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Wilms AE, de Boer I, Pelzer N, In't Veld SGJG, Middelkoop HAM, Teunissen CE, Terwindt GM. NFL and GFAP in (pre)symptomatic RVCL-S carriers: a monogenic cerebral small vessel disease. J Neurol 2024:10.1007/s00415-024-12292-6. [PMID: 38581544 DOI: 10.1007/s00415-024-12292-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) have emerged as biomarkers for cerebral small vessel disease (SVD). We investigated their role in a hereditary SVD model, retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S). METHODS NfL and GFAP levels of 17 pre-symptomatic, 22 symptomatic RVCL-S mutation carriers and 69 controls were measured using a Simoa assay. We assessed the association of serum and cerebrospinal fluid (CSF) levels of NfL and GFAP with RVCL-S symptomatology and neuropsychological functioning. RESULTS Serum and CSF NfL levels were higher in symptomatic RVCL-S compared to controls ≥ 45 years (33.5 pg/mL vs. 9.2 pg/mL, p < 0.01; 8.5*102 pg/mL vs. 3.9*102 pg/mL, p < 0.01, respectively). Serum NfL levels were higher in symptomatic RVCL-S than pre-symptomatic carriers (33.5 pg/mL vs. 5.9 pg/mL, p = 0.02). Pre-symptomatic RVCL-S carriers had increased CSF NfL levels compared to controls < 45 years (5.2*102 pg/mL vs. 1.9*102 pg/mL, p < 0.01). No differences were found in GFAP levels across groups, but in RVCL-S carriers higher serum levels of both NfL and GFAP were linked to poorer global cognitive functioning (β[95%CI] = - 2.86 [- 5.58 to - 0.13], p = 0.04 and β[95%CI] = - 6.85 [- 11.54 to - 2.15], p = 0.01, respectively) and prolonged psychomotor test times (β[95%CI] = 6.71 [0.78-12.65], p = 0.03 and β[95%CI] = 13.84 [3.09-24.60], p = 0.01). DISCUSSION Higher levels of serum NfL and GFAP are associated with worse cognitive functioning in RVCL-S carriers and may serve as marker for disease progression. CSF NfL levels may serve as early marker as pre-symptomatic RVCL-S patients already show differences compared to young controls.
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Affiliation(s)
- Annelise E Wilms
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300RC, Leiden, The Netherlands
| | - I de Boer
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300RC, Leiden, The Netherlands
| | - N Pelzer
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300RC, Leiden, The Netherlands
| | - S G J G In't Veld
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H A M Middelkoop
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300RC, Leiden, The Netherlands
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | - C E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300RC, Leiden, The Netherlands.
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van der Zwet R, Koemans EA, Voigt S, van Dort R, Rasing I, Kaushik K, van Harten TW, Schipper MR, Terwindt GM, van Osch M, van Walderveen M, van Etten ES, Wermer M. Sensitivity of the Boston criteria version 2.0 in Dutch-type hereditary cerebral amyloid angiopathy. Int J Stroke 2024:17474930241239801. [PMID: 38444323 DOI: 10.1177/17474930241239801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND AND AIM The revised Boston criteria v2.0 for cerebral amyloid angiopathy (CAA) add two radiological markers to the existing criteria: severe visible perivascular spaces in the centrum semiovale and white matter hyperintensities (WMHs) in a multispot pattern. This study aims to determine the sensitivity of the updated criteria in mutation carriers with Dutch-type hereditary CAA (D-CAA) in an early and later disease stage. METHODS In this cross-sectional study, we included presymptomatic and symptomatic D-CAA mutation carriers from our prospective natural history study (AURORA) at the Leiden University Medical Center between 2018 and 2021. 3-Tesla scans were assessed for CAA-related magnetic resonance imaging (MRI) markers. We compared the sensitivity of the Boston criteria v2.0 to the previously used modified Boston criteria v1.5. RESULTS We included 64 D-CAA mutation carriers (mean age 49 years, 55% women, 55% presymptomatic). At least one white matter (WM) feature was seen in 55/64 mutation carriers (86%: 74% presymptomatic, 100% symptomatic). Fifteen (23%) mutation carriers, all presymptomatic, showed only WM features and no hemorrhagic markers. The sensitivity for probable CAA was similar between the new and the previous criteria: 11/35 (31%) in presymptomatic mutation carriers and 29/29 (100%) in symptomatic mutation carriers. The sensitivity for possible CAA in presymptomatic mutation carriers increased from 0/35 (0%) to 15/35 (43%) with the new criteria. CONCLUSION The Boston criteria v2.0 increase the sensitivity for detecting possible CAA in presymptomatic D-CAA mutation carriers and, therefore, improve the detection of the early phase of CAA.
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Affiliation(s)
- Rgj van der Zwet
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - E A Koemans
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - S Voigt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - R van Dort
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - I Rasing
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Kaushik
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - T W van Harten
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M R Schipper
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mjp van Osch
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maa van Walderveen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - E S van Etten
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mjh Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
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Hoogeveen ES, Pelzer N, Ghariq E, van Osch MJP, Dahan A, Terwindt GM, Kruit MC. Cerebrovascular reactivity to hypercapnia in patients with migraine: A dual-echo arterial spin labeling MRI study. Headache 2024; 64:276-284. [PMID: 38429974 DOI: 10.1111/head.14680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE This study aimed to compare cerebrovascular reactivity between patients with migraine and controls using state-of-the-art magnetic resonance imaging (MRI) techniques. BACKGROUND Migraine is associated with an increased risk of cerebrovascular disease, but the underlying mechanisms are still not fully understood. Impaired cerebrovascular reactivity has been proposed as a link. Previous studies have evaluated cerebrovascular reactivity with different methodologies and results are conflicting. METHODS In this single-center, observational, case-control study, we included 31 interictal patients with migraine without aura (aged 19-66 years, 17 females) and 31 controls (aged 22-64 years, 18 females) with no history of vascular disease. Global and regional cerebrovascular reactivities were assessed with a dual-echo arterial spin labeling (ASL) 3.0 T MRI scan of the brain which measured the change in cerebral blood flow (CBF) and BOLD (blood oxygen level dependent) signal to inhalation of 5% carbon dioxide. RESULTS When comparing patients with migraine to controls, cerebrovascular reactivity values were similar between the groups, including mean gray matter CBF-based cerebrovascular reactivity (3.2 ± 0.9 vs 3.4 ± 1% ΔCBF/mmHg CO2 ; p = 0.527), mean gray matter BOLD-based cerebrovascular reactivity (0.18 ± 0.04 vs 0.18 ± 0.04% ΔBOLD/mmHg CO2 ; p = 0.587), and mean white matter BOLD-based cerebrovascular reactivity (0.08 ± 0.03 vs 0.08 ± 0.02% ΔBOLD/mmHg CO2 ; p = 0.621).There was no association of cerebrovascular reactivity with monthly migraine days or migraine disease duration (all analyses p > 0.05). CONCLUSION Cerebrovascular reactivity to carbon dioxide seems to be preserved in patients with migraine without aura.
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Affiliation(s)
- E S Hoogeveen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - N Pelzer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - E Ghariq
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- C.J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Radiology and Nuclear Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - M J P van Osch
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- C.J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - A Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - M C Kruit
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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van Welie FC, Kreft LA, Huisman JMA, Terwindt GM. Sex-specific metabolic profiling to explain the increased CVD risk in women with migraine: a narrative review. J Headache Pain 2023; 24:64. [PMID: 37277733 DOI: 10.1186/s10194-023-01601-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/23/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Migraine is a disabling neurological disorder whose diagnosis is based on clinical criteria. A shortcoming of these criteria is that they do not fully capture the underlying neurobiological factors and sex-specific complications in migraine such as cardio- and cerebrovascular disease. Biomarker research can help to improve disease characterization and identify pathophysiological mechanism underlying these comorbidities. OBJECTIVE In this narrative review we searched for sex-specific metabolomics research to identify markers that may explain the migraine-cardiovascular disease (CVD) relationship. DISCUSSION Large-scale plasma metabolome analyses revealed alterations in migraine. Sex-specific findings showed a less CVD-protective HDL metabolism as well as the ApoA1 lipoprotein, especially for women with migraine. To explore other possible pathophysiological pathways, we expanded our review to include inflammatory markers, endothelial and vascular markers and sex hormones. Biological sex differences may affect the pathophysiology of migraine and its complications. CONCLUSIONS There is no general large dyslipidemia profile in migraine patients, in line with findings that the increased risk of CVD in migraine patients seems not to be due to (large artery) atherosclerosis. Sex-specific associations are indicative towards a less CVD-protective lipoprotein profile in women with migraine. Future studies into the pathophysiology of CVD and migraine need to take sex specific factors into account. By establishing the overlapping pathophysiological mechanism of migraine and CVD, and unraveling the associated effects these diseases exert on each other, better preventative measures can be identified.
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Affiliation(s)
- F C van Welie
- Department of Neurology, Leiden University Medical Center, P.O. 9600, 2300 WB, Leiden, The Netherlands
| | - L A Kreft
- Department of Neurology, Leiden University Medical Center, P.O. 9600, 2300 WB, Leiden, The Netherlands
| | - J M A Huisman
- Department of Neurology, Leiden University Medical Center, P.O. 9600, 2300 WB, Leiden, The Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, P.O. 9600, 2300 WB, Leiden, The Netherlands.
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5
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Voigt S, Koemans EA, Rasing I, van Etten ES, Terwindt GM, Baas F, Kaushik K, van Es ACGM, van Buchem MA, van Osch MJP, van Walderveen MAA, Klijn CJM, Verbeek MM, van der Weerd L, Wermer MJH. Minocycline for sporadic and hereditary cerebral amyloid angiopathy (BATMAN): study protocol for a placebo-controlled randomized double-blind trial. Trials 2023; 24:378. [PMID: 37277877 DOI: 10.1186/s13063-023-07371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is a disease caused by the accumulation of the amyloid-beta protein and is a major cause of intracerebral hemorrhage (ICH) and vascular dementia in the elderly. The presence of the amyloid-beta protein in the vessel wall may induce a chronic state of cerebral inflammation by activating astrocytes, microglia, and pro-inflammatory substances. Minocycline, an antibiotic of the tetracycline family, is known to modulate inflammation, gelatinase activity, and angiogenesis. These processes are suggested to be key mechanisms in CAA pathology. Our aim is to show the target engagement of minocycline and investigate in a double-blind placebo-controlled randomized clinical trial whether treatment with minocycline for 3 months can decrease markers of neuroinflammation and of the gelatinase pathway in cerebrospinal fluid (CSF) in CAA patients. METHODS The BATMAN study population consists of 60 persons: 30 persons with hereditary Dutch type CAA (D-CAA) and 30 persons with sporadic CAA. They will be randomized for either placebo or minocycline (15 sporadic CAA/15 D-CAA minocycline, 15 sporadic CAA/15 D-CAA placebo). At t = 0 and t = 3 months, we will collect CSF and blood samples, perform a 7-T MRI, and collect demographic characteristics. DISCUSSION The results of this proof-of-principle study will be used to assess the potential of target engagement of minocycline for CAA. Therefore, our primary outcome measures are markers of neuroinflammation (IL-6, MCP-1, and IBA-1) and of the gelatinase pathway (MMP2/9 and VEGF) in CSF. Secondly, we will look at the progression of hemorrhagic markers on 7-T MRI before and after treatment and investigate serum biomarkers. TRIAL REGISTRATION ClinicalTrials.gov NCT05680389. Registered on January 11, 2023.
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Affiliation(s)
- S Voigt
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - E A Koemans
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - I Rasing
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - E S van Etten
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - F Baas
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - K Kaushik
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - A C G M van Es
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - M A van Buchem
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - M J P van Osch
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - M A A van Walderveen
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - C J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M M Verbeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L van der Weerd
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - M J H Wermer
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
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6
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Voigt S, de Kruijff PC, Koemans EA, Rasing I, van Etten ES, Terwindt GM, van Osch M, van Buchem MA, van Walderveen M, Wermer M. Cerebellar hemorrhages in patients with Dutch-type hereditary cerebral amyloid angiopathy. Int J Stroke 2021; 17:637-644. [PMID: 34427476 PMCID: PMC9260473 DOI: 10.1177/17474930211043663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Recent studies suggest that superficially located cerebellar intracerebral
hemorrhage (ICH) and microbleeds might point towards sporadic cerebral
amyloid angiopathy (CAA). Aims We investigated the proportion of cerebellar ICH and asymptomatic macro- and
microbleeds in Dutch-type hereditary CAA (D-CAA), a severe and essentially
pure form of CAA. Methods Symptomatic patients with D-CAA (defined as ≥1 symptomatic ICH) and
presymptomatic D-CAA mutation-carriers were included. We assessed magnetic
resonance imaging scans for symptomatic (cerebellar) ICH and asymptomatic
cerebellar macro- and microbleeds according to the STRIVE-criteria. Location
was assessed as superficial-cerebellar (cortex, vermis or juxta-cortical) or
deep-cerebellar (white matter, pedunculi cerebelli and gray nuclei). Results We included 63 participants (mean age 58 years, 60% women, 42 symptomatic).
In total, the 42 symptomatic patients with D-CAA had 107 symptomatic ICH
(range 1–7). None of these ICH were located in the cerebellum. Six of 42
(14%, 95%CI 4–25%) symptomatic patients and none of the 21 (0%, 95%CI 0–0%)
presymptomatic carriers had ≥ 1 asymptomatic cerebellar macrobleed(s). All
macrobleeds were superficially located. Cerebellar microbleeds were found in
40 of 63 (64%, 95%CI 52–76) participants (median 1.0, range 0–159), 81% in
symptomatic patients and 29% in presymptomatic carriers. All microbleeds
were strictly or predominantly superficially (ratio superficial versus deep
15:1) located. Conclusions Superficially located asymptomatic cerebellar macrobleeds and microbleeds are
common in D-CAA. Cerebellar microbleeds are already present in the
presymptomatic stage. Despite the high frequency of cerebellar micro and
macrobleeds, CAA pathology did not result in symptomatic cerebellar ICH in
patients with D-CAA.
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Affiliation(s)
- S Voigt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - P C de Kruijff
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - E A Koemans
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - I Rasing
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - E S van Etten
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mjp van Osch
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - M A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maa van Walderveen
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mjh Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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7
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Hoogeveen ES, Pelzer N, de Boer I, van Buchem MA, Terwindt GM, Kruit MC. Neuroimaging Findings in Retinal Vasculopathy with Cerebral Leukoencephalopathy and Systemic Manifestations. AJNR Am J Neuroradiol 2021; 42:1604-1609. [PMID: 34167956 DOI: 10.3174/ajnr.a7194] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/12/2021] [Indexed: 11/07/2022]
Abstract
Retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations is caused by TREX1 mutations. High-quality systematic follow-up neuroimaging findings have not been described in presymptomatic and symptomatic mutation carriers. We present MR imaging findings of 29 TREX1 mutation carriers (20-65 years of age) and follow-up of 17 mutation carriers (30-65 years of age). Mutation carriers younger than 40 years of age showed a notable number of punctate white matter lesions, but scan findings were generally unremarkable. From 40 years of age onward, supratentorial lesions developed with long-term contrast enhancement (median, 24 months) and diffusion restriction (median, 8 months). In these lesions, central susceptibility artifacts developed, at least partly corresponding to calcifications on available CT scans. Some lesions (n = 2) additionally showed surrounding edema and mass effect (pseudotumors). Cerebellar punctate enhancing lesions developed mainly in individuals older than 50 years of age. These typical neuroimaging findings should aid neuroradiologic recognition of retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations, which may enable early treatment of manifestations of the disease.
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Affiliation(s)
- E S Hoogeveen
- From the Departments of Radiology (E.S.H., M.A.v.B., M.C.K.)
| | - N Pelzer
- Neurology (N.P., I.d.B., G.M.T.), Leiden University Medical Center, Leiden, the Netherlands
| | - I de Boer
- Neurology (N.P., I.d.B., G.M.T.), Leiden University Medical Center, Leiden, the Netherlands
| | - M A van Buchem
- From the Departments of Radiology (E.S.H., M.A.v.B., M.C.K.)
| | - G M Terwindt
- Neurology (N.P., I.d.B., G.M.T.), Leiden University Medical Center, Leiden, the Netherlands
| | - M C Kruit
- From the Departments of Radiology (E.S.H., M.A.v.B., M.C.K.)
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8
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Koemans EA, Voigt S, Rasing I, Jolink W, van Harten TW, van der Grond J, van Rooden S, Schreuder F, Freeze WM, van Buchem MA, van Zwet EW, van Veluw SJ, Terwindt GM, van Osch M, Klijn C, van Walderveen M, Wermer M. Striped occipital cortex and intragyral hemorrhage: Novel magnetic resonance imaging markers for cerebral amyloid angiopathy. Int J Stroke 2021; 16:1031-1038. [PMID: 33535905 PMCID: PMC8669214 DOI: 10.1177/1747493021991961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and aim To investigate whether a striped occipital cortex and intragyral hemorrhage, two markers recently detected on ultra-high-field 7-tesla-magnetic resonance imaging in hereditary cerebral amyloid angiopathy (CAA), also occur in sporadic CAA (sCAA) or non-sCAA intracerebral hemorrhage (ICH). Methods We performed 7-tesla-magnetic resonance imaging in patients with probable sCAA and patients with non-sCAA-ICH. Striped occipital cortex (linear hypointense stripes perpendicular to the cortex) and intragyral hemorrhage (hemorrhage restricted to the juxtacortical white matter of one gyrus) were scored on T2*-weighted magnetic resonance imaging. We assessed the association between the markers, other CAA-magnetic resonance imaging markers and clinical features. Results We included 33 patients with sCAA (median age 70 years) and 29 patients with non-sCAA-ICH (median age 58 years). Striped occipital cortex was detected in one (3%) patient with severe sCAA. Five intragyral hemorrhages were found in four (12%) sCAA patients. The markers were absent in the non-sCAA-ICH group. Patients with intragyral hemorrhages had more lobar ICHs (median count 6.5 vs. 1.0), lobar microbleeds (median count >50 vs. 15), and lower median cognitive scores (Mini Mental State Exam: 20 vs. 28, Montreal Cognitive Assessment: 18 vs. 24) compared with patients with sCAA without intragyral hemorrhage. In 12 (36%) patients, sCAA diagnosis was changed to mixed-type small vessel disease due to deep bleeds previously unobserved on lower field-magnetic resonance imaging. Conclusion Whereas a striped occipital cortex is rare in sCAA, 12% of patients with sCAA have intragyral hemorrhages. Intragyral hemorrhages seem to be related to advanced disease and their absence in patients with non-sCAA-ICH could suggest specificity for CAA.
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Affiliation(s)
- E A Koemans
- Department of Neurology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - S Voigt
- Department of Neurology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - I Rasing
- Department of Neurology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - Wmt Jolink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - T W van Harten
- Department of Radiology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - J van der Grond
- Department of Radiology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - S van Rooden
- Department of Radiology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - Fhbm Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - W M Freeze
- Department of Radiology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - M A van Buchem
- Department of Radiology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - E W van Zwet
- Department of Biomedical Data Sciences, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - S J van Veluw
- Department of Radiology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - G M Terwindt
- Department of Neurology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - Mjp van Osch
- Department of Radiology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - Cjm Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maa van Walderveen
- Department of Radiology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - Mjh Wermer
- Department of Neurology, 4501Leiden University Medical Center, Leiden, the Netherlands
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9
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Linstra KM, Fronczek R, Terwindt GM. Response to: migraine symptoms and the role of the autonomic dysfunction. Eur J Neurol 2020; 27:e96. [DOI: 10.1111/ene.14374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/01/2022]
Affiliation(s)
- K. M. Linstra
- Department of Neurology Leiden University Medical Center Leiden The Netherlands
- Division of Pharmacology and Vascular Medicine Department of Internal Medicine Erasmus University Medical Center Rotterdam The Netherlands
| | - R. Fronczek
- Department of Neurology Leiden University Medical Center Leiden The Netherlands
- Sleep‐Wake Centre SEIN Heemstede The Netherlands
| | - G. M. Terwindt
- Department of Neurology Leiden University Medical Center Leiden The Netherlands
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10
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van Etten ES, de Boer I, Steenmeijer SR, Al-Nofal M, Wermer MJH, Notting IC, Terwindt GM. Optical coherence tomography detects retinal changes in hereditary cerebral amyloid angiopathy. Eur J Neurol 2020; 27:2635-2640. [PMID: 32894579 PMCID: PMC7702135 DOI: 10.1111/ene.14507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Investigating mutation carriers with Dutch-type hereditary (D-) cerebral amyloid angiopathy (CAA), offers the possibility to identify markers in pre- and symptomatic stages of CAA. Optical coherence tomography (OCT) has shown potential to detect retinal changes in several neurodegenerative diseases. The aim of the present exploratory study was to investigate thinning of retinal layers as a possible (early) biomarker in D-CAA mutation carriers. METHODS Twenty-one D-CAA mutation carriers (n = 8 presymptomatic, n = 13 symptomatic, median age 50 years) and nine controls (median age 53 years) were scanned using spectral-domain OCT. Symptomatic mutation carriers were defined as having a history of ≥1 symptomatic intracerebral hemorrhage. D-CAA mutation carriers and controls were recruited from our D-CAA cohort and a healthy control cohort. Total peripapillary retinal nerve fiber layer (pRNFL) thickness, six regions of pRNFL, total macular volume (TMV), and individual macular region thickness were measured and analysed, adjusted for age. RESULTS The overall median (interquartile range) thickness of pRNFL was lower in symptomatic, but not presymptomatic D-CAA mutation carriers compared with controls [91 (86-95) µm vs. 99 (87-108) µm; P = 0.006]. Both presymptomatic [111 (93-122) µm vs. 131 (123-143) µm; P < 0.001] and symptomatic carriers [119 (95-128) µm vs. 131 (123-143) µm; P = 0.034] had a thinner temporal-superior quadrant of the pRNFL versus controls. TMV or individual macular layer thickness did not differ between carriers and controls. CONCLUSIONS Thinning of the retinal nerve fiber layer may be a candidate marker of disease in hereditary CAA. Further studies are needed to determine whether retinal thinning is present in sporadic CAA and estimate its value as a marker for disease progression.
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Affiliation(s)
- E S van Etten
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - I de Boer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - S R Steenmeijer
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Al-Nofal
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - M J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - I C Notting
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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11
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Linstra KM, Perenboom MJL, van Zwet EW, van Welie FC, Fronczek R, Tannemaat MR, Wermer MJH, Maassenvandenbrink A, Terwindt GM. Cold extremities in migraine: a marker for vascular dysfunction in women. Eur J Neurol 2020; 27:1197-1200. [PMID: 32356361 PMCID: PMC7383740 DOI: 10.1111/ene.14289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/23/2020] [Indexed: 01/11/2023]
Abstract
Background and purpose Migraine is recognized as a vascular risk factor, especially in women. Presumably, migraine, stroke and cardiovascular events share pathophysiological mechanisms. Self‐reported cold extremities were investigated as a marker for vascular dysfunction in migraine. Secondly, it was hypothesized that suffering from cold extremities affects sleep quality, possibly exacerbating migraine attack frequency. Methods In this case–control study, a random sample of 1084 migraine patients and 348 controls (aged 22–65 years) from the LUMINA migraine cohort were asked to complete questionnaires concerning cold extremities, sleep quality and migraine. Results A total of 594 migraine patients and 199 controls completed the questionnaires. In women, thermal discomfort and cold extremities (TDCE) were more often reported by migraineurs versus controls (odds ratio 2.3, 95% confidence interval 1.4–3.7; P < 0.001), but not significantly so in men (odds ratio 2.5, 95% confidence interval 0.9–6.9; P = 0.09). There was no difference in TDCE comparing migraine with or without aura. Female migraineurs who reported TDCE had higher attack frequencies compared to female migraineurs without TDCE (4 vs. 3 attacks per month; P = 0.003). The association between TDCE and attack frequency was mediated by the presence of difficulty initiating sleep (P = 0.02). Conclusion Women with migraine more often reported cold extremities compared with controls, possibly indicating a sex‐specific vascular vulnerability. Female migraineurs with cold extremities had higher attack frequencies, partly resulting from sleep disturbances. Future studies need to demonstrate whether cold extremities in female migraineurs are a predictor for cardiovascular and cerebrovascular events.
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Affiliation(s)
- K M Linstra
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M J L Perenboom
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - E W van Zwet
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - F C van Welie
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - R Fronczek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Sleep-Wake centre SEIN, Heemstede, The Netherlands
| | - M R Tannemaat
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - M J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - A Maassenvandenbrink
- Department of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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12
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Goadsby PJ, Terwindt GM, Ruff DD, Ford JH, Tockhorn‐Heidenreich A, Stauffer VL, Govindan S, Aurora SK. Response to ‘Do different treatment strategies of galcanezumab have similar effect on migraine?’. Eur J Neurol 2020; 27:e25. [DOI: 10.1111/ene.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/08/2020] [Indexed: 11/30/2022]
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13
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Ruff DD, Ford JH, Tockhorn-Heidenreich A, Stauffer VL, Govindan S, Aurora SK, Terwindt GM, Goadsby PJ. Efficacy of galcanezumab in patients with episodic migraine and a history of preventive treatment failure: results from two global randomized clinical trials. Eur J Neurol 2019; 27:609-618. [PMID: 31692188 PMCID: PMC7155018 DOI: 10.1111/ene.14114] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/04/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The efficacy of galcanezumab, a monoclonal antibody for migraine prevention, has been demonstrated in two pivotal trials in patients with episodic migraine. METHODS EVOLVE-1 and EVOLVE-2 were identical phase 3, randomized, double-blind, placebo-controlled studies in patients with episodic migraine. Mean migraine headache days per month at baseline was 9. Patients were randomized 2:1:1 to monthly injections of placebo, galcanezumab 120 mg/240 mg during the 6-month double-blind treatment period. Key efficacy outcomes were assessed in subgroups amongst patients for whom, previously, for efficacy and/or safety/tolerability reasons (i) one or more (≥1) preventives failed, (ii) two or more (≥2) preventives failed and (iii) preventives were never used, or used but not failed (no prior failure). RESULTS In an integrated analysis of EVOLVE studies, galcanezumab 120 mg/240 mg versus placebo led to larger overall mean (SE) reductions in monthly migraine headache days across 6 months in patients with prior preventive failures (P < 0.001): ≥1 failure: 120 mg: -4.0 (0.4); 240 mg: -4.2 (0.5); placebo: -1.3 (0.4); ≥2 failures: 120 mg: -3.1 (0.7); 240 mg: -3.8 (0.8); placebo: -0.5 (0.6). Similar results were observed amongst patients with no prior failure, but the placebo response was larger: 120 mg: -4.7 (0.2); 240 mg: -4.5 (0.2); placebo: -3.0 (0.2) (P < 0.001 versus placebo). Significant improvements were observed with galcanezumab versus placebo for ≥50% and ≥75% reduction in monthly migraine headache days. CONCLUSION In patients with episodic migraine treated with galcanezumab, those with ≥1 or ≥2 prior preventive failures had significantly larger improvements, versus placebo, in efficacy outcomes. Similar results were observed in patients with no prior failure, with a larger placebo response.
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Affiliation(s)
- D D Ruff
- Eli Lilly and Company, Indianapolis, IN, USA
| | - J H Ford
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - S Govindan
- Eli Lilly Services India Private Limited, Bengaluru, India
| | - S K Aurora
- Eli Lilly and Company, Indianapolis, IN, USA
| | - G M Terwindt
- Leiden University Medical Center, Leiden, The Netherlands
| | - P J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College London, London, UK
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Boer ID, Maagdenberg AMJMVD, Terwindt GM. Letter to the Editor. Rev Invest Clin 2019; 71:141-142. [PMID: 31066373 DOI: 10.24875/ric.19002979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Affiliation(s)
- I de Boer
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - A M J M van den Maagdenberg
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
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16
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Onderwater GLJ, van Oosterhout WPJ, Schoonman GG, Ferrari MD, Terwindt GM. Alcoholic beverages as trigger factor and the effect on alcohol consumption behavior in patients with migraine. Eur J Neurol 2018; 26:588-595. [PMID: 30565341 DOI: 10.1111/ene.13861] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/06/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Alcoholic beverages are frequently reported migraine triggers. We aimed to assess self-reported alcohol consumption as a migraine attack trigger and to investigate the effect on alcohol consumption behavior in a large migraine cohort. METHODS We conducted a cross-sectional, web-based, questionnaire study among 2197 patients with migraine from the well-defined Leiden University MIgraine Neuro-Analysis (LUMINA) study population. We assessed alcoholic beverage consumption and self-reported trigger potential, reasons behind alcohol abstinence and time between alcohol consumption and migraine attack onset. RESULTS Alcoholic beverages were reported as a trigger by 35.6% of participants with migraine. In addition, over 25% of patients with migraine who had stopped consuming or never consumed alcoholic beverages did so because of presumed trigger effects. Wine, especially red wine (77.8% of participants), was recognized as the most common trigger among the alcoholic beverages. However, red wine consistently led to an attack in only 8.8% of participants. Time of onset was rapid (<3 h) in one-third of patients and almost 90% had an onset <10 h independent of beverage type. CONCLUSIONS Alcoholic beverages, especially red wine, are recognized as a migraine trigger factor by patients with migraine and have a substantial effect on alcohol consumption behavior. Rapid onset of provoked migraine attacks in contrast to what is known about hangover headache might point to a different mechanism. The low consistency of provocation suggests that alcoholic beverages acting as a singular trigger is insufficient and may depend on a fluctuating trigger threshold.
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Affiliation(s)
- G L J Onderwater
- Department of Neurology, Leiden University Medical Center, Leiden
| | - W P J van Oosterhout
- Department of Neurology, Leiden University Medical Center, Leiden.,Department of Neurology, OLVG Hospital, Amsterdam
| | - G G Schoonman
- Department of Neurology, Leiden University Medical Center, Leiden.,Department of Neurology, Elisabeth-TweeSteden Hospital Tilburg, Tilburg, The Netherlands
| | - M D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden
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17
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Pijpers JA, Wiendels NJ, Koppen H, Ferrari MD, Haan J, Terwindt GM. [Medication-overuse headache]. Ned Tijdschr Geneeskd 2018; 162:D1749. [PMID: 29350119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
- Medication-overuse headache is a highly prevalent disorder with a major impact on the quality of life.- Medication-overuse headache is defined as headache on ≥ 15 days per month with overuse of acute headache medication for ≥ 3 months. We talk about overuse in case of intake of simple analgesics on ≥ 15 days per month or triptans or combinations of analgesics on ≥ 10 days per month.- The underlying type of headache is usually migraine or tension-type headache.- One of the possible underlying mechanisms of medication-overuse headache is changed sensitivity as a consequence of central sensitisation.- The initial treatment is detoxification of the headache medication. The preferred detoxification method is outpatient, abrupt withdrawal of all acute-headache medication and caffeine-containing products. Essential for successful detoxification is education about the reasons for detoxification, the expected course and the subsequent treatment.
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Affiliation(s)
- J A Pijpers
- Leids Universitair Medisch Centrum, afd. Neurologie, Leiden
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18
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Abstract
Background It has been suggested that migraine attacks strike according to circadian patterns and that this might be related to individual chronotype. Here we evaluated and correlated individual chronotypes, stability of the circadian rhythm, and circadian attack timing in a large and well-characterised migraine population. Methods In 2875 migraine patients and 200 non-headache controls we assessed differences in: (i) distribution of chronotypes (Münich Chronotype Questionnaire); (ii) the circadian rhythm's amplitude and stability (Circadian Type Inventory); and (iii) circadian timing of migraine attacks. Data were analysed using multinomial and linear regression models adjusted for age, gender, sleep quality and depression. Results Migraineurs more often showed an early chronotype compared with controls (48.9% versus 38.6%; adjusted odds ratio [OR] = 2.42; 95% confidence interval [CI] = 1.58-3.69; p < 0.001); as well as a late chronotypes (37.7% versus 38.1%; adjusted OR = 1.69; 95% CI = 1.10-2.61; p = 0.016). Migraineurs, particularly those with high attack frequency, were more tired after changes in circadian rhythm (i.e. more languid; p < 0.001) and coped less well with being active at unusual hours (i.e. more rigid; p < 0.001) than controls. Of 2389 migraineurs, 961 (40.2%) reported early morning attack onset. Conclusion Migraine patients are less prone to be of a normal chronotype than controls. They are more languid and more rigid when changes in circadian rhythm occur. Most migraine attacks begin in the early morning. These data suggest that chronobiological mechanisms play a role in migraine pathophysiology.
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Affiliation(s)
- Wpj van Oosterhout
- 1 Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ejw van Someren
- 2 Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands.,3 Depts. of Integrative Neurophysiology and Medical Psychology, Center for Neurogenomics and Cognitive Research (CNCR), VU University and Medical Center, Amsterdam, the Netherlands
| | - G G Schoonman
- 1 Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,4 Department of Neurology, Elisabeth-Tweesteden Hospital Tilburg, Tilburg, the Netherlands
| | - M A Louter
- 1 Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,5 Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - G J Lammers
- 1 Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,6 Sleep Wake Center SEIN Heemstede, Heemstede, the Netherlands
| | - M D Ferrari
- 1 Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - G M Terwindt
- 1 Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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19
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Linstra KM, Wermer MJH, Terwindt GM. [Women with migraine have an increased risk of cardiovascular disease; what are the consequences for the clinical management of young patients?]. Ned Tijdschr Geneeskd 2017; 161:D1143. [PMID: 28247836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Migraine is often regarded as a debilitating headache disorder without long-term consequences. However, migraine is an important risk factor for cardiovascular disease, especially in young women who suffer from migraine with aura. This increased risk is not limited to stroke but includes cardiac disease. The absolute risk for cardiovascular disease remains low in young women, however the prevalence of migraine is particularly high in this population. Migraine should therefore be incorporated as a factor in cardiovascular risk assessment. Mechanisms underlying the relationship between migraine and cardiovascular disease are complex and probably multifactorial. Endothelial dysfunction may play a pivotal role. Knowledge about the interaction of migraine with other risk factors and evidence-based recommendations on clinical management remain limited. Lifestyle advice, including the promotion of smoking cessation, is of utmost importance.
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Affiliation(s)
- K M Linstra
- Leids Universitair Medisch Centrum, afd. Neurologie, Leiden
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20
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Ibrahimi K, Danser AHJ, Terwindt GM, van den Meiracker AH, MaassenVanDenBrink A. A human trigeminovascular biomarker for antimigraine drugs: A randomised, double-blind, placebo-controlled, crossover trial with sumatriptan. Cephalalgia 2016; 37:94-98. [DOI: 10.1177/0333102416637833] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Current antimigraine drugs are believed, besides their direct vasoconstrictive effect, to inhibit calcitonin gene-related peptide (CGRP) release from trigeminal nerve endings during migraine. Objective The objective of this report is to establish a biomarker for the CGRP-interfering effect of antimigraine drugs. Methods We quantified the effect of sumatriptan on the trigeminal nerve-mediated rise in forehead dermal blood flow (DBF), induced by capsaicin application (0.6 mg/ml) and electrical stimulation (0.2–1.0 mA), in a randomised, double-blind, placebo-controlled, crossover study in healthy male ( n = 11, age ± SD: 29 ± 8 years) and female ( n = 11, 32 ± 7 years) individuals. Results DBF responses to capsaicin were attenuated by sumatriptan (ΔDBF, mean ± SEM: 82 ± 18 AU, p = 0.0002), but not by placebo (ΔDBF: 21 ± 12 AU, p = 0.1026). Conclusion We demonstrated that sumatriptan inhibits increases in DBF, induced by the release of, most likely, CGRP. Thus, our model may be used as a biomarker to establish the trigeminovascular effects of (potential) antimigraine drugs, such as CGRP receptor antagonists or antibodies directed against CGRP or its receptor.
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Affiliation(s)
- K Ibrahimi
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, The Netherlands
| | - AHJ Danser
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, The Netherlands
| | - GM Terwindt
- Department of Neurology, Leiden University Medical Center, The Netherlands
| | - AH van den Meiracker
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, The Netherlands
| | - A MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, The Netherlands
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21
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Hottenga JJ, Vanmolkot KRJ, Kors EE, Kheradmand Kia S, de Jong PTVM, Haan J, Terwindt GM, Frants RR, Ferrari MD, van den Maagdenberg AMJM. The 3p21.1-p21.3 Hereditary Vascular Retinopathy Locus Increases the Risk for Raynaud's Phenomenon and Migraine. Cephalalgia 2016; 25:1168-72. [PMID: 16305605 DOI: 10.1111/j.1468-2982.2005.00994.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Previously, we described a large Dutch family with hereditary vascular retinopathy (HVR), Raynaud's phenomenon and migraine. A locus for HVR was mapped on chromosome 3p21.1-p21.3, but the gene has not yet been identified. The fact that all three disorders share a vascular aetiology prompted us to study whether the HVR haplotype also contributed to Raynaud's phenomenon and migraine in this family. Whereas the parent-child transmission disequilibrium test (TDT) did not reach significance, the sibling TDT revealed that the HVR haplotype harbours a susceptibility factor for Raynaud's phenomenon and migraine. Identification of the HVR gene will improve the understanding of the pathophysiology of HVR, Raynaud's phenomenon and migraine.
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Affiliation(s)
- J J Hottenga
- Department of Human Genetics, Leiden University Medical Centre, Leiden, and Department of Neurology, Rijnland Hospital, Leiderdorp, The Netherlands
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22
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Abstract
Migraine attacks are often preceded by premonitory symptoms. Prevalence rates of migraine patients reporting one or more premonitory symptoms show considerable variability and rates range between 12% and 79%. Sources of variability might be differences in study population or research design. Using a questionnaire, we retrospectively studied the prevalence of 12 predefined premonitory symptoms in a clinic-based population. Of 461 migraine patients, 374 (81%) responded. At least one premonitory symptom was reported by 86.9% and 71.1% reported two or more. The most frequently reported premonitory symptoms were fatigue (46.5%), phonophobia (36.4%) and yawning (35.8%). The mean number of premonitory symptoms per person was 3.2 (± 2.5). Women reported 3.3 premonitory symptoms compared with 2.5 symptoms in men ( P = 0.01). Age, education, migraine subtype (with or without aura) and mean attack frequency had no effect on the mean number of symptoms per individual. In conclusion, premonitory symptoms are frequently reported by migraine patients. Sensitivity and specificity of premonitory symptoms for migraine need to be assessed using prospective methods.
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Affiliation(s)
- G G Schoonman
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.
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23
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Pelzer N, Blom DE, Stam AH, Vijfhuizen LS, Hageman A, van Vliet JA, Ferrari MD, van den Maagdenberg A, Haan J, Terwindt GM. Recurrent coma and fever in familial hemiplegic migraine type 2. A prospective 15-year follow-up of a large family with a novel ATP1A2 mutation. Cephalalgia 2016; 37:737-755. [PMID: 27226003 DOI: 10.1177/0333102416651284] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Familial hemiplegic migraine (FHM) is a rare monogenic migraine subtype characterised by attacks associated with transient motor weakness. Clinical information is mainly based on reports of small families with only short follow-up. Here, we document a prospective 15-year follow-up of an extended family with FHM type 2. Patients and methods After diagnosing FHM in a patient with severe attacks associated with coma and fever, we identified eight more family members with FHM and one with possible FHM. All family members were prospectively followed for 15 years. In total 13 clinically affected and 21 clinically non-affected family members were genetically tested and repeatedly investigated. Results A novel p.Arg348Pro ATP1A2 mutation was found in 14 family members: 12 with clinical FHM, one with psychomotor retardation and possible FHM, and one without FHM features. In 9/12 (75%) family members with genetically confirmed FHM, attacks were severe, long-lasting, and often associated with impaired consciousness and fever. Such attacks were frequently misdiagnosed and treated as viral meningitis or stroke. Epilepsy was reported in three family members with FHM and in the one with psychomotor retardation and possible FHM. Ataxia was not observed. Conclusion FHM should be considered in patients with recurrent coma and fever.
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Affiliation(s)
- N Pelzer
- 1 Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - D E Blom
- 1 Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - A H Stam
- 1 Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - L S Vijfhuizen
- 2 Department of Human Genetics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Atm Hageman
- 3 Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
| | - J A van Vliet
- 4 Department of Neurology, Slingeland Hospital, Doetinchem, the Netherlands
| | - M D Ferrari
- 1 Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Amjm van den Maagdenberg
- 1 Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.,2 Department of Human Genetics, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Haan
- 1 Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.,5 Department of Neurology, Alrijne Hospital, Leiderdorp, the Netherlands
| | - G M Terwindt
- 1 Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
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van Oosterhout WPJ, van Someren EJW, Louter MA, Schoonman GG, Lammers GJ, Rijsman RM, Ferrari MD, Terwindt GM. Restless legs syndrome in migraine patients: prevalence and severity. Eur J Neurol 2016; 23:1110-6. [PMID: 26998996 DOI: 10.1111/ene.12993] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/02/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Our aim was to study not only the prevalence but more importantly the severity and the correlation between sleep quality and restless legs syndrome (RLS) in a large population of well-defined migraine patients as poor sleep presumably triggers migraine attacks. METHODS In a large cross-sectional and observational study, data on migraine and RLS were collected from 2385 migraine patients (according to the International Classification of Headache Disorders ICHD-IIIb) and 332 non-headache controls. RLS severity (International RLS Study Group severity scale) and sleep quality (Pittsburgh Sleep Quality Index) were assessed. Risk factors for RLS and RLS severity were calculated using multivariable-adjusted regression models. RESULTS Restless legs syndrome prevalence in migraine was higher than in controls (16.9% vs. 8.7%; multivariable-adjusted odds ratio 1.83; 95% confidence interval 1.18-2.86; P = 0.008) and more severe (adjusted severity score 14.5 ± 0.5 vs. 12.0 ± 1.1; P = 0.036). Poor sleepers were overrepresented amongst migraineurs (50.1% vs. 25.6%; P < 0.001). Poorer sleep quality was independently associated with RLS occurrence (odds ratio 1.08; P < 0.001) and RLS severity (P < 0.001) in migraine patients. CONCLUSION Restless legs syndrome is not only twice as prevalent but also more severe in migraine patients, and associated with decreased sleep quality.
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Affiliation(s)
- W P J van Oosterhout
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - E J W van Someren
- The Netherlands Institute of Neuroscience, Amsterdam, The Netherlands.,Departments of Integrative Neurophysiology and Medical Psychology, Centre for Neurogenomics and Cognitive Research (CNCR), Neuroscience Campus Amsterdam, VU University and Medical Centre, Amsterdam, The Netherlands
| | - M A Louter
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Departments of Neurology and Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - G G Schoonman
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Neurology, Elisabeth-Tweesteden Hospital Tilburg, Tilburg, The Netherlands
| | - G J Lammers
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Sleep Wake Centre SEIN Heemstede, Heemstede, The Netherlands
| | - R M Rijsman
- Centre for Sleep and Wake Disorders, Medical Centre Haaglanden, The Hague, 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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25
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Louter MA, Pijpers JA, Wardenaar KJ, van Zwet EW, van Hemert AM, Zitman FG, Ferrari MD, Penninx BW, Terwindt GM. Symptom dimensions of affective disorders in migraine patients. J Psychosom Res 2015; 79:458-63. [PMID: 26526323 DOI: 10.1016/j.jpsychores.2015.09.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/08/2015] [Accepted: 09/27/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE A strong association has been established between migraine and depression. However, this is the first study to differentiate in a large sample of migraine patients for symptom dimensions of the affective disorder spectrum. METHODS Migraine patients (n=3174) from the LUMINA (Leiden University Medical Centre Migraine Neuro-analysis Program) study and patients with current psychopathology (n=1129), past psychopathology (n=477), and healthy controls (n=561) from the NESDA (Netherlands Study of Depression and Anxiety) study, were compared for three symptom dimensions of depression and anxiety. The dimensions -lack of positive affect (depression specific); negative affect (nonspecific); and somatic arousal (anxiety specific)- were assessed by a shortened adaptation of the Mood and Anxiety Symptom Questionnaire (MASQ-D30). Within the migraine group, the association with migraine specific determinants was established. Multivariate regression analyses were conducted. RESULTS Migraine patients differed significantly (p<0.001) from healthy controls for all three dimensions: Cohen's d effect sizes were 0.37 for lack of positive affect, 0.68 for negative affect, and 0.75 for somatic arousal. For the lack of positive affect and negative affect dimensions, migraine patients were predominantly similar to the past psychopathology group. For the somatic arousal dimension, migraine patients scores were more comparable with the current psychopathology group. Migraine specific determinants for high scores on all dimensions were high frequency of attacks and cutaneous allodynia during attacks. CONCLUSION This study shows that affective symptoms in migraine patients are especially associated with the somatic arousal component.
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Affiliation(s)
- M A Louter
- Dept. Neurology, Leiden University Medical Centre, Leiden, The Netherlands; Dept. Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - J A Pijpers
- Dept. Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - K J Wardenaar
- Dept. Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands; University of Groningen, University Medical Centre Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, The Netherlands
| | - E W van Zwet
- Dept. Biostatistics, Leiden University Medical Centre, Leiden, The Netherlands
| | - A M van Hemert
- Dept. Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - F G Zitman
- Dept. Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - M D Ferrari
- Dept. Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - B W Penninx
- Dept. of Psychiatry, EMGO Institute for Health and Care Research, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - G M Terwindt
- Dept. Neurology, Leiden University Medical Centre, Leiden, The Netherlands.
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de Coo IF, Wilbrink LA, Haan J, Ferrari MD, Terwindt GM. Evaluation of the new ICHD-III beta cluster headache criteria. Cephalalgia 2015; 36:547-51. [DOI: 10.1177/0333102415607856] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/27/2015] [Indexed: 11/15/2022]
Abstract
Aim In the revised criteria of the International Classification of Headache Disorders (ICHD-III beta) the following items are added to the diagnostic criteria of cluster headache: ipsilateral sensation of fullness in the ear and ipsilateral forehead/facial flushing. We evaluated the possible additional value of these symptoms for diagnosing cluster headache. Methods In this cross-sectional cohort study of (potential) cluster headache patients we investigated these additional symptoms using a Web-based questionnaire. Patients not fulfilling the ICHD-II criteria for cluster headache but fulfilling the ICHD-III beta criteria were interviewed. Results Response rate was 916/1138 (80.5%). Of all 573 patients with cluster headache according to ICHD-II criteria, 192 (33.5%) reported ipsilateral ear fullness and 113 (19.7%) facial flushing during attacks. There was no difference in reporting ipsilateral ear fullness and facial flushing between patients who received a diagnosis of cluster headache and patients who did not. None of the patients who did not fulfill all ICHD-II criteria could be categorized as cluster headache according to the ICHD-III beta criteria. Conclusion The results of this study do not support the addition of ear fullness and facial flushing to the new ICHD-III beta criteria.
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Affiliation(s)
- IF de Coo
- Department of Neurology, Leiden University Medical Center, the Netherlands
| | - LA Wilbrink
- Department of Neurology, Leiden University Medical Center, the Netherlands
| | - J Haan
- Department of Neurology, Leiden University Medical Center, the Netherlands
- Department of Neurology, Alrijne Hospital, the Netherlands
| | - MD Ferrari
- Department of Neurology, Leiden University Medical Center, the Netherlands
| | - GM Terwindt
- Department of Neurology, Leiden University Medical Center, the Netherlands
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27
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Postma IR, van Oosterhout WPJ, de Groot JC, Terwindt GM, Zeeman GG. The presence of brain white matter lesions in relation to preeclampsia and migraine. Cephalalgia 2015; 36:284-8. [PMID: 25957305 DOI: 10.1177/0333102415586065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 04/05/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Identifying female-specific risk markers for cerebrovascular disease is becoming increasingly important. Both migraine and preeclampsia have been associated with higher incidence of brain white matter lesions (WML) and stroke. We assessed the association between WML and migraine among formerly (pre)eclamptic women. METHODS A total of 118 women (76 formerly (pre)eclamptic and 42 control women) were screened for migraine and WML presence. Independent effects of migraine and (pre)eclampsia on WML were assessed. RESULTS Migraine prevalence did not differ between the (pre)eclamptic (26/76; 34%); and control group (10/42; 24%), p = 0.17. Age-adjusted regression analysis failed to show a significant independent effect of migraine (OR 1.14; 95% CI 0.47-2.76; p = 0.77) on WML presence, and showed a non-significant effect of (pre)eclampsia (OR 2.30; 95% CI 0.90-5.83; p = 0.08). CONCLUSION Migraine prevalence was not found to be an independent risk factor for WML prevalence in formerly (pre)eclamptic women. Since this study had a small sample size, larger prospective studies are needed to examine female-specific risk factors for WML and its consequences.
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Affiliation(s)
- I R Postma
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, the Netherlands
| | | | - J C de Groot
- Department of Radiology, University Medical Center Groningen, the Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, the Netherlands
| | - G G Zeeman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, the Netherlands
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28
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Pijpers JA, Louter MA, de Bruin ME, van Zwet EW, Zitman FG, Ferrari MD, Terwindt GM. Detoxification in medication-overuse headache, a retrospective controlled follow-up study: Does care by a headache nurse lead to cure? Cephalalgia 2015; 36:122-30. [PMID: 25903762 DOI: 10.1177/0333102415583146] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/24/2015] [Indexed: 11/15/2022]
Abstract
AIM J.A.P. and M.A.L. contributed equally to this manuscript.The aim of this article is to determine whether support by a headache nurse in the treatment of medication-overuse headache (MOH) increases successful withdrawal, and to study determinants of response to withdrawal therapy. METHODS A retrospective, controlled follow-up study was performed with 416 MOH patients. All patients were treated with outpatient withdrawal therapy, with two treatment arms: with or without the support of a specialised headache nurse. The outcome measures were: i) successful withdrawal, defined as discontinuation of all headache medication according to the study protocol; and ii) the responder rate, defined as the percentage of patients with ≥ 50% reduction in headache days after successful withdrawal and iii) relative reduction in headache days after successful withdrawal. RESULTS Successful withdrawal percentages were significantly higher in the group supported by the headache nurse than in the group without support (73.1% vs. 60.7%; p = 0.008), which was confirmed in multivariate analysis (OR 1.73, 95% CI 1.11-2.71, p = 0.016). Support by a headache nurse was not associated with response. The underlying primary headache diagnosis, determined after withdrawal, was significantly correlated with response. CONCLUSION The support by a headache nurse results in an increased adherence to detoxification.
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Affiliation(s)
- J A Pijpers
- Department of Neurology, Leiden University Medical Centre, the Netherlands
| | - M A Louter
- Department of Neurology, Leiden University Medical Centre, the Netherlands Department of Psychiatry, Leiden University Medical Centre, the Netherlands
| | - M E de Bruin
- Department of Neurology, Leiden University Medical Centre, the Netherlands
| | - E W van Zwet
- Department of Medical Statistics, Leiden University Medical Centre, Leiden, the Netherlands
| | - F G Zitman
- Department of Psychiatry, Leiden University Medical Centre, the Netherlands
| | - M D Ferrari
- Department of Neurology, Leiden University Medical Centre, the Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Centre, the Netherlands
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Ibrahimi K, van Oosterhout WPJ, van Dorp W, Danser AHJ, Garrelds IM, Kushner SA, Lesaffre EMEH, Terwindt GM, Ferrari MD, van den Meiracker AH, MaassenVanDenBrink A. Reduced trigeminovascular cyclicity in patients with menstrually related migraine. Neurology 2014; 84:125-31. [PMID: 25503623 DOI: 10.1212/wnl.0000000000001142] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE A case-control study to investigate the effect of the menstrual cycle on trigeminal nerve-induced vasodilation in healthy women and patients with menstrually related migraine (MRM). METHODS Using a laser-Doppler imager, we compared the vasodilator effects of capsaicin application and electrical stimulation (ES) on the forehead skin, a trigeminal nerve-innervated dermatome, in premenopausal patients with MRM (n = 22), healthy controls (n = 20), and postmenopausal women without migraine (n = 22). Blood samples were collected for female sex hormone measurements. RESULTS Dermal blood flow (DBF) responses to capsaicin were higher in controls during days 1-2 than during days 19-21 of their menstruation cycle (mean Emax ± SEM: 203 ± 28 AU vs 156 ± 27 AU [p = 0.031] for 0.06 mg/mL capsaicin and 497 ± 25 AU vs 456 ± 24 AU [p = 0.009] for 6.0 mg/mL capsaicin). In contrast, patients with MRM demonstrated DBF responses without significant cycle-dependent variability (days 1-2 vs days 19-21: Emax 148 ± 20 AU vs 154 ± 20 AU [p = 0.788] for 0.06 mg/mL capsaicin and 470 ± 17 AU vs 465 ± 20 AU [p = 0.679] for 6.0 mg/mL capsaicin). DBF responses to ES were not different between either patients with MRM or controls, at either occasion. Estradiol levels on days 19-21 of the menstrual cycle were higher in healthy controls (mean ± SEM: 75 ± 8 pg/mL) than in patients with MRM (52 ± 4 pg/mL, p = 0.014). In postmenopausal women, DBF responses to capsaicin and ES, as well as estradiol levels at both visits, were all significantly reduced compared to patients with MRM and controls (in all cases, p < 0.05). CONCLUSIONS Our study provides evidence for a reduced menstrual cyclicity of both estradiol levels and the trigeminovascular vasodilator system in patients with MRM.
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Affiliation(s)
- Khatera Ibrahimi
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (K.I., A.H.J.D., I.M.G., A.H.v.d.M., A.M.V.D.B.), and Departments of Gynaecology (W.v.D.), Psychiatry (S.A.K.), and Biostatistics (E.M.E.H.L.), Erasmus MC, Rotterdam; and Department of Neurology (W.P.J.v.O., G.M.T., M.D.F.), Leiden University Medical Center, the Netherlands
| | - Willebrordus Petrus Johannes van Oosterhout
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (K.I., A.H.J.D., I.M.G., A.H.v.d.M., A.M.V.D.B.), and Departments of Gynaecology (W.v.D.), Psychiatry (S.A.K.), and Biostatistics (E.M.E.H.L.), Erasmus MC, Rotterdam; and Department of Neurology (W.P.J.v.O., G.M.T., M.D.F.), Leiden University Medical Center, the Netherlands
| | - Wendy van Dorp
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (K.I., A.H.J.D., I.M.G., A.H.v.d.M., A.M.V.D.B.), and Departments of Gynaecology (W.v.D.), Psychiatry (S.A.K.), and Biostatistics (E.M.E.H.L.), Erasmus MC, Rotterdam; and Department of Neurology (W.P.J.v.O., G.M.T., M.D.F.), Leiden University Medical Center, the Netherlands
| | - A H Jan Danser
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (K.I., A.H.J.D., I.M.G., A.H.v.d.M., A.M.V.D.B.), and Departments of Gynaecology (W.v.D.), Psychiatry (S.A.K.), and Biostatistics (E.M.E.H.L.), Erasmus MC, Rotterdam; and Department of Neurology (W.P.J.v.O., G.M.T., M.D.F.), Leiden University Medical Center, the Netherlands
| | - Ingrid M Garrelds
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (K.I., A.H.J.D., I.M.G., A.H.v.d.M., A.M.V.D.B.), and Departments of Gynaecology (W.v.D.), Psychiatry (S.A.K.), and Biostatistics (E.M.E.H.L.), Erasmus MC, Rotterdam; and Department of Neurology (W.P.J.v.O., G.M.T., M.D.F.), Leiden University Medical Center, the Netherlands
| | - Steven A Kushner
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (K.I., A.H.J.D., I.M.G., A.H.v.d.M., A.M.V.D.B.), and Departments of Gynaecology (W.v.D.), Psychiatry (S.A.K.), and Biostatistics (E.M.E.H.L.), Erasmus MC, Rotterdam; and Department of Neurology (W.P.J.v.O., G.M.T., M.D.F.), Leiden University Medical Center, the Netherlands
| | - Emmanuel M E H Lesaffre
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (K.I., A.H.J.D., I.M.G., A.H.v.d.M., A.M.V.D.B.), and Departments of Gynaecology (W.v.D.), Psychiatry (S.A.K.), and Biostatistics (E.M.E.H.L.), Erasmus MC, Rotterdam; and Department of Neurology (W.P.J.v.O., G.M.T., M.D.F.), Leiden University Medical Center, the Netherlands
| | - G M Terwindt
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (K.I., A.H.J.D., I.M.G., A.H.v.d.M., A.M.V.D.B.), and Departments of Gynaecology (W.v.D.), Psychiatry (S.A.K.), and Biostatistics (E.M.E.H.L.), Erasmus MC, Rotterdam; and Department of Neurology (W.P.J.v.O., G.M.T., M.D.F.), Leiden University Medical Center, the Netherlands
| | - Michel D Ferrari
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (K.I., A.H.J.D., I.M.G., A.H.v.d.M., A.M.V.D.B.), and Departments of Gynaecology (W.v.D.), Psychiatry (S.A.K.), and Biostatistics (E.M.E.H.L.), Erasmus MC, Rotterdam; and Department of Neurology (W.P.J.v.O., G.M.T., M.D.F.), Leiden University Medical Center, the Netherlands
| | - Anton H van den Meiracker
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (K.I., A.H.J.D., I.M.G., A.H.v.d.M., A.M.V.D.B.), and Departments of Gynaecology (W.v.D.), Psychiatry (S.A.K.), and Biostatistics (E.M.E.H.L.), Erasmus MC, Rotterdam; and Department of Neurology (W.P.J.v.O., G.M.T., M.D.F.), Leiden University Medical Center, the Netherlands
| | - Antoinette MaassenVanDenBrink
- From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine (K.I., A.H.J.D., I.M.G., A.H.v.d.M., A.M.V.D.B.), and Departments of Gynaecology (W.v.D.), Psychiatry (S.A.K.), and Biostatistics (E.M.E.H.L.), Erasmus MC, Rotterdam; and Department of Neurology (W.P.J.v.O., G.M.T., M.D.F.), Leiden University Medical Center, the Netherlands.
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van Oosterhout WPJ, Schoonman GG, Garrelds IM, Danser AHJ, Chan KY, Terwindt GM, Ferrari MD, MaassenVanDenBrink A. A human capsaicin model to quantitatively assess salivary CGRP secretion. Cephalalgia 2014; 35:675-82. [PMID: 25366550 DOI: 10.1177/0333102414553824] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 09/08/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Capsaicin induces the release of calcitonin gene-related peptide (CGRP) via the transient receptor potential channel V1 (TRPV1). The CGRP response after capsaicin application on the tongue might reflect the "activation state" of the trigeminal nerve, since trigeminal CGRP-containing vesicles are depleted on capsaicin application. We tested (i) the quantitative CGRP response after oral capsaicin application; (ii) the optimal concentration of red chili homogenate; and (iii) the day-to-day variability in this response. METHODS Saliva was collected for two consecutive days after oral application of eight capsaicin dilutions (red chili homogenates) of increasing concentrations in 13 healthy individuals. Effects of homogenate concentration were assessed. Consecutively, saliva was sampled after application of vehicle and undiluted homogenates. RESULTS CGRP secretion (pg/ml) increased dose-dependently with homogenate concentration (p < 0.001). CGRP levels were highest after application of nondiluted homogenate (vs. baseline: 13.3 (5.0) vs. 9.7 (2.9); p = 0.003, as was total CGRP secretion in five minutes (pg) with undiluted (vs. baseline): 89.2 (44.1) vs. 14.1 (2.8); p < 0.001. The dose-dependent response in CGRP was not affected by day (p = 0.14) or day*concentration (p = 0.60). Increase in CGRP (undiluted - baseline; pg/ml) did not differ between measurements on dose-finding (p = 0.67) and follow-up days (p = 0.46). CONCLUSION Oral application of red chili homogenate is well tolerated and causes a dose-dependent CGRP release in saliva, without day-to-day effects in this response. This model could be used to noninvasively study the activation state of the trigeminal nerve innervating salivary glands.
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Affiliation(s)
| | - G G Schoonman
- Department of Neurology Leiden University Medical Center, The Netherlands
| | - I M Garrelds
- Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus MC, The Netherlands
| | - A H J Danser
- Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus MC, The Netherlands
| | - K Y Chan
- Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus MC, The Netherlands
| | - G M Terwindt
- Department of Neurology Leiden University Medical Center, The Netherlands
| | - M D Ferrari
- Department of Neurology Leiden University Medical Center, The Netherlands
| | - A MaassenVanDenBrink
- Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus MC, The Netherlands
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Louter MA, Fernandez-Morales J, de Vries B, Winsvold B, Anttila V, Fernandez-Cadenas I, Vila-Pueyo M, Sintas C, van Duijn CM, Cormand B, Álvarez-Sabin J, Montaner J, Ferrari MD, van den Maagdenberg A, Palotie A, Zwart JA, Macaya A, Terwindt GM, Pozo-Rosich P. Candidate-gene association study searching for genetic factors involved in migraine chronification. Cephalalgia 2014; 35:500-7. [PMID: 25169732 DOI: 10.1177/0333102414547141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 07/20/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Chronic migraine (CM) is at the severe end of the clinical migraine spectrum, but its genetic background is unknown. Our study searched for evidence that genetic factors are involved in the chronification process. METHODS We initially selected 144 single-nucleotide polymorphisms (SNPs) from 48 candidate genes, which we tested for association in two stages: The first stage encompassed 262 CM patients, the second investigated 226 patients with high-frequency migraine (HFM). Subsequently, SNPs with p values < 0.05 were forwarded to the replication stage containing 531 patients with CM or HFM. RESULTS Eight SNPs were significantly associated with CM and HFM in the two-stage phase. None survived replication in the third stage. DISCUSSION We present the first comprehensive genetic association study for migraine chronification. There were no significant findings. Future studies may benefit from larger, genome-wide data sets or should use other genetic approaches to identify genetic factors involved in migraine chronification.
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Affiliation(s)
- M A Louter
- Department of Neurology, Leiden University Medical Center (LUMC), the Netherlands Department of Psychiatry, Leiden University Medical Center (LUMC), the Netherlands
| | - J Fernandez-Morales
- Headache and Neurological Pain Research Group, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona
| | - B de Vries
- Department of Human Genetics, Leiden University Medical Center (LUMC), the Netherlands
| | - B Winsvold
- Department of Human Genetics, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, United Kingdom FORMI, Oslo University Hospital, Norway Department of Neurology, Oslo University Hospital, Norway Institute of Clinical Medicine, University of Oslo, Norway
| | - V Anttila
- Analytical and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, USA Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, USA Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Finland
| | - I Fernandez-Cadenas
- Stroke Genetics and Pharmacogenetics, Fundació per la Docència i Recerca Mutua Terrassa, Spain Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universidad Autonoma de Barcelona, Spain
| | - M Vila-Pueyo
- Pediatric Neurology Research Group, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Spain
| | - C Sintas
- Departament de Genètica, Facultat de Biologia, Universitat de Barcelona, Spain Centre for Biomedical Network Research on Rare Diseases (CIBERER), Spain
| | - C M van Duijn
- Department of Epidemiology, Erasmus University Medical Center, the Netherlands
| | - B Cormand
- Departament de Genètica, Facultat de Biologia, Universitat de Barcelona, Spain Centre for Biomedical Network Research on Rare Diseases (CIBERER), Spain Institute of Biomedicine of the University of Barcelona (IBUB), Spain
| | - J Álvarez-Sabin
- Neurology Department, Hospital Universitari Vall d'Hebron (HUVH), Spain
| | - J Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universidad Autonoma de Barcelona, Spain Neurology Department, Hospital Universitari Vall d'Hebron (HUVH), Spain
| | - M D Ferrari
- Department of Neurology, Leiden University Medical Center (LUMC), the Netherlands
| | - Amjm van den Maagdenberg
- Department of Neurology, Leiden University Medical Center (LUMC), the Netherlands Department of Human Genetics, Leiden University Medical Center (LUMC), the Netherlands
| | - A Palotie
- Department of Human Genetics, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, United Kingdom Analytical and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, USA Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, USA Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Finland
| | - J A Zwart
- FORMI, Oslo University Hospital, Norway Department of Neurology, Oslo University Hospital, Norway Institute of Clinical Medicine, University of Oslo, Norway
| | - A Macaya
- Pediatric Neurology Research Group, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Spain
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center (LUMC), the Netherlands
| | - P Pozo-Rosich
- Headache and Neurological Pain Research Group, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona Neurology Department, Hospital Universitari Vall d'Hebron (HUVH), Spain
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Pelzer N, de Vries B, Kamphorst JT, Vijfhuizen LS, Ferrari MD, Haan J, van den Maagdenberg AMJM, Terwindt GM. PRRT2 and hemiplegic migraine: A complex association. Neurology 2014; 83:288-90. [DOI: 10.1212/wnl.0000000000000590] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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van Oosterhout WPJ, Terwindt GM, Vein AA, Ferrari MD. Space headache on Earth: Head-down-tilted bed rest studies simulating outer-space microgravity. Cephalalgia 2014; 35:335-43. [DOI: 10.1177/0333102414536058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Headache is a common symptom during space travel, both isolated and as part of space motion syndrome. Head-down-tilted bed rest (HDTBR) studies are used to simulate outer space microgravity on Earth, and allow countermeasure interventions such as artificial gravity and training protocols, aimed at restoring microgravity-induced physiological changes. Objectives The objectives of this article are to assess headache incidence and characteristics during HDTBR, and to evaluate the effects of countermeasures. Methods In a randomized cross-over design by the European Space Agency (ESA), 22 healthy male subjects, without primary headache history, underwent three periods of –6-degree HDTBR. In two of these episodes countermeasure protocols were added, with either centrifugation or aerobic exercise training protocols. Headache occurrence and characteristics were daily assessed using a specially designed questionnaire. Results In total 14/22 (63.6%) subjects reported a headache during ≥1 of the three HDTBR periods, in 12/14 (85.7%) non-specific, and two of 14 (14.4%) migraine. The occurrence of headache did not differ between HDTBR with and without countermeasures: 12/22 (54.5%) subjects vs. eight of 22 (36.4%) subjects; p = 0.20; 13/109 (11.9%) headache days vs. 36/213 (16.9%) headache days; p = 0.24). During countermeasures headaches were, however, more often mild ( p = 0.03) and had fewer associated symptoms ( p = 0.008). Conclusions Simulated microgravity during HDTBR induces headache episodes, mostly on the first day. Countermeasures are useful in reducing headache severity and associated symptoms. Reversible, microgravity-induced cephalic fluid shift may cause headache, also on Earth. HDTBR can be used to study space headache on Earth.
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Affiliation(s)
- WPJ van Oosterhout
- Department of Neurology, Leiden University Medical Center, the Netherlands
| | - GM Terwindt
- Department of Neurology, Leiden University Medical Center, the Netherlands
| | - AA Vein
- Department of Neurology, Leiden University Medical Center, the Netherlands
| | - MD Ferrari
- Department of Neurology, Leiden University Medical Center, the Netherlands
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Louter MA, Wardenaar KJ, Veen G, van Oosterhout WPJ, Zitman FG, Ferrari MD, Terwindt GM. Allodynia is associated with a higher prevalence of depression in migraine patients. Cephalalgia 2014; 34:1187-92. [DOI: 10.1177/0333102414532554] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction There is a strong association between migraine and depression. The aim of this study is to identify migraine-specific factors involved in this association. Methods We conducted a cross-sectional study in a large, well-defined cohort of migraine patients ( n = 2533). We assessed lifetime depression using validated questionnaires, and diagnosed migraine based on the International Classification of Headache Disorders III-beta criteria. Multivariate regression analyses were conducted. Results Of the 2533 migraineurs that were eligible, 1137 (45%) suffered from lifetime depression. The following independent factors were associated with an increased depression prevalence: i) migraine-specific risk factors: high migraine attack frequency and the presence of allodynia, ii) general factors: being a bad sleeper, female gender, high BMI, being single, smoking, and a low alcohol consumption. Conclusion This study identified allodynia, in addition to high migraine attack frequency, as a new migraine-specific factor associated with depression.
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Affiliation(s)
- MA Louter
- Department of Neurology, Leiden University Medical Centre, the Netherlands
- Department of Psychiatry, Leiden University Medical Centre, the Netherlands
| | - KJ Wardenaar
- Department of Psychiatry, Leiden University Medical Centre, the Netherlands
- University of Groningen, University Medical Centre Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, the Netherlands
| | - G Veen
- GGZ Ingeest/VU Medical Centre, the Netherlands
| | - WPJ van Oosterhout
- Department of Neurology, Leiden University Medical Centre, the Netherlands
| | - FG Zitman
- Department of Psychiatry, Leiden University Medical Centre, the Netherlands
| | - MD Ferrari
- Department of Neurology, Leiden University Medical Centre, the Netherlands
| | - GM Terwindt
- Department of Neurology, Leiden University Medical Centre, the Netherlands
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Zielman R, Teeuwisse WM, Bakels F, Van der Grond J, Webb A, van Buchem MA, Ferrari MD, Kruit MC, Terwindt GM. Biochemical changes in the brain of hemiplegic migraine patients measured with 7 tesla 1H-MRS. Cephalalgia 2014; 34:959-67. [PMID: 24651393 DOI: 10.1177/0333102414527016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The aim of this study was to assess biochemical changes in the brain of patients with hemiplegic migraine in between attacks. METHODS Eighteen patients with hemiplegic migraine (M:F, 7:11; age 38 ± 14 years) of whom eight had a known familial hemiplegic migraine (FHM) mutation (five in the CACNA1A gene (FHM1), three in the ATP1A2 gene (FHM2)) and 19 age- and sex-matched healthy controls (M:F, 7:12; mean age 38 ± 12 years) were studied. We used single-voxel 7 tesla (1)H-MRS (STEAM, TR/TM/TE = 2000/19/21 ms) to investigate four brain regions in between attacks: cerebellum, hypothalamus, occipital lobe, and pons. RESULTS Patients with hemiplegic migraine showed a significantly lower total N-acetylaspartate/total creatine ratio (tNAA/tCre) in the cerebellum (median 0.73, range 0.59-1.03) than healthy controls (median 0.79, range (0.67-0.95); p = 0.02). In FHM1 patients with a CACNA1A mutation, the tNAA/tCre was lowest. DISCUSSION We found a decreased cerebellar tNAA/tCre ratio that might serve as an early biomarker for neuronal dysfunction and/or loss. This is the first high-spectral resolution 7 tesla (1)H-MRS study of interictal biochemical brain changes in hemiplegic migraine patients.
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Affiliation(s)
- R Zielman
- Department of Neurology, Leiden University Medical Centre, the Netherlands
| | - W M Teeuwisse
- Department of Radiology, Leiden University Medical Centre, the Netherlands
| | - F Bakels
- Department of Neurology, Leiden University Medical Centre, the Netherlands
| | - J Van der Grond
- Department of Radiology, Leiden University Medical Centre, the Netherlands
| | - A Webb
- Department of Radiology, Leiden University Medical Centre, the Netherlands
| | - M A van Buchem
- Department of Radiology, Leiden University Medical Centre, the Netherlands
| | - M D Ferrari
- Department of Neurology, Leiden University Medical Centre, the Netherlands
| | - M C Kruit
- Department of Radiology, Leiden University Medical Centre, the Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Centre, the Netherlands
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Pelzer N, de Vries B, Boon EMJ, Kruit MC, Haan J, Ferrari MD, van den Maagdenberg AMJM, Terwindt GM. Heterozygous TREX1 mutations in early-onset cerebrovascular disease. J Neurol 2013; 260:2188-90. [PMID: 23881107 DOI: 10.1007/s00415-013-7050-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 07/12/2013] [Indexed: 11/24/2022]
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De Vries B, Weller CM, De Fàbregues O, Koelewijn SC, Stam AH, Haan J, Ferrari MD, Terwindt GM, van den Maagdenberg AMJ. Novel SCN1A mutation in the IFMT motif of the α1 subunit of the voltage-gated NaV1.1 channel causing familial hemiplegic migraine. J Headache Pain 2013. [PMCID: PMC3620160 DOI: 10.1186/1129-2377-14-s1-p19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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van Oosterhout WPJ, van der Plas AA, van Zwet EW, Zielman R, Ferrari MD, Terwindt GM. Postdural puncture headache in migraineurs and nonheadache subjects: a prospective study. Neurology 2013; 80:941-8. [PMID: 23390176 DOI: 10.1212/wnl.0b013e3182840bf6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To prospectively assess 1) the incidence and duration of postdural puncture headache (PDPH) in migraineurs and healthy subjects; 2) the associated risk factors; and 3) the risk of getting a migraine attack shortly before or after lumbar puncture (LP). METHODS As part of an extensive biochemical migraine research program, we assessed the occurrence, duration, and characteristics of PDPH in 160 migraineurs and 53 age- and sex-matched healthy controls. In addition, we evaluated potential risk factors for PDPH as well as the risk of developing a migraine attack before or after LP. RESULTS In total, 64 of 199 subjects (32.2%) developed PDPH. Young age, low body mass index, severe headache immediately after LP, and sitting sampling position, but not being a migraineur, increased the risk of PDPH (all p < 0.05). Duration of PDPH was prolonged by history of depression, sitting sampling position, high perceived stress during the LP procedure, and multiple LP efforts (all p < 0.05). Migraine attacks were less likely to occur before or shortly after LP. CONCLUSIONS Migraineurs are not at increased risk of developing PDPH. PDPH duration is similar in migraineurs and age- and sex-matched controls. LP does not trigger migraine attacks, and the stress of an upcoming LP might even have a protective effect against onset of migraine attacks.
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Affiliation(s)
- W P J van Oosterhout
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Koppen H, Palm-Meinders IH, Horlings CGC, Terwindt GM, Launer LJ, van Buchem MA, Kruit MC, Bloem MR, Ferrari MD. Postural sway in migraine patients and controls, results from a population based CAMERA-2 study. J Headache Pain 2013. [PMCID: PMC3619993 DOI: 10.1186/1129-2377-14-s1-p119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Houben T, Shyti R, Dees Q, van Berloo S, de Groote L, Terwindt GM, Ferrari MD, Tolner EA, van den Maagdenberg AM. Monitoring cortical neuronal activity and spreading depression in freely behaving familial hemiplegic migraine Cacna1a R192Q knockin mice. J Headache Pain 2013. [PMCID: PMC3620439 DOI: 10.1186/1129-2377-14-s1-p79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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De Vries BL, Freilinger T, Anttila V, Malik R, Terwindt GM, Pozo-Rosich P, Winsvold B, Nyholt D, van Oosterhout WPJ, Artto V, Todt M, Hämäläinen E, Fernandez-Moralez J, Louter M, Kaunisto MA, Schoenen J, Raitakari O, Lehtimäki T, Ville-Pueyo M, Göbel H, Wichman E, Sintas C, Uitterlinden A, Hofman A, Rivadeneira F, Heinze A, Tronvik E, van Duin CM, Kaprio J, Cormand B, Wessman M, Frants RR, Meitinger T, Müller-Myhsok B, Zwart JA, Färkkilä M, Macaya A, Ferrari MD, Kubisch C, Palotie A, Dichgans M, van den Maagdenberg AMJ. Migraine without aura: genome-wide association analysis identifies several novel susceptibility. J Headache Pain 2013. [PMCID: PMC3620256 DOI: 10.1186/1129-2377-14-s1-p21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Houben T, Shyti R, Dees Q, van Berloo S, de Groote L, Terwindt GM, Ferrari MD, Tolner EA, van den Maagdenberg AM. Monitoring cortical neuronal activity and spreading depression in freely behaving familial hemiplegic migraine Cacna1a R192Q knockin mice. J Headache Pain 2013. [DOI: 10.1186/1129-2377-1-s1-p79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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De Vries B, Weller CM, De Fàbregues O, Koelewijn SC, Stam AH, Haan J, Ferrari MD, Terwindt GM, van den Maagdenberg AMJ. Novel SCN1A mutation in the IFMT motif of the α1 subunit of the voltage-gated NaV1.1 channel causing familial hemiplegic migraine. J Headache Pain 2013. [DOI: 10.1186/1129-2377-1-s1-p19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Koppen H, Palm-Meinders IH, Horlings CGC, Terwindt GM, Launer LJ, van Buchem MA, Kruit MC, Bloem MR, Ferrari MD. Postural sway in migraine patients and controls, results from a population based CAMERA-2 study. J Headache Pain 2013. [DOI: 10.1186/1129-2377-1-s1-p119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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van Oosterhout WPJ, Weller CM, Stam AH, Bakels F, Stijnen T, Ferrari MD, Terwindt GM. Validation of the web-based LUMINA questionnaire for recruiting large cohorts of migraineurs. Cephalalgia 2011; 31:1359-67. [DOI: 10.1177/0333102411418846] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess validity of a self-administered web-based migraine-questionnaire in diagnosing migraine aura for the use of epidemiological and genetic studies. Methods: Self-reported migraineurs enrolled via the LUMINA website and completed a web-based questionnaire on headache and aura symptoms, after fulfilling screening criteria. Diagnoses were calculated using an algorithm based on the International Classification of Headache Disorders (ICHD-2), and semi-structured telephone-interviews were performed for final diagnoses. Logistic regression generated a prediction rule for aura. Algorithm-based diagnoses and predicted diagnoses were subsequently compared to the interview-derived diagnoses. Results: In 1 year, we recruited 2397 migraineurs, of which 1067 were included in the validation. A seven-question subset provided higher sensitivity (86% vs. 45%), slightly lower specificity (75% vs. 95%), and similar positive predictive value (86% vs. 88%) in assessing aura when comparing with the ICHD-2-based algorithm. Conclusions: This questionnaire is accurate and reliable in diagnosing migraine aura among self-reported migraineurs and enables detection of more aura cases with low false-positive rate.
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Affiliation(s)
| | | | - AH Stam
- Leiden University, The Netherlands
| | - F Bakels
- Leiden University, The Netherlands
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Koppen H, Terwindt GM, Haan J, de Bruijn SFTM, Bax JJ, Ferrari MD. No indication for patent foramen ovale closure in migraine. Neth Heart J 2011; 17:320-1. [PMID: 19949472 DOI: 10.1007/bf03086276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- H Koppen
- Department of Neurology, Leiden University Medical Center, Leiden and Hagaziekenhuis, The Hague, the Netherlands
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Kruit MC, van Buchem MA, Launer LJ, Terwindt GM, Ferrari MD. Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: the population-based MRI CAMERA study. Cephalalgia 2011; 30:129-36. [PMID: 19515125 DOI: 10.1111/j.1468-2982.2009.01904.x] [Citation(s) in RCA: 248] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Previous studies have suggested that migraine is a risk factor for brain lesions, but methodological issues hampered drawing definite conclusions. Therefore, we initiated the magnetic resonance imaging (MRI) ‘CAMERA’ (Cerebral Abnormalities in Migraine, an Epidemiological Risk Analysis) study. We summarize our previously published results. A total of 295 migraineurs and 140 controls were randomly selected from a previously diagnosed population-based sample (n = 6039), who underwent an interview, physical examination and a brain MRI scan. Migraineurs, notably those with aura, had higher prevalence of subclinical infarcts in the posterior circulation [odds ratio (OR) 13.7; 95% confidence interval (CI) 1.7, 112]. Female migraineurs were at independent increased risk of white matter lesions (WMLs; OR 2.1; 95% CI 1.0, 4.1), and migraineurs had a higher prevalence of brainstem hyperintense lesions (4.4% vs. 0.7%, P = 0.04). We observed a higher lifetime prevalence of (frequent) syncope and orthostatic insufficiency in migraineurs; future research needs to clarify whether autonomic nervous system dysfunction could explain (part of) the increased risk of WMLs in female migraineurs. Finally, in migraineurs aged < 50 years, compared with controls, we found evidence of increased iron concentrations in putamen (P = 0.02), globus pallidus (P = 0.03) and red nucleus (P = 0.03). Higher risks in those with higher attack frequency or longer disease duration were found consistent with a causal relationship between migraine and lesions. This summary of our population-based data illustrates that migraine is associated with a significantly increased risk of brain lesions. Longitudinal studies are needed to assess whether these lesions are progressive and have relevant (long-term) functional correlates.
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Affiliation(s)
- M C Kruit
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
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Stam AH, de Vries B, Janssens ACJW, Vanmolkot KRJ, Aulchenko YS, Henneman P, Oostra BA, Frants RR, van den Maagdenberg AMJM, Ferrari MD, van Duijn CM, Terwindt GM. Shared genetic factors in migraine and depression: evidence from a genetic isolate. Neurology 2010; 74:288-94. [PMID: 20071666 DOI: 10.1212/wnl.0b013e3181cbcd19] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the co-occurrence of migraine and depression and assess whether shared genetic factors may underlie both diseases. METHODS Subjects were 2,652 participants of the Erasmus Rucphen Family genetic isolate study. Migraine was diagnosed using a validated 3-stage screening method that included a telephone interview. Symptoms of depression were assessed using the Center for Epidemiologic Studies Depression scale and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). The contribution of shared genetic factors in migraine and depression was investigated by comparing heritability estimates for migraine with and without adjustment for symptoms of depression, and by comparing the heritability scores of depression between migraineurs and controls. RESULTS We identified 360 migraine cases: 209 had migraine without aura (MO) and 151 had migraine with aura (MA). Odds ratios for depression in patients with migraine were 1.29 (95% confidence interval [CI] 0.98-1.70) for MO and 1.70 (95% CI 1.28-2.24) for MA. Heritability estimates were significant for all migraine (0.56), MO (0.77), and MA (0.96), and decreased after adjustment for symptoms of depression or use of antidepressant medication, in particular for MA. Comparison of the heritability scores for depression between patients with migraine and controls showed a genetic correlation between HADS-D score and MA. CONCLUSIONS There is a bidirectional association between depression and migraine, in particular migraine with aura, which can be explained, at least partly, by shared genetic factors.
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Affiliation(s)
- A H Stam
- Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, the Netherlands. G
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de Vries B, Steup-Beekman GM, Haan J, Bollen EL, Luyendijk J, Frants RR, Terwindt GM, van Buchem MA, Huizinga TWJ, van den Maagdenberg AMJM, Ferrari MD. TREX1 gene variant in neuropsychiatric systemic lupus erythematosus. Ann Rheum Dis 2009; 69:1886-7. [PMID: 19875384 DOI: 10.1136/ard.2009.114157] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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