[Conservative therapy in endocrine orbitopathy: "State of the art"]

The vascular risk associations with migraine: relation to migraine susceptibility and progression

Migraine is a common disorder in which changes in cortical excitability, neuroinflammation and dysfunction of the vascular wall contribute to its pathophysiology. Repeated attacks of migraine over prolonged periods result in inflammatory arteriopathy of the cranial vessels. Several studies indicate that migraine is associated with special pattern of inflammatory markers and some adverse vascular risk factors including: increased levels of CRP, ILs, TNF-alpha and adhesion molecules which are markers of systemic inflammation, oxidative stress and thrombosis, increased body weight, high blood pressure, hypercholesterolemia, impaired insulin sensitivity, high homocysteine levels, stroke and coronary heart disease. Such comorbidities are not explained by bias but indicate possible shared underlying pathogenic mechanisms. Recent studies have shown involvement of cranial as well as peripheral vascular dysfunction with migraine indicating that migraine may be a local manifestation of a systemic disease rather than a primary brain phenomenon. The associated inflammatory process of migraine together with the associated adverse medical comorbidities exposes patients to endothelial vascular wall injury which further increases migraine susceptibility and progression as well as increases the risk for atherogenesis. The knowledge that migraine is a risk for vascular diseases raises important clinical implications, recommendations and future perspectives in migraine treatment and prevention.

Serum thyroid hormone balance and lipid profile in patients with epilepsy

PURPOSE

Patients with epilepsy may exhibit changes in thyroid hormone balance, lipids and lipoproteins concentrations. The suggestion that lipid abnormalities are associated with subclinical thyroid dysfunction remains controversial. The aim of this study was to analyze whether thyroid dysfunction encountered in patients with epilepsy would also be associated with abnormal lipid profile.

METHODS

Eighty-eight patients with epilepsy and 30 control subjects were included in the study. A fasting blood sample for thyroid hormones, lipid profile and GGT determination was obtained.

RESULTS

The serum levels of FT3 was elevated in 10.2% of patients, FT4 was low in 28.4%, TSH was high in 4.6% and low in 2.3%. 13.6% of patients had high TC, 17.1% had high LDL-c, 60.2% had marked reduction of HDL-c levels (P<0.0001) and only 2.3% had high TG levels. Abnormalities were predominated in CBZ-treated patients. 27.3% patients with abnormal hormones had abnormal lipid profile. Significant association was identified between the serum TC, LDL-c, TG, GGT and EIAEDs and between the duration of illness and TG (r=-0.411; P=0.017), and FT4 (r=-0.412; P=0.018). HDL was higher in women than men (r=0.416; P<0.002). However, changes in HDL-c levels associated neither with duration of illness, type or serum levels of AEDs nor with age or degree of control on AEDs.

CONCLUSIONS

Our results support that (1) altered lipid metabolism might be associated but not solely influenced by thyroid hormones and (2) enzyme induction is not the main or only reason for altered thyroid function or HDL-c among patients with epilepsy. Hypothalamic/pituitary dysregulation by precisely mechanism caused by epilepsy itself or AEDs seems possible and (3) it is important to recognize that patients with epilepsy are at great risk for atherosclerosis, hence monitoring and correction of the culprit risks are mandatory.