1
|
Zhu H, Wang W, Li Y. The interplay between microbiota and brain-gut axis in epilepsy treatment. Front Pharmacol 2024; 15:1276551. [PMID: 38344171 PMCID: PMC10853364 DOI: 10.3389/fphar.2024.1276551] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/12/2024] [Indexed: 08/12/2024] Open
Abstract
The brain-gut axis plays a vital role in connecting the cognitive and emotional centers of the brain with the intricate workings of the intestines. An imbalance in the microbiota-mediated brain-gut axis extends far beyond conditions like Irritable Bowel Syndrome (IBS) and obesity, playing a critical role in the development and progression of various neurological disorders, including epilepsy, depression, Alzheimer's disease (AD), and Parkinson's disease (PD). Epilepsy, a brain disorder characterized by unprovoked seizures, affects approximately 50 million people worldwide. Accumulating evidence suggests that rebuilding the gut microbiota through interventions such as fecal microbiota transplantation, probiotics, and ketogenic diets (KD) can benefit drug-resistant epilepsy. The disturbances in the gut microbiota could contribute to the toxic side effects of antiepileptic drugs and the development of drug resistance in epilepsy patients. These findings imply the potential impact of the gut microbiota on epilepsy and suggest that interventions targeting the microbiota, such as the KD, hold promise for managing and treating epilepsy. However, the full extent of the importance of microbiota in epilepsy treatment is not yet fully understood, and many aspects of this field remain unclear. Therefore, this article aims to provide an overview of the clinical and animal evidence supporting the regulatory role of gut microbiota in epilepsy, and of potential pathways within the brain-gut axis that may be influenced by the gut microbiota in epilepsy. Furthermore, we will discuss the recent advancements in epilepsy treatment, including the KD, fecal microbiota transplantation, and antiseizure drugs, all from the perspective of the gut microbiota.
Collapse
Affiliation(s)
- Hanxiao Zhu
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, China
- Clinical Medical School, Dali University, Dali, China
| | - Wei Wang
- Neurobiology Laboratory, China Agricultural University, Beijing, China
| | - Yun Li
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, China
- Clinical Medical School, Dali University, Dali, China
| |
Collapse
|
2
|
Abd-Allah WH, El-Mohsen Anwar MA, Mohammed ER, El Moghazy SM. Anticonvulsant Classes and Possible Mechanism of Actions. ACS Chem Neurosci 2023; 14:4076-4092. [PMID: 37948544 DOI: 10.1021/acschemneuro.3c00613] [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] [Indexed: 11/12/2023] Open
Abstract
Epilepsy is considered one of the most common neurological disorders worldwide; it needs long-term or life-long treatment. Despite the presence of several novel antiepileptic drugs, approximately 30% patients still suffer from drug-resistant epilepsy. Subsequently, searching for new anticonvulsants with lower toxicity and better efficacy is still in paramount demand. Using target-based studies in the discovery of novel antiepileptics is uncommon owing to the insufficient information on the molecular pathway of epilepsy and complex mode of action for most of known antiepileptic drugs. In this review, we investigated the properties of anticonvulsants, types of epileptic seizures, and mechanism of action for anticonvulsants.
Collapse
Affiliation(s)
- Walaa Hamada Abd-Allah
- Pharmaceutical Chemistry Department, Collage of Pharmaceutical Science and Drug Manufacturing, Misr University for Science and Technology, P.O. 77, 12568 6th of October City, Giza, Egypt
| | - Mostafa Abd El-Mohsen Anwar
- Pharmaceutical Chemistry Department, Collage of Pharmaceutical Science and Drug Manufacturing, Misr University for Science and Technology, P.O. 77, 12568 6th of October City, Giza, Egypt
| | - Eman R Mohammed
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Cairo University, 11562 Cairo, Egypt
| | - Samir M El Moghazy
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Cairo University, 11562 Cairo, Egypt
| |
Collapse
|
3
|
Green EW, Byers IS, Deutsch-Link S. Closing the Care Gap: Management of Alcohol Use Disorder in Patients with Alcohol-associated Liver Disease. Clin Ther 2023; 45:1189-1200. [PMID: 38052695 DOI: 10.1016/j.clinthera.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 12/07/2023]
Abstract
Alcohol-associated liver disease (ALD)-related morbidity and mortality are rising in the United States. Although effective medications and behavioral interventions are available for the treatment of patients with alcohol use disorder (AUD), patients with ALD are profoundly undertreated for AUD. This article reviews the management of AUD in patients with ALD, with a focus on appropriate screening and diagnosis, management of alcohol withdrawal syndrome, pharmacotherapy for AUD, alcohol biomarkers, and behavioral interventions. Expanding access to AUD treatment is imperative for improving health outcomes in patients with ALD.
Collapse
Affiliation(s)
- Ellen W Green
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Isabelle S Byers
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sasha Deutsch-Link
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
| |
Collapse
|
4
|
Cheng Z, Purcell W, Ghadiri N, Tan SZ, Madhusudhan S. Presumed topiramate-induced retinopathy in a 58-year-old woman. Digit J Ophthalmol 2023; 29:50-57. [PMID: 37727465 PMCID: PMC10506614 DOI: 10.5693/djo.02.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
We present a case of presumed topiramate-induced retinopathy in a 58-year-old woman who presented with progressive, bilateral visual loss following a 3- to 4-year history of oral topiramate intake for migraine. She reported difficulty with light adaptation, hemeralopia, and color desaturation. Her best-corrected visual acuity was 1/60 (20/1200) in the right eye and 6/18 (20/60) in the left eye, and she performed poorly on Ishihara color plate testing. Anterior segment examination was normal; dilated funduscopy showed mild macular pigmentary changes. Optical coherence tomography revealed subtle thinning and reduced reflectivity of the subfoveal ellipsoid zone and interdigitation zone bilaterally, associated with increased foveal autofluorescence. Humphrey visual field 24-2 revealed central defects. Electrodiagnostic testing showed a reduced and delayed b-wave and a normal a-wave on photopic full-field electroretinogram (ERG), with normal scotopic responses; multifocal ERG revealed reduced responses in the inner 10° in both eyes. She underwent extensive investigations including whole-body computed tomography and positron emission tomography scan, magnetic resonance imaging of the brain, uveitis screening, retinal autoantibody testing, and genetic testing on the retinal dystrophy panel to rule-out other causes for her presentation, all of which were normal or negative.
Collapse
Affiliation(s)
- Zhihang Cheng
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - William Purcell
- University of Liverpool School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Nima Ghadiri
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Shi Zhuan Tan
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
- Department of Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom
| | - Savita Madhusudhan
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
- Department of Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
5
|
Sullivan-Baca E, Lorkiewicz SA, Rehman R, Van Cott AC, Towne AR, Haneef Z. Utilization of epilepsy care among Women Veterans: A population-based study. Epilepsy Res 2023; 192:107130. [PMID: 37004372 DOI: 10.1016/j.eplepsyres.2023.107130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/01/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Higher healthcare utilization in epilepsy correlates with better clinical and quality of life outcomes. Women Veterans with epilepsy (WVE) have unique characteristics that may affect access and utilization of care. This study investigates epilepsy care in WVE, with respect to utilization of outpatient, inpatient, and emergency room care. METHODS Data were collected from 58,525 Veterans with epilepsy using the Veterans Health Administration (VHA) Corporate Data Warehouse administrative data. Overall, 8.5% of the sample were women (n = 4983). Neurology visits, comprehensive epilepsy care, neuroimaging, ASM prescription and hospital and emergency care were analyzed, and comparisons were made with men Veterans with epilepsy to identify gender differences. RESULTS Compared to men, a greater proportion of WVE utilized services including neurology (73.8% vs. 62.0%), comprehensive epilepsy care (16.1% vs. 11.7%), epilepsy monitoring unit evaluation (EMU; 6.1% vs. 2.9%), neuroimaging (CT: 39.1% vs. 36.6%; MRI: 43.7% vs. 32.5%), and electroencephalograms: (EEG: 36.5% vs. 29.1%). WVE also evidenced higher percentages of seizure-related emergency room care usage vs. men (15.2 vs. 12.6) and hospitalizations (12.3 vs. 10.0) and were prescribed a greater number of ASMs (average:2.3 vs. 1.9). Valproate was prescribed to 17.6% of WVE, despite potential teratogenic concerns. SIGNIFICANCE WVE have greater utilization of epilepsy care within the VHA system compared to men, which could lead to better epilepsy management and quality of life. However, higher rates of emergency care, hospitalizations, and concurrent ASMs among WVE highlight the clinical complexity and raise concern for potentially comorbid conditions including psychogenic non-epileptic seizures.
Collapse
Affiliation(s)
- Erin Sullivan-Baca
- Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Sara A Lorkiewicz
- Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA
| | - Rizwana Rehman
- Epilepsy Centers of Excellence, Veteran's Health Administration, USA; Durham VA Medical Center, 508 Fulton St., Durham, NC 27705, USA
| | - Anne C Van Cott
- Neurology Division, VA Pittsburgh Healthcare System, 4100 Allequippa St., Pittsburgh, PA 15240, USA; Department of Neurology, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Alan R Towne
- Epilepsy Centers of Excellence, Veteran's Health Administration, USA; Epilepsy Centers of Excellence, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd., Richmond, VA 23249, USA; Department of Neurology, Virginia Commonwealth University School of Medicine, 1201 East Marshall Street, Richmond, VA 23298, USA
| | - Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA; Epilepsy Centers of Excellence, Veteran's Health Administration, USA.
| |
Collapse
|
6
|
Seagroves A, Ross HM, Vidmar AP, Geffner ME, Kim WS, Hwang D, Borzutzky C, Fraga NR, Kim MS. Weight Loss During Topiramate Treatment in a Severely Obese Adolescent with Congenital Adrenal Hyperplasia and Migraine. J Clin Res Pediatr Endocrinol 2023; 15:81-85. [PMID: 34423627 PMCID: PMC9976166 DOI: 10.4274/jcrpe.galenos.2021.2020.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Youth with classical congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency exhibit an increased prevalence of obesity, early adiposity rebound, and increased abdominal adiposity compared to unaffected youth. Current obesity management in CAH largely focuses on lifestyle modifications. There is evidence that topiramate therapy is effective in reducing body mass index (BMI), as well as visceral adipose tissue (VAT), in unaffected adolescents with exogenous obesity. However, little is known about the efficacy of topiramate in patients with classical CAH. We report on a 17-year-old female with severe obesity and salt-wasting CAH due to 21-hydroxylase deficiency, who demonstrated reductions in BMI, as well as abdominal visceral and subcutaneous adipose tissue (SAT) while on topiramate therapy. The patient was diagnosed with classical CAH as a newborn with a 17-hydroxyprogesterone 11,000 ng/dL. She had a BMI over the 95th percentile at 3 years of age, followed by unremitting obesity. At 17 years old, she was started on topiramate to treat chronic migraines. Following three years of topiramate therapy, her BMI z-score decreased from +2.6 to +2.1. After four years of therapy, her waist circumference decreased from 110 to 101 cm, abdominal VAT decreased substantially by 34.2%, and abdominal SAT decreased by 25.6%. Topiramate therapy was associated with effective weight loss and reduced central adiposity in an adolescent with classical CAH and severe obesity, without any side effects. Further study is warranted regarding topiramate therapy in obese youth with classical CAH and increased central adiposity, who are at higher risk for significant morbidity.
Collapse
Affiliation(s)
- Amy Seagroves
- Children’s Hospital Los Angeles, Center for Endocrinology, Diabetes and Metabolism, California, USA
| | - Heather M. Ross
- Children’s Hospital Los Angeles, Center for Endocrinology, Diabetes and Metabolism, California, USA
| | - Alaina P. Vidmar
- Children’s Hospital Los Angeles, Center for Endocrinology, Diabetes and Metabolism, California, USA,University of Southern California, Keck School of Medicine, Department of Pediatrics, California, USA
| | - Mitchell E. Geffner
- Children’s Hospital Los Angeles, Center for Endocrinology, Diabetes and Metabolism, California, USA,University of Southern California, Keck School of Medicine, Department of Pediatrics, California, USA,The Saban Research Institute, California, USA
| | - William S. Kim
- Children’s Hospital Los Angeles, Center for Endocrinology, Diabetes and Metabolism, California, USA
| | - Darryl Hwang
- University of Southern California, Keck School of Medicine, Department of Pediatrics, California, USA
| | - Claudia Borzutzky
- University of Southern California, Keck School of Medicine, Department of Pediatrics, California, USA,Children’s Hospital Los Angeles, Clinic of Adolescent and Young Adult Medicine, California, USA
| | - Nicole R. Fraga
- Children’s Hospital Los Angeles, Center for Endocrinology, Diabetes and Metabolism, California, USA
| | - Mimi S. Kim
- Children’s Hospital Los Angeles, Center for Endocrinology, Diabetes and Metabolism, California, USA,University of Southern California, Keck School of Medicine, Department of Pediatrics, California, USA,The Saban Research Institute, California, USA,* Address for Correspondence: Children’s Hospital Los Angeles, Clinic of Pediatrics, California, USA Phone: +1 323-361-1358 E-mail:
| |
Collapse
|
7
|
Al-Beltagi M, Saeed NK. Epilepsy and the gut: Perpetrator or victim? World J Gastrointest Pathophysiol 2022; 13:143-156. [PMID: 36187601 PMCID: PMC9516455 DOI: 10.4291/wjgp.v13.i5.143] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/08/2022] [Accepted: 08/25/2022] [Indexed: 02/07/2023] Open
Abstract
The brain and the gut are linked together with a complex, bi-path link known as the gut-brain axis through the central and enteric nervous systems. So, the brain directly affects and controls the gut through various neurocrine and endocrine processes, and the gut impacts the brain via different mechanisms. Epilepsy is a central nervous system (CNS) disorder with abnormal brain activity, causing repeated seizures due to a transient excessive or synchronous alteration in the brain’s electrical activity. Due to the strong relationship between the enteric and the CNS, gastrointestinal dysfunction may increase the risk of epilepsy. Meanwhile, about 2.5% of patients with epilepsy were misdiagnosed as having gastrointestinal disorders, especially in children below the age of one year. Gut dysbiosis also has a significant role in epileptogenesis. Epilepsy, in turn, affects the gastrointestinal tract in different forms, such as abdominal aura, epilepsy with abdominal pain, and the adverse effects of medications on the gut and the gut microbiota. Epilepsy with abdominal pain, a type of temporal lobe epilepsy, is an uncommon cause of abdominal pain. Epilepsy also can present with postictal states with gastrointestinal manifestations such as postictal hypersalivation, hyperphagia, or compulsive water drinking. At the same time, antiseizure medications have many gastrointestinal side effects. On the other hand, some antiseizure medications may improve some gastrointestinal diseases. Many gut manipulations were used successfully to manage epilepsy. Prebiotics, probiotics, synbiotics, postbiotics, a ketogenic diet, fecal microbiota transplantation, and vagus nerve stimulation were used successfully to treat some patients with epilepsy. Other manipulations, such as omental transposition, still need more studies. This narrative review will discuss the different ways the gut and epilepsy affect each other.
Collapse
Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medica City, Arabian Gulf University, Manama 26671, Bahrain
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 26612, Bahrain
- Department of Microbiology, Irish Royal College of Surgeon, Busaiteen 15503, Muharraq, Bahrain
| |
Collapse
|
8
|
Pan LLH, Wang YF, Ling YH, Lai KL, Chen SP, Chen WT, Treede RD, Wang SJ. Pain sensitivities predict prophylactic treatment outcomes of flunarizine in chronic migraine patients: A prospective study. Cephalalgia 2022; 42:899-909. [PMID: 35400174 DOI: 10.1177/03331024221080572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND We aimed to assess the differences in quantitative sensory testing between chronic migraine and healthy controls and to explore the association between pain sensitivities and outcomes in chronic migraine following preventive treatment. METHODS In this prospective open-label study, preventive-naïve chronic migraine and healthy controls were recruited, and cold, heat, mechanical punctate, and pressure pain thresholds over the dermatomes of first branch of trigeminal nerve and first thoracic nerve were measured by quantitative sensory testing at baseline. Chronic migraines were treated with flunarizine and treatment response was defined as ≥50% reduction in the number of monthly headache days over the 12-week treatment period. RESULTS Eighty-four chronic migraines and fifty age-and-sex-matched healthy controls were included in the analysis. The chronic migraine had higher cold pain thresholds over the dermatomes of the first branch of trigeminal nerve and the first thoracic nerve (p < 0.001 and < 0.001), lower pressure pain thresholds over the dermatomes of the first thoracic nerve (p = 0.003), heat pain thresholds over the dermatomes of the first branch of the trigeminal nerve and the first thoracic nerve (p < 0.001 and p = 0.015) than healthy controls. After treatment, 24/84 chronic migraine had treatment response. The responders with relatively normal pain sensitivity had higher heat pain thresholds over the dermatome of the first branch of the trigeminal nerve (p = 0.002), mechanical punctate pain thresholds over the dermatomes of the first branch of the trigeminal nerve (p = 0.023), and pressure pain thresholds over the dermatomes of the first branch of the trigeminal nerve (p = 0.026) than the hypersensitive non-responders. Decision tree analysis showed that patients with mechanical punctate pain threshold over the dermatomes of the first branch of the trigeminal nerve > 158 g (p = 0.020) or heat pain threshold over the dermatome of the first branch of the trigeminal nerve > 44.9°C (p = 0.002) were more likely to be responders. CONCLUSIONS Chronic migraine were generally more sensitive compared to healthy controls. Preventive treatment with flunarizine should be recommended particularly for chronic migraine who have relatively normal sensitivity to mechanical punctate or heat pain.Trial registration: This study was registered on ClinicalTrials.gov (Identifier: NCT02747940).
Collapse
Affiliation(s)
- Li-Ling Hope Pan
- Brain Research Center, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Feng Wang
- College of Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hsiang Ling
- College of Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuan-Lin Lai
- College of Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Pin Chen
- Brain Research Center, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,College of Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ta Chen
- Brain Research Center, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,College of Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Neurology, 38004Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Rolf-Detlef Treede
- Chair of Neurophysiology, Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Shuu-Jiun Wang
- Brain Research Center, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,College of Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei, Taiwan
| |
Collapse
|
9
|
Huber N, Korhonen S, Hoffmann D, Leskelä S, Rostalski H, Remes AM, Honkakoski P, Solje E, Haapasalo A. Deficient neurotransmitter systems and synaptic function in frontotemporal lobar degeneration-Insights into disease mechanisms and current therapeutic approaches. Mol Psychiatry 2022; 27:1300-1309. [PMID: 34799692 PMCID: PMC9095474 DOI: 10.1038/s41380-021-01384-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/15/2022]
Abstract
Frontotemporal lobar degeneration (FTLD) comprises a heterogenous group of fatal neurodegenerative diseases and, to date, no validated diagnostic or prognostic biomarkers or effective disease-modifying therapies exist for the different clinical or genetic subtypes of FTLD. Current treatment strategies rely on the off-label use of medications for symptomatic treatment. Changes in several neurotransmitter systems including the glutamatergic, GABAergic, dopaminergic, and serotonergic systems have been reported in FTLD spectrum disease patients. Many FTLD-related clinical and neuropsychiatric symptoms such as aggressive and compulsive behaviour, agitation, as well as altered eating habits and hyperorality can be explained by disturbances in these neurotransmitter systems, suggesting that their targeting might possibly offer new therapeutic options for treating patients with FTLD. This review summarizes the present knowledge on neurotransmitter system deficits and synaptic dysfunction in model systems and patients harbouring the most common genetic causes of FTLD, the hexanucleotide repeat expansion in C9orf72 and mutations in the granulin (GRN) and microtubule-associated protein tau (MAPT) genes. We also describe the current pharmacological treatment options for FLTD that target different neurotransmitter systems.
Collapse
Affiliation(s)
- Nadine Huber
- grid.9668.10000 0001 0726 2490A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Sonja Korhonen
- grid.9668.10000 0001 0726 2490A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Dorit Hoffmann
- grid.9668.10000 0001 0726 2490A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Stina Leskelä
- grid.9668.10000 0001 0726 2490A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Hannah Rostalski
- grid.9668.10000 0001 0726 2490A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Anne M. Remes
- grid.10858.340000 0001 0941 4873Unit of Clinical Neuroscience, Neurology, University of Oulu, P. O. Box 8000, University of Oulu, FI-90014 Oulu, Finland ,grid.412326.00000 0004 4685 4917MRC Oulu, Oulu University Hospital, P. O. Box 8000, University of Oulu, FI-90014 Oulu, Finland
| | - Paavo Honkakoski
- grid.9668.10000 0001 0726 2490School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70210 Kuopio, Finland ,grid.10698.360000000122483208Department of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Eino Solje
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine—Neurology, University of Eastern Finland, P.O. Box 1627, FI-70210 Kuopio, Finland ,grid.410705.70000 0004 0628 207XNeuro Center, Neurology, Kuopio University Hospital, P.O. Box 100, KYS, FI-70029 Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
| |
Collapse
|
10
|
SUNCT/SUNA in Pediatric Age: A Review of Pathophysiology and Therapeutic Options. Brain Sci 2021; 11:brainsci11091252. [PMID: 34573272 PMCID: PMC8466007 DOI: 10.3390/brainsci11091252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 12/27/2022] Open
Abstract
The International Classification of Headache Disorders, 3rd edition (ICHD3) defines Short-lasting Unilateral Neuralgiform Headache Attacks (SUNHA) as attacks of moderate or severe, strictly unilateral head pain lasting from seconds to minutes, occurring at least once a day and usually associated with prominent lacrimation and redness of the ipsilateral eye. Two subtypes of SUNHA are identified: Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT) and Short-lasting Unilateral Neuralgiform headache attacks with cranial Autonomic symptoms (SUNA). These pathologies are infrequent in children and difficult to diagnose. The authors reviewed the existing literature on SUNCT and SUNA, especially in the developmental age, which describes the pathophysiology in detail and focuses on the therapeutic options available to date. SUNHA-type headaches must be considered on the one hand, for the possibility of the onset of forms secondary to underlying pathologies even of a neoplastic nature, and on the other hand, for the negative impact they can have on an individual’s quality of life, particularly in young patients. Until now, published cases suggest that no chronic variants occur in childhood and adolescents. In light of this evidence, the authors offer a review that may serve as a source to be drawn upon in the implementation of suitable treatments in children and adolescents suffering from these headaches, focusing on therapies that are non-invasive and as risk-free as possible for pediatric patients.
Collapse
|
11
|
Alzendi NA, Badawi AH, Alhazzaa B, Alshahrani A, Owaidhah O. Topiramate-induced angle closure glaucoma: Two unique case reports. Saudi J Ophthalmol 2021; 34:202-204. [PMID: 34085015 PMCID: PMC8081079 DOI: 10.4103/sjopt.sjopt_9_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/31/2020] [Accepted: 12/02/2020] [Indexed: 01/25/2023] Open
Abstract
The aim of this study is to report the side effects of oral topiramate in two young patients presented with bilateral ocular blurring and discomfort, causing unique development of secondary acute angle closure (AAC) after discontinuation of oral topiramate. Both patients, with a history of seizure and migraine, respectively, were taking oral topiramate to control their mentioned diseases. Both had secondary AAC and high intraocular pressure, after discontinuing topiramate. They were treated with topical medications and underwent initial and subsequent multimodal imaging to track up their response to the management. Ocular side effect, during topiramate use and possibly even after discontinuation, will improve early detection of secondary AAC. Topical management along with multimodal imaging of such cases can give optimal results.
Collapse
Affiliation(s)
- Nouf A Alzendi
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Bader Alhazzaa
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ali Alshahrani
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ohoud Owaidhah
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| |
Collapse
|
12
|
Mishra P, Sinha JK, Rajput SK. Efficacy of Cicuta virosa medicinal preparations against pentylenetetrazole-induced seizures. Epilepsy Behav 2021; 115:107653. [PMID: 33358679 DOI: 10.1016/j.yebeh.2020.107653] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/03/2020] [Accepted: 11/19/2020] [Indexed: 12/15/2022]
Abstract
Epileptic seizures are characterized by imbalanced inhibition-excitation cycle that triggers biochemical alterations responsible for jeopardized neuronal integrity. Conventional antiepileptic drugs (AEDs) have been the mainstay option for treatment and control; however, symptomatic control and potential to exacerbate the seizure condition calls for viable alternative to these chemical agents. In this context, natural product-based therapies have accrued great interest in recent years due to competent disease management potential and lower associated adversities. Cicuta virosa (CV) is one such herbal remedy that is used in traditional system of medicine against myriad of disorders including epilepsy. Homeopathic medicinal preparations (HMPs) of CV were assessed for their efficacy in pentylenetetrazole (PTZ)-induced acute and kindling models of epilepsy. CV HMPs increased the latency and reduced the duration of tonic-clonic phase in acute model while lowering the kindling score in the kindling model that signified their role in modulating GABAergic neurotransmission and potassium conductance. Kindling-induced impairment of cognition, memory, and motor coordination was ameliorated by the CV HMPs that substantiated their efficacy in imparting sustained neuronal fortification. Furthermore, biochemical evaluation showed attenuated oxidative stress load through reduced lipid peroxidation and strengthened free radical scavenging mechanism. Taken together, CV HMPs exhibited promising results in acute and kindling models and must be further assessed through molecular and epigenomic studies.
Collapse
Affiliation(s)
- Priya Mishra
- Amity Institute of Neuropsychology and Neurosciences (AINN), Amity University, Uttar Pradesh, Noida 201303, India.
| | - Jitendra Kumar Sinha
- Amity Institute of Neuropsychology and Neurosciences (AINN), Amity University, Uttar Pradesh, Noida 201303, India.
| | - Satyendra Kumar Rajput
- Department of Pharmaceutical Sciences, Gurukul Kangri (deemed to be University), Haridwar, Uttrakhand, 249404, India.
| |
Collapse
|
13
|
Tzeng HR, Lee MT, Fan PC, Knutson DE, Lai TH, Sieghart W, Cook J, Chiou LC. α6GABA A Receptor Positive Modulators Alleviate Migraine-like Grimaces in Mice via Compensating GABAergic Deficits in Trigeminal Ganglia. Neurotherapeutics 2021; 18:569-585. [PMID: 33111258 PMCID: PMC8116449 DOI: 10.1007/s13311-020-00951-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2020] [Indexed: 11/29/2022] Open
Abstract
Migraine is caused by hyperactivity of the trigeminovascular system, where trigeminal ganglia (TG) play an important role. This hyperactivity might originate from an underfunctional GABAergic system in TG. To investigate this possibility, we adapted a mouse model of migraine by inducing migraine-like grimaces in male mice via repeated injections of nitroglycerin (NTG, 10 mg/kg, i.p.), once every 2 days, for up to 5 sessions. Migraine-like facial pain scores were measured using the mouse grimace scale. Repeated NTG treatments in mice caused significant increases in migraine-like grimaces that were aborted and prevented by two anti-migraine agents sumatriptan and topiramate, respectively. After 5 sessions of NTG injections, the GABA-synthesizing enzyme, 65-kDa glutamate decarboxylase (GAD65), but not the GABA transporter 1 (GAT1) or the α6 subunit-containing GABAA receptors (α6GABAARs), was downregulated in mouse TG tissues. Taking advantage of the unaffected TG α6GABAAR expression in NTG-treated mice, we demonstrated that an α6GABAAR-selective positive allosteric modulator (PAM), DK-I-56-1, exhibited both abortive and prophylactic effects, comparable to those of sumatriptan and topiramate, respectively, in this migraine-mimicking mouse model. The brain-impermeable furosemide significantly prevented the effects of DK-I-56-1, suggesting its peripheral site of action, likely via preventing α6GABAAR modulation in TG. Results suggest that a decreased GABA synthesis caused by the reduced GAD65 expression in TG contributes to the trigeminovascular activation in this repeated NTG-induced migraine-mimicking model and that the unaltered α6GABAARs in TG are potential targets for migraine treatment. Thus, α6GABAAR-selective PAMs are potential anti-migraine agents for both abortive and preventive therapies.
Collapse
Affiliation(s)
- Hung-Ruei Tzeng
- Department of Pharmacology, Graduate Institute of Pharmacology College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd., Section 1, Taipei, 10051, Taiwan
| | - Ming Tatt Lee
- Graduate Institute of Brain and Mind Sciences College of Medicine, National Taiwan University, Taipei, 10051, Taiwan
- Faculty of Pharmaceutical Sciences, UCSI University, 56000, Kuala Lumpur, Malaysia
| | - Pi-Chuan Fan
- Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, Taipei, 10002, Taiwan
| | - Daniel E Knutson
- Department of Chemistry and Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, WI, 53211, USA
| | - Tzu-Hsuan Lai
- Department of Pediatrics, National Taiwan University Hospital, Taipei, 10002, Taiwan
| | - Werner Sieghart
- Center for Brain Research, Department of Molecular Neurosciences, Medical University Vienna, 1090, Vienna, Austria
| | - James Cook
- Department of Chemistry and Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, WI, 53211, USA
| | - Lih-Chu Chiou
- Department of Pharmacology, Graduate Institute of Pharmacology College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd., Section 1, Taipei, 10051, Taiwan.
- Graduate Institute of Brain and Mind Sciences College of Medicine, National Taiwan University, Taipei, 10051, Taiwan.
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, 40402, Taiwan.
| |
Collapse
|
14
|
Orsolini L, Pompili S, Volpe U. The ‘collateral side’ of mood stabilizers: safety and evidence-based strategies for managing side effects. Expert Opin Drug Saf 2020; 19:1461-1495. [DOI: 10.1080/14740338.2020.1820984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Simone Pompili
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| |
Collapse
|
15
|
Watkins AK, Gee ME, Brown JN. Efficacy and safety of levetiracetam for migraine prophylaxis: A systematic review. J Clin Pharm Ther 2018; 43:467-475. [DOI: 10.1111/jcpt.12715] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 10/10/2017] [Indexed: 12/13/2022]
Affiliation(s)
- A. K. Watkins
- Geriatric Research, Education, and Clinical Center; Durham VA Health Care System; Durham NC USA
| | - M. E. Gee
- Geriatric Research, Education, and Clinical Center; Durham VA Health Care System; Durham NC USA
| | - J. N. Brown
- Pharmacy Service; Durham VA Health Care System; Durham NC USA
| |
Collapse
|
16
|
Kurt A, Kalkan Y, Turut H, Cure MC, Tumkaya L, Cure E. Topiramate Reduces Aortic Cross-Clamping-Induced Lung Injury in Male Rats. ACTA MEDICA (HRADEC KRALOVE) 2018; 61:144-149. [PMID: 30664447 DOI: 10.14712/18059694.2018.133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Topiramate (TPM) decreases cytokine release and generation of reactive oxygen species (ROS). Cytokine and endothelin-1 (ET-1) secretion and ROS formation play an important role in ischemia-reperfusion (I/R) injury. We aimed to evaluate whether TPM prevents damage occurring in lung tissue during I/R. MATERIALS AND METHODS A total of 27 Wistar albino rats were divided into three groups of nine. To the I/R group, two hours of ischemia via infrarenal abdominal aorta cross-ligation and then two hours of reperfusion process were applied. TPM (100 mg/kg/day) orally for seven days was administered in the TPM treatment group. After the last dose of TPM treatment, respectively, two hours of ischemia and two hours of reperfusion were applied in this group. RESULTS Tumor necrosis factor-alpha (TNF-α) (p < 0.05), malondialdehyde (MDA) (p < 0.05), myeloperoxidase (MPO) (p < 0.05) and ET-1 (p < 0.05) levels of TPM treatment group's lung tissue were significantly lower than for the I/R group. Caspase-3 and histopathological damage were rather lower than that of the I/R group. CONCLUSIONS During I/R, lung damage occurs due to excessive TNF-α and ET-1 release and ROS generation. TPM could well reduce development of lung damage by decreasing cytokine and ET-1 release and levels of ROS produced.
Collapse
Affiliation(s)
- Aysel Kurt
- Private Practice, Department of Thoracic Surgery, Rize, Turkey
| | - Yildiray Kalkan
- Private Practice, Department of Histology and Embryology, Rize, Turkey
| | - Hasan Turut
- Recep Tayyip Erdogan University, School of Medicine, Department of Thoracic Surgery, Rize, Turkey
| | | | - Levent Tumkaya
- Recep Tayyip Erdogan University, School of Medicine, Department of Histology and Embryology, Rize, Turkey
| | - Erkan Cure
- Camlica Erdem Hospital, Department of Internal Medicine, Istanbul, Turkey.
| |
Collapse
|
17
|
Topiramate-induced paresthesia is more frequently reported by migraine than epileptic patients. Neurol Sci 2016; 37:585-9. [DOI: 10.1007/s10072-015-2458-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 12/21/2015] [Indexed: 11/26/2022]
|
18
|
Smith MB, Griffiths EA, Thompson JE, Wang ES, Wetzler M, Freyer CW. High pseudotumor cerebri incidence in tretinoin and arsenic treated acute promyelocytic leukemia and the role of topiramate after acetazolamide failure. Leuk Res Rep 2014; 3:62-6. [PMID: 25180154 PMCID: PMC4145165 DOI: 10.1016/j.lrr.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/09/2014] [Accepted: 07/14/2014] [Indexed: 12/28/2022] Open
Abstract
Dual differentiation therapy with arsenic trioxide and tretinoin (all-trans-retinoic acid; ATRA) for the management of low and intermediate risk acute promyelocytic leukemia has recently been recommended by the National Comprehensive Cancer Network. Some less common toxicities of the combination may have yet to be fully realized. Of ten patients we have treated thus far, five (50%) have developed pseudotumor cerebri. In one patient, temporary discontinuation of ATRA and initiation of acetazolamide controlled symptoms. In four patients, topiramate was substituted for acetazolamide to relieve symptoms and allow ATRA dose re-escalation. We conclude that providers should monitor for pseudotumor cerebri and consider topiramate if acetazolamide fails. We identify five cases of pseudotumor cerebri during arsenic and tretinoin therapy. We report four cases of pseudotumor cerebri successfully treated with topiramate. Topiramate may have a role in the management of pseudotumor cerebri. Addition of arsenic trioxide to tretinoin may potentiate pseudotumor cerebri.
Collapse
Affiliation(s)
- Morgan B Smith
- Department of Pharmacy, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - Elizabeth A Griffiths
- Leukemia Section, Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - James E Thompson
- Leukemia Section, Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - Eunice S Wang
- Leukemia Section, Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - Meir Wetzler
- Leukemia Section, Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - Craig W Freyer
- Department of Pharmacy, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| |
Collapse
|
19
|
Abbaskhanian A, Sadeghi HR, Erfani A, Rezai MS. Effective dose of topiramate in pediatric migraine prophylaxis. J Pediatr Neurosci 2013; 7:171-4. [PMID: 23559999 PMCID: PMC3611901 DOI: 10.4103/1817-1745.106470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: Migraine is a common neurological disorder in childhood and adolescence. Topiramate is a new anticonvulsant drug, recently being used in migraine prophylaxis in adults, although it is not approved by the Food and Drug Administration for prevention of pediatric migraine. The present study was planned and performed to evaluate the efficacy of low-dose topiramate in pediatric migraine prophylaxis. Materials and Methods: A prospective study, including 60 patients with migraine headaches was performed for a period of two months. The patients were randomly divided into two treatment groups – treated by topiramate < 2 mg/kg/day and > 2 mg/kg/day. All the patients were evaluated at 0, 4, and 8 weeks of the study for the clinical response. Results: The patients receiving topiramate < 2 mg/kg/day (mean dose of 1.2 ± 0.7 mg/kg/day) showed a reduction in the mean (±SD) of migraine frequency from 6.2 (±2.4) to 3.0 (±1.8) episodes per month, headache intensity from 7.2 (±1.95) to 3.7 (±1.8) based on the Visual Analog Scale, and headache duration from 5.4 (±2.1) to 2.2 (±1.3) h. In the patients treated with topiramate > 2 mg/kg/day (mean dose of 2.4 ± 0.5 mg/kg/day), the mean (±SD) of monthly headache frequency reduced from 6.9 (±2.1) to 3.24 (±1.2) per month, intensity from 7.11 (±1.4) to 3.14 (±2.41), and headache duration from 5.2 (±2.4) to 1.8 (±1.2) h, at the end of follow-up (P > 0.05). The most common side effects of topiramate were paresthesias (five patients), anorexia (four patients), drowsiness (four patients). Conclusion: The results of this study demonstrated that low-dose of topiramate (<2 mg/kg/day) is effective, well-tolerated, safe, and suggested as an alternative prophylactic treatment for pediatric migraine.
Collapse
|
20
|
Abstract
Migraine is among the 10 most disabling disorders worldwide. It is characterized by episodes of moderate or severe headaches with various degree of disability, resulting in a considerable health burden upon the sufferers and their family. The objective of this article is to review the use of prophylaxis with antiepileptic drugs. Particular focus is given to their mechanism of action, metabolism, pharmacokinetics, safety profile, efficacy and to provide a summary of the most relevant clinical studies and patient preference.
Collapse
Affiliation(s)
- R Shahien
- Department of Neurology, Ziv Medical Center, affiliated to Bar Ilan University, Safed 13100, Israel
| | | |
Collapse
|