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Curtiss P, Svigos K, Schwager Z, Lo Sicco K, Franks AG. Part I: Epidemiology, pathophysiology, and clinical considerations of primary and secondary Raynaud's phenomenon. J Am Acad Dermatol 2024; 90:223-234. [PMID: 35809798 DOI: 10.1016/j.jaad.2022.06.1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/24/2022]
Abstract
Raynaud's phenomenon (RP) is a relatively common disease with both primary and secondary forms. It is well understood as a vasospastic condition affecting the acral and digital arteries, resulting in characteristic, well-demarcated color changes typically in the hands and feet in response to cold or stress. Secondary RP (SRP) has been described in association with a variety of rheumatologic and nonrheumatologic diseases, environmental exposures, and/or medications. While both primary RP and SRP may impact the quality of life, SRP may lead to permanent and potentially devastating tissue destruction when undiagnosed and untreated. It is therefore crucial for dermatologists to distinguish between primary and secondary disease forms early in clinical evaluation, investigate potential underlying causes, and risk stratify SRP patients for the development of associated autoimmune connective tissue disease. The epidemiology, pathogenesis, and clinical presentation and diagnosis of both forms of RP are described in detail in this review article.
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Affiliation(s)
- Paul Curtiss
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Katerina Svigos
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Zachary Schwager
- Department of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.
| | - Andrew G Franks
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York; Department of Internal Medicine, Division of Rheumatology, New York University School of Medicine, New York, New York
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2
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Pelzer N, Hoogeveen ES, Haan J, Bunnik R, Poot CC, van Zwet EW, Inderson A, Fogteloo AJ, Reinders MEJ, Middelkoop HAM, Kruit MC, van den Maagdenberg AMJM, Ferrari MD, Terwindt GM. Systemic features of retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations: a monogenic small vessel disease. J Intern Med 2019; 285:317-332. [PMID: 30411414 DOI: 10.1111/joim.12848] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S) is a small vessel disease caused by C-terminal truncating TREX1 mutations. The disease is typically characterized by vascular retinopathy and focal and global brain dysfunction. Systemic manifestations have also been reported but not yet systematically investigated. METHODS In a cross-sectional study, we compared the clinical characteristics of 33 TREX1 mutation carriers (MC+) from three Dutch RVCL-S families with those of 37 family members without TREX1 mutation (MC-). All participants were investigated using personal interviews, questionnaires, physical, neurological and neuropsychological examinations, blood and urine tests, and brain MRI. RESULTS In MC+, vascular retinopathy and Raynaud's phenomenon were the earliest symptoms presenting from age 20 onwards. Kidney disease became manifest from around age 35, followed by liver disease, anaemia, markers of inflammation and, in some MC+, migraine and subclinical hypothyroidism, all from age 40. Cerebral deficits usually started mildly around age 50, associated with white matter and intracerebral mass lesions, and becoming severe around age 60-65. CONCLUSIONS Retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations is a rare, but likely underdiagnosed, systemic small vessel disease typically starting with vascular retinopathy, followed by multiple internal organ disease, progressive brain dysfunction, and ultimately premature death.
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Affiliation(s)
- N Pelzer
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - E S Hoogeveen
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J Haan
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Neurology, Alrijne Hospital, Leiderdorp, The Netherlands
| | - R Bunnik
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - C C Poot
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - E W van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - A Inderson
- Department of Gastroenterology-Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - A J Fogteloo
- Department of Internal Medicine (Acute Care), Leiden University Medical Centre, Leiden, The Netherlands
| | - M E J Reinders
- Department of Internal Medicine (Nephrology), Leiden University Medical Centre, Leiden, The Netherlands
| | - H A M Middelkoop
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | - M C Kruit
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - A M J M van den Maagdenberg
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - M D Ferrari
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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3
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Stam AH, Kothari PH, Shaikh A, Gschwendter A, Jen JC, Hodgkinson S, Hardy TA, Hayes M, Kempster PA, Kotschet KE, Bajema IM, van Duinen SG, Maat-Schieman MLC, de Jong PTVM, de Smet MD, de Wolff-Rouendaal D, Dijkman G, Pelzer N, Kolar GR, Schmidt RE, Lacey J, Joseph D, Fintak DR, Grand MG, Brunt EM, Liapis H, Hajj-Ali RA, Kruit MC, van Buchem MA, Dichgans M, Frants RR, van den Maagdenberg AMJM, Haan J, Baloh RW, Atkinson JP, Terwindt GM, Ferrari MD. Retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations. Brain 2018; 139:2909-2922. [PMID: 27604306 DOI: 10.1093/brain/aww217] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 07/11/2016] [Indexed: 02/02/2023] Open
Affiliation(s)
- Anine H Stam
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Parul H Kothari
- Department of Medicine, Division of Rheumatology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | - Aisha Shaikh
- Department of Medicine, Division of Rheumatology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | - Andreas Gschwendter
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians Universität, D-81377 München, Germany
| | - Joanna C Jen
- Department of Neurology, University of California at Los Angeles, Los Angeles, California 90095, USA
| | - Suzanne Hodgkinson
- Department of Neurology, Liverpool Hospital, Liverpool, New South Wales 2170, Australia
| | - Todd A Hardy
- Department of Neurology, Concord Repatriation General Hospital, Concord, New South Wales 2139, Australia.,Brain and Mind Centre, University of Sydney, Australia
| | - Michael Hayes
- Department of Neurology, Concord Repatriation General Hospital, Concord, New South Wales 2139, Australia
| | - Peter A Kempster
- Neurosciences Department, Monash Medical Centre, Clayton, Victoria 3168, Australia
| | - Katya E Kotschet
- Neurosciences Department, Monash Medical Centre, Clayton, Victoria 3168, Australia
| | - Ingeborg M Bajema
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sjoerd G van Duinen
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Paulus T V M de Jong
- Department of Ophthalmology, Academic Medical Centre, 1100 DD Amsterdam, The Netherlands.,Department of Retinal Signaling, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, 1000 GC Amsterdam, The Netherlands.,Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marc D de Smet
- Department of Ophthalmology, Academic Medical Centre, 1100 DD Amsterdam, The Netherlands
| | | | - Greet Dijkman
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Nadine Pelzer
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Grant R Kolar
- Department of Medicine, Division of Rheumatology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, 63110 USA
| | - Robert E Schmidt
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, 63110 USA
| | - JoAnne Lacey
- West County Radiology Group, Mercy Hospital in St Louis, MO 63141, USA
| | - Daniel Joseph
- The Retina Institute, Department of Ophthalmology, Washington University School of Medicine, St. Louis, Missouri, 63110 USA
| | - David R Fintak
- The Retina Institute, Department of Ophthalmology, Washington University School of Medicine, St. Louis, Missouri, 63110 USA
| | - M Gilbert Grand
- The Retina Institute, Department of Ophthalmology, Washington University School of Medicine, St. Louis, Missouri, 63110 USA
| | - Elizabeth M Brunt
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, 63110 USA
| | - Helen Liapis
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, 63110 USA
| | - Rula A Hajj-Ali
- Department of Rheumatic and Immunologic Disease, Cleveland Clinic, Cleveland, Ohio, 44195 USA
| | - Mark C Kruit
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians Universität, D-81377 München, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Rune R Frants
- Department of Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Arn M J M van den Maagdenberg
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joost Haan
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Neurology, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Robert W Baloh
- Department of Neurology, University of California at Los Angeles, Los Angeles, California 90095, USA
| | - John P Atkinson
- Department of Medicine, Division of Rheumatology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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5
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Ferrari MD, Klever RR, Terwindt GM, Ayata C, van den Maagdenberg AMJM. Migraine pathophysiology: lessons from mouse models and human genetics. Lancet Neurol 2015; 14:65-80. [PMID: 25496898 DOI: 10.1016/s1474-4422(14)70220-0] [Citation(s) in RCA: 259] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Migraine is a common, disabling, and undertreated episodic brain disorder that is more common in women than in men. Unbiased genome-wide association studies have identified 13 migraine-associated variants pointing at genes that cluster in pathways for glutamatergic neurotransmission, synaptic function, pain sensing, metalloproteinases, and the vasculature. The individual pathogenetic contribution of each gene variant is difficult to assess because of small effect sizes and complex interactions. Six genes with large effect sizes were identified in patients with rare monogenic migraine syndromes, in which hemiplegic migraine and non-hemiplegic migraine with or without aura are part of a wider clinical spectrum. Transgenic mouse models with human monogenic-migraine-syndrome gene mutations showed migraine-like features, increased glutamatergic neurotransmission, cerebral hyperexcitability, and enhanced susceptibility to cortical spreading depression, which is the electrophysiological correlate of aura and a putative trigger for migraine. Enhanced susceptibility to cortical spreading depression increased sensitivity to focal cerebral ischaemia, and blocking of cortical spreading depression improved stroke outcome in these mice. Changes in female hormone levels in these mice modulated cortical spreading depression susceptibility in much the same way that hormonal fluctuations affect migraine activity in patients. These findings confirm the multifactorial basis of migraine and might allow new prophylactic options to be developed, not only for migraine but potentially also for migraine-comorbid disorders such as epilepsy, depression, and stroke.
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Affiliation(s)
- Michel D Ferrari
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands.
| | - Roselin R Klever
- Department of Human Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | - Cenk Ayata
- Department of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Arn M J M van den Maagdenberg
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands; Department of Human Genetics, Leiden University Medical Centre, Leiden, Netherlands
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6
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Guidetti D, Rota E, Morelli N, Immovilli P. Migraine and stroke: "vascular" comorbidity. Front Neurol 2014; 5:193. [PMID: 25339937 PMCID: PMC4189436 DOI: 10.3389/fneur.2014.00193] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/15/2014] [Indexed: 01/03/2023] Open
Abstract
Several comorbidities are associated to migraine. Recent meta-analyses have consistently demonstrated a relationship between migraine and stroke, which is well-defined for ischemic stroke and migraine with aura (MA), even stronger in females on oral contraceptives or smokers. However, there seems to be no clear-cut association between stroke in migraineurs and the common vascular risk factors, at least in the young adult population. Migraineurs also run an increased risk of hemorrhagic stroke, while the association between migraine and cardiovascular disease remains poorly defined. Another aspect is the relationship between migraine and the presence of silent brain lesions. It has been demonstrated that there is an increased frequency of ischemic lesions in the white matter of migraineurs, especially silent infarcts in the posterior circulation territory in patients with at least 10 attacks per month. Although there is a higher prevalence of patent foramen ovale (PFO) in migraineurs, the relationship between migraine and PFO remains controversial and PFO closure is not a recommended procedure to prevent migraine. As an increased frequency of cervical artery dissections has been observed in migrainous patients, it has been hypothesized that migraine may represent a predisposing factor for cervical artery dissection. There still remains the question as to whether migraine should be considered a true “vascular disease” or if the comorbidity between migraine and cerebrovascular disease may have underlying shared risk factors or pathophysiological mechanisms. Although further studies are required to clarify this issue, current evidence supports a clinical management where MA patients should be screened for other concomitant vascular risk factors and treated accordingly.
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Affiliation(s)
- Donata Guidetti
- Neurology Unit, Guglielmo da Saliceto Hospital , Piacenza , Italy
| | - Eugenia Rota
- Neurology Unit, Guglielmo da Saliceto Hospital , Piacenza , Italy
| | - Nicola Morelli
- Neurology Unit, Guglielmo da Saliceto Hospital , Piacenza , Italy
| | - Paolo Immovilli
- Neurology Unit, Guglielmo da Saliceto Hospital , Piacenza , Italy
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8
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Chu ERL, Lee AW, Chen CS. Resolution of visual field constriction with verapamil in a patient with bilateral optic neuropathy, migraine and Raynaud's phenomenon. Intern Med J 2010; 39:851-3. [PMID: 20233249 DOI: 10.1111/j.1445-5994.2009.02080.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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9
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Di Lorenzo C, Di Lorenzo G, Santorelli FM. Pharmacogenomics and medication overuse headache: when the cure may turn to poison. Pharmacogenomics 2010; 10:1557-9. [PMID: 19842926 DOI: 10.2217/pgs.09.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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10
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Abstract
Migraine attacks with auras are sometimes associated with underlying hereditary or acquired cerebrovascular disorders. A unifying pathophysiological explanation linking migraine to these conditions has been difficult to identify. On the basis of genetic and epidemiological evidence, we suggest that changes in blood vessels, hypoperfusion disorders, and microembolisation can cause neurovascular dysfunction and evoke cortical spreading depression, an event that is widely thought to underlie aura symptoms. In fact, recent experimental data have indicated that focal, mild, and transient ischaemia can trigger cortical spreading depression without an enduring tissue signature. Although migraine with aura has many causes (eg, neuronal network excitability), it seems that migraine and stroke might both be triggered by hypoperfusion and could therefore exist on a continuum of vascular complications in a subset of patients who have these hereditary or acquired comorbid vascular conditions.
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11
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Van Den Maagdenberg AMJM, Terwindt GM, Haan J, Frants RR, Ferrari MD. Genetics of headaches. HANDBOOK OF CLINICAL NEUROLOGY 2010; 97:85-97. [PMID: 20816412 DOI: 10.1016/s0072-9752(10)97006-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Insight into the molecular mechanisms involved in primary headaches is important to identify drug targets for improving treatment of patients, but essentially lacking. Genetic research is increasingly successful in pinpointing these mechanisms. Most progress has been made for Familial Hemiplegic Migraine, a rare subtype of migraine with aura. Three genes (CACNA1A, ATP1A2 and SCN1A) have been identified that all encode ion transporters. Cellular and transgenic mouse studies suggest that neuronal hyperexcitability and increased susceptibility to cortical spreading depression, the correlate of migraine aura, are important molecular mechanisms in migraine. Investigating monogenic diseases in which migraine is a prominent feature such as CADASIL, which is caused by mutations in the NOTCH3 gene, can help understanding the pathology of migraine. Candidate gene association studies and linkage studies in the common forms of migraine were less successful. Except for the MTHFR gene no gene variant has been identified yet. Convincingly demonstrated genetic findings in other primary headaches such as cluster headache and tension-type headache are even rarer. However, with current technical possibilities of massive genotyping and international efforts to collect large well-phenotyped patient cohorts, the first gene variants for various primary headache types are likely to be discovered in the coming decade.
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12
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Stam AH, Haan J, van den Maagdenberg AMJM, Ferrari MD, Terwindt GM. Migraine and Genetic and Acquired Vasculopathies. Cephalalgia 2009; 29:1006-17. [PMID: 19689610 DOI: 10.1111/j.1468-2982.2009.01940.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.
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Affiliation(s)
- AH Stam
- Department of Neurology, Leiden University Medical Centre, Leiden
| | - J Haan
- Department of Neurology, Leiden University Medical Centre, Leiden
- Department of Neurology, Rijnland Hospital, Leiderdorp, the Netherlands
| | - AMJM van den Maagdenberg
- Department of Neurology, Leiden University Medical Centre, Leiden
- Department of Human Genetics, Leiden University Medical Centre, Leiden
| | - MD Ferrari
- Department of Neurology, Leiden University Medical Centre, Leiden
| | - GM Terwindt
- Department of Neurology, Leiden University Medical Centre, Leiden
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13
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Bonavita V, De Simone R. Towards a definition of comorbidity in the light of clinical complexity. Neurol Sci 2008; 29 Suppl 1:S99-102. [PMID: 18545908 DOI: 10.1007/s10072-008-0898-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clinical complexity encompasses multiple levels, including all the disorders and conditions experienced by a person along cross-sectional and longitudinal contexts, the diversity of severity levels and courses of clinical conditions, but also the plurality of values of people experiencing health problems and seeking help for them. The term comorbidity refers to the association of two distinct diseases in the same individual at a rate higher than expected by chance. Looking systematically to comorbidity represents the main road to approach patients' clinical complexity. Once epidemiologically established through population or community surveys, the study of the comorbidity direction and of the chronological patterns of associated clinical entities may offer relevant information from both a clinical and a scientific point of view. Comorbidity profiles of migraine and tension-type headache offer a paradigmatic example to appraise and highlight headache patient clinical complexity, allowing the conversion of diagnosis from a validated cluster of symptoms to a person-centred clinical diagnosis.
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Affiliation(s)
- Vincenzo Bonavita
- Headache Centre Department of Neurological Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
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14
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Facheris MF, Vogl FD, Hollmann S, Sixt G, Pattaro C, Schönhuber R, Pramstaller PP. Adapted Finnish Migraine-Specific Questionnaire for family studies (FMSQFS): a validation study in two languages. Eur J Neurol 2008; 15:1071-4. [DOI: 10.1111/j.1468-1331.2008.02248.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
PURPOSE OF REVIEW To highlight recent genetic findings in migraine and discuss, new mutations in hemiplegic migraine genes in familial and sporadic cases and relevant candidate gene association studies. Special attention will be given to comorbid diseases of migraine. RECENT FINDINGS Familial hemiplegic migraine (FHM) is genetically heterogeneous with mutations in the CACNA1A (FHM1), ATP1A2 (FHM2) and SCN1A (FHM3) genes. Nineteen novel ATP1A2 mutations were identified last year, eleven of them in FHM2 families. A systematic genetic analysis of patients with sporadic hemiplegic migraine revealed five mutations in this gene, which has implications for genetic counselling. The identification of a second FHM3 SCN1A mutation definitely established SCN1A as a migraine gene. The identification of TREX1 mutations in families with retinal vasculopathy and associated diseases such as migraine may provide new insights in migraine pathophysiology. SUMMARY Many novel ATP1A2 mutations were identified in patients with familial and sporadic hemiplegic migraine. In sporadic patients, ATP1A2 screening has the highest chance of finding a causal mutation. A second FHM3 mutation definitely established the epilepsy SCN1A gene as a migraine gene. The discovery of genes in monogenic diseases in which migraine is prominent may lead to new insights in the molecular pathways involved in migraine pathophysiology.
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Abstract
A debate is presented that examines whether it is the blood vessel or the brain that determines the essence of migraine.
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Affiliation(s)
- David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
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17
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Vanmolkot KRJ, Terwindt GM, Frants RR, Haan J, van den Maagdenberg AMJM, Ferrari MD. A Gene for a New Monogenic Neurovascular Migraine Syndrome: A Next Step in Unravelling Molecular Pathways for Migraine? Cephalalgia 2008; 28:471-3. [DOI: 10.1111/j.1468-2982.2007.01511.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- KRJ Vanmolkot
- Department of Human Genetics, Leiden University Medical Centre, Leiden
| | - GM Terwindt
- Department of Neurology, Leiden University Medical Centre, Leiden
| | - RR Frants
- Department of Human Genetics, Leiden University Medical Centre, Leiden
| | - J Haan
- Department of Neurology, Leiden University Medical Centre, Leiden
- Department of Neurology, Rijnland Hospital, Leiderdorp, the Netherlands
| | - AMJM van den Maagdenberg
- Department of Human Genetics, Leiden University Medical Centre, Leiden
- Department of Neurology, Leiden University Medical Centre, Leiden
| | - MD Ferrari
- Department of Neurology, Leiden University Medical Centre, Leiden
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Bernatsky S, Pineau CA, Lee JL, Clarke AE. Headache, Raynaud's syndrome and serotonin receptor agonists in systemic lupus erythematosus. Lupus 2007; 15:671-4. [PMID: 17120594 DOI: 10.1177/0961203306069997] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are potential concerns regarding serotonin receptor agonists in SLE patients with migraine, particularly patients with concomitant Raynaud's syndrome. We estimated the prevalence of lupus-related headache and Raynaud's syndrome in the Montreal General Hospital SLE clinic cohort and evaluated the relationship between these two variables in multivariable logistic regression models, controlling for age, sex, race, SLE duration and the presence of lupus anticoagulant and antibodies to cardiolipin and beta2 glycoprotein I. We also assessed, through chart review in those individuals with both Raynaud's syndrome and migraine, a history of serotonin receptor agonist use, and any associated worsening vasospasm. Based on Systemic Lupus Activity Measure (SLAM) scores, the cumulative incidence of lupus-related headache in our sample (n = 391) was 46.1%; the prevalence of Raynaud's syndrome was 49.4%. The adjusted odds ratio (OR) for lupus-related headache and Raynaud's syndrome was 1.7 (95% CI 1.1, 2.5). In addition, there was a strong independent relationship between headache and anti-beta2 glycoprotein I antibodies (adjusted OR 5.6 [95% CI 1.8, 17.0]). The data from our chart review suggest that careful use of serotonin receptor agonists in patients with both Raynaud's syndrome and migraines may be undertaken, although caution would necessitate that these agents not be used in individuals with very severe Raynaud's (eg, digital ulcerations, and so on).
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Affiliation(s)
- S Bernatsky
- Division of Clinical Epidemiology, Montreal General Hospital, Montreal, PQ, Canada
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19
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Migraine as a Cerebral Ionopathy with Abnormal Central Sensory Processing**Some portions of the pathophysiology have appeared fully referenced [1]. Neurobiol Dis 2007. [DOI: 10.1016/b978-012088592-3/50034-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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