1
|
Xiang Y, Li F, Song Z, Yi Z, Yang C, Xue J, Zhang Y. Two pediatric patients with hemiplegic migraine presenting as acute encephalopathy: case reports and a literature review. Front Pediatr 2023; 11:1214837. [PMID: 37576133 PMCID: PMC10419215 DOI: 10.3389/fped.2023.1214837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Hemiplegic migraine (HM) is a rare subtype of migraine. HM in children may be atypical in the initial stage of the disease, which could easily lead to misdiagnosis. Methods We report two cases of atypical hemiplegic migraine that onset as an acute encephalopathy. And a comprehensive search was performed using PubMed, Web of Science, and Scopus. We selected only papers that reported complete clinical information about the patients with CACNA1A or ATP1A2 gene mutation. Results Patient #1 showed a de novo mutation, c.674C>A (p. Pro225His), in exon 5 of the CACNA1A gene. And patient #2 showed a missense mutation (c.2143G>A, p. Gly715Arg) in exon 16 of the ATP1A2. Together with our two cases, a total of 160 patients (73 CACNA1A and 87 ATP1A2) were collected and summarized finally. Discussion Acute encephalopathy is the main manifestation of severe attacks of HM in children, which adds to the difficulty of diagnosis. Physicians should consider HM in the differential diagnosis of patients presenting with somnolence, coma, or convulsion without structural, epileptic, infectious, or inflammatory explanation. When similar clinical cases appear, gene detection is particularly important, which is conducive to early diagnosis and treatment. Early recognition and treatment of the disease can help improve the prognosis.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ying Zhang
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
2
|
Bonemazzi I, Brunello F, Pin JN, Pecoraro M, Sartori S, Nosadini M, Toldo I. Hemiplegic Migraine in Children and Adolescents. J Clin Med 2023; 12:jcm12113783. [PMID: 37297978 DOI: 10.3390/jcm12113783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Only a few studies have focused on hemiplegic migraine (HM) in children despite its early age of onset. The aim of this review is to describe the peculiar characteristics of pediatric HM. METHODS This is a narrative review based on 14 studies on pediatric HM selected from 262 papers. RESULTS Different from HM in adults, pediatric HM affects both genders equally. Early transient neurological symptoms (prolonged aphasia during a febrile episode, isolated seizures, transient hemiparesis, and prolonged clumsiness after minor head trauma) can precede HM long before its onset. The prevalence of non-motor auras among children is lower than it is in adults. Pediatric sporadic HM patients have longer and more severe attacks compared to familial cases, especially during the initial years after disease onset, while familial HM cases tend to have the disease for longer. During follow-up, the frequency, intensity, and duration of HM attacks often decrease. The outcome is favorable in most patients; however, neurological conditions and comorbidities can be associated. CONCLUSION Further studies are needed to better define the clinical phenotype and the natural history of pediatric HM and to refine genotype-phenotype correlations in order to improve the knowledge on HM physiopathology, diagnosis, and outcome.
Collapse
Affiliation(s)
- Ilaria Bonemazzi
- Juvenile Headache Center, Department of Woman's and Child's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Francesco Brunello
- Juvenile Headache Center, Department of Woman's and Child's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Jacopo Norberto Pin
- Juvenile Headache Center, Department of Woman's and Child's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Mattia Pecoraro
- Juvenile Headache Center, Department of Woman's and Child's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Stefano Sartori
- Juvenile Headache Center, Department of Woman's and Child's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Margherita Nosadini
- Juvenile Headache Center, Department of Woman's and Child's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Irene Toldo
- Juvenile Headache Center, Department of Woman's and Child's Health, University Hospital of Padua, 35128 Padua, Italy
| |
Collapse
|
3
|
Dannenberg F, Prager C, Schmidt F, Tietze A, Bittigau P, Kaindl AM. Intravenous Nimodipine Treatment for Severe Episode of ATP1A2 Hemiplegic Migraine. Pediatr Neurol 2020; 112:71-72. [PMID: 32920306 DOI: 10.1016/j.pediatrneurol.2020.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/05/2020] [Accepted: 07/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Fabian Dannenberg
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christine Prager
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Schmidt
- Pediatric Pulmology and Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Tietze
- Institute of Neuroradiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Petra Bittigau
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Angela M Kaindl
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany; Institute for Cell Biology and Neurobiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
4
|
Li F, Fei Q, Mao D, Si Q, Dai M, Ma Q, Zhang H, Bai L, He N. Comparative Pharmacokinetics of Nimodipine in Rat Plasma and Tissues Following Intraocular, Intragastric, and Intravenous Administration. AAPS PharmSciTech 2020; 21:234. [PMID: 32794077 DOI: 10.1208/s12249-020-01772-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022] Open
Abstract
We investigated the pharmacokinetics of nimodipine (NMD) in rats plasma and tissues following intraocular (io), intragastric (ig), and intravenous (iv) administration at doses of 5.0 mg/kg io and iv and 10.0 mg/kg ig. After a single dose of NMD, plasma, heart, liver, spleen, lung, kidney, and brain samples were collected at the scheduled time points. The concentration of NMD in rat plasma and tissues was determined by high-performance liquid chromatography, and the main pharmacokinetic parameters were calculated and compared. NMD was rapidly absorbed and reached the maximum plasma concentration in approximately 5 min after io administration. The absolute bioavailability after io administration was higher than that after ig administration (40.05% vs. 5.67%). There were significant differences in the tissue distribution of NMD with different administration routes. After io administration, NMD was distributed more in the lung, spleen, and brain tissues, and less in the kidney. The maximum drug concentration after io administration in the heart, liver, spleen, lung, kidney, and brain was 1.00, 0.47, 2.02, 1.47, 0.22, and 5.79 times higher than that after via ig administration, and the area under the curve value was 0.59, 0.78, 1.71, 1.84, 0.25, and 4.59 times greater, respectively. Nimodipine appears to achieve systemic effects via io administration. Compared with ig, io administration could significantly increase NMD distribution in the brain tissue, indicating that NMD could be delivered to the brain via io administration.
Collapse
Affiliation(s)
- Fang Li
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China.,College of Biology and Pharmaceutical Engineering, West Anhui University, Lu'an, 237012, China
| | - Qingsong Fei
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China
| | - Dan Mao
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China
| | - Qiaoyun Si
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China
| | - Manman Dai
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China
| | - Qun Ma
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China
| | - Huimin Zhang
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China
| | - Luyu Bai
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China
| | - Ning He
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, No. 1, Qianjiang Road, Hefei, 230012, Anhui, China. .,Institute of Pharmaceutics, Anhui Academy of Chinese Medical Sciences, Hefei, 230012, China. .,Anhui Province Key Laboratory of Chinese Medicinal Formula, Hefei, 230012, China. .,Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application, Hefei, 230012, China.
| |
Collapse
|
8
|
Pelzer N, Stam AH, Haan J, Ferrari MD, Terwindt GM. Familial and sporadic hemiplegic migraine: diagnosis and treatment. Curr Treat Options Neurol 2013. [PMID: 23203776 DOI: 10.1007/s11940-012-0208-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OPINION STATEMENT Hemiplegic migraine (HM) is a rare subtype of migraine with aura, characterized by transient hemiparesis during attacks. Diagnosis is based on the International Classification of Headache Disorders criteria (ICHD-II). Two types of HM are recognized: familial (FHM) and sporadic hemiplegic migraine (SHM). HM is genetically heterogeneous. Three genes have been identified (CACNA1A, ATP1A2, and SCN1A) but more, so far unknown genes, are involved. Clinically, attacks of the 3 subtypes cannot be distinguished. The diagnosis can be confirmed but not ruled out by genetic testing, because in some HM patients other, not yet identified, genes are involved. The presence of additional symptoms (such as chronic ataxia or epilepsy) may increase the likelihood of identifying a mutation. Additional diagnostics like imaging, CSF analysis, or an EEG are mainly performed to exclude other causes of focal neurological symptoms associated with headache. Conventional cerebral angiography is contraindicated in HM because this may provoke an attack. Because HM is a rare condition, no clinical treatment trials are available in this specific subgroup of migraine patients. Thus, the treatment of HM is based on empirical data, personal experience of the treating neurologist, and involves a trial-and-error strategy. Acetaminophen and NSAIDs often are the first choice in acute treatment. Although controversial in HM, triptans can be prescribed when headaches are not relieved sufficiently with common analgesics. An effective treatment for the severe and often prolonged aura symptoms is more warranted, but currently no such acute treatment is available. Prophylactic treatment can be considered when attack frequency exceeds 2 attacks per month, or when severe attacks pose a great burden that requires reduction of severity and frequency. In no strictly preferred order, flunarizine, sodium valproate, lamotrigine, verapamil, and acetazolamide can be tried. While less evidence is available for prophylactic treatment with topiramate, candesartan, and pizotifen, these drugs can also be considered. The use of propranolol in HM is more controversial, but evidence of adverse effects is insufficient to contraindicate beta-blockers.
Collapse
Affiliation(s)
- Nadine Pelzer
- Department of Neurology, Leiden University Medical Center, P.O. Box 9600, 2300, RC Leiden, The Netherlands
| | | | | | | | | |
Collapse
|