLOR: rgb(0,70,130); FONT-STYLE: normal; ORPHANS: 2; WIDOWS: 2; LETTER-SPACING: normal; BACKGROUND-COLOR: rgb(255,255,255); TEXT-INDENT: 0px; font-variant-ligatures: normal; font-variant-caps: normal; -webkit-text-stroke-width: 0px" href="http://bit.ly/Nerivio-info">לאתר NERIVIO</A><o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"' dir=ltr><o:p> </o:p></SPAN></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%" dir=rtl><SPAN style="mso-bookmark: _Hlk62317514"><B><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>ביבליוגרפיה</SPAN></B></SPAN><SPAN style="mso-bookmark: _Hlk62317514"><SPAN lang=HE style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>:<o:p></o:p></SPAN></SPAN></P> <P class=MsoNormal style="unicode-bidi: embed; DIRECTION: ltr; TEXT-ALIGN: left; MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: 150%; TEXT-AUTOSPACE: ; mso-layout-grid-align: none"><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'><o:p> </o:p></SPAN></SPAN></P> <P class=MsoListParagraphCxSpFirst style="unicode-bidi: embed; DIRECTION: ltr; TEXT-ALIGN: left; MARGIN: 0cm 0cm 0pt 36pt; LINE-HEIGHT: 150%; TEXT-AUTOSPACE: ; TEXT-INDENT: -18pt; mso-list: l3 level1 lfo7; mso-layout-grid-align: none; mso-add-space: auto"><SPAN style="mso-bookmark: _Hlk62317514"><SPAN style='FONT-FAMILY: "Arial",sans-serif; COLOR: #231f20; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Arial; mso-fareast-theme-font: minor-bidi'><SPAN style="mso-list: Ignore">1.<SPAN style='FONT: 7pt "Times New Roman"'>    </SPAN></SPAN></SPAN><SPAN dir=ltr></SPAN><SPAN style='FONT-FAMILY: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "Times New Roman"'>Yarnitsky D et al. <SPAN style="COLOR: #231f20">Nonpainful remote electrical stimulation alleviates episodic migraine pain. 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