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Cagnazzo F, Ducros A, Risi G, Charif M, Corti L, Rapido F, Le Bars E, Lonjon N, Costalat V. Safety and efficacy of transvenous embolization of cerebrospinal fluid-venous fistula in patients with spontaneous intracranial hypotension. Interv Neuroradiol 2024:15910199241247698. [PMID: 38651327 DOI: 10.1177/15910199241247698] [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: 04/25/2024] Open
Abstract
BACKGROUND Transvenous embolization is a recent treatment strategy for cerebrospinal fluid-venous fistulas (CSFVF), which are associated with spontaneous intracranial hypotension (SIH). METHODS Participants were selected from a prospective database on patients with CSFVF that received transvenous Onyx embolization. All patients underwent a brain magnetic resonance imaging (MRI) before and after embolization with MRI follow-up performed at least 3 months after treatment. Clinical and MRI results after treatment were described. RESULTS Twenty-one consecutive patients (median age 63 years, IQR = 58-71; females: 15/21 = 71.5%) with 30 CSFVF were included. Most lesions were situated between T9 and L1 (19/30 = 63%), 70% were right-sided, and 38% of the patients had multiples fistulas. Embolization was successful in all cases. The mean MRI SIH score before and after treatment was 6 (±2.5) and 1.4 (±1.6), respectively (p < 0.0001). Twenty patients (90%) experienced improvement of their initial condition, of which 67% reported complete clinical recovery. The mean HIT-6 score decreased from 67 (±15) to 38 (±9) (p < 0.0001), the mean amount of monthly headache days from 23.5 (±10) and 3.2 (±6.6) (p < 0.0001), the visual assessment scale (VAS) for headache severity from 8 (±1.9) to 1.2 (±2) (p < 0.0001), and the mean VAS for perception quality of life improved from 2.6 (±2.5) to 8.6 (±1.8) (p < 0.0001). There were no major complications. The suspected rebound headache rate after treatment was 33%. CONCLUSION Transvenous embolization of CSFVF allowed high rates of clinical improvement with no morbidity related to the treatment.
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Affiliation(s)
- Federico Cagnazzo
- Neuroradiology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Anne Ducros
- Neurorology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Gaetano Risi
- Neuroradiology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Mahmoud Charif
- Neurorology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Lucas Corti
- Neurorology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Francesca Rapido
- Anesthesiology and Critical Care Medicine, Montpellier University Hospital, Gui de Chauliac Montpellier, France
| | - Emmanuelle Le Bars
- Neuroradiology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Nicolas Lonjon
- Anesthesiology and Critical Care Medicine, Montpellier University Hospital, Gui de Chauliac Montpellier, France
| | - Vincent Costalat
- Neuroradiology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
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Cagnazzo F, Radu RA, Rapido F, Fendeleur J, Charif M, Corti L, Lonjon N, Ducros A, Costalat V. A technique to localize posteriorly located spinal dural leaks associated with spontaneous intracranial hypotension: Dorsal-decubitus dynamic CT myelography. Interv Neuroradiol 2023:15910199231222672. [PMID: 38151024 DOI: 10.1177/15910199231222672] [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: 12/29/2023] Open
Abstract
BACKGROUND Precise localization and understanding of the origin of cerebrospinal fluid (CSF) leak is crucial to allow targeted treatment. We report the technical feasibility and utility of dorsal-decubitus dynamic computed tomography (DDDCT) myelography to localize posteriorly located dural defects in patients with suspicion of posterolateral dural tears. METHODS This study reports a series of four consecutive patients with posteriorly located SLEC and suspicion of posterolateral CSF leak who received DDDCT to localize the site of the leak. Patients were collected between October 2022 and October 2023. The technique of DDDCT and its efficacy to detect the site of CSF leak are reported. RESULTS In all four patients (three females, one male, mean age 39 years), DDDCT myelography was technically successful and precisely demonstrated the site of the CSF leak. In one patient with both anterior and posterior SLEC, DDDCT allowed to exclude the presence of a posteriorly located leak, while a subsequent ventral decubitus dynamic CT myelography localized the leak. Leak sites were all thoracic, except for one that was cervical. Information obtained from the DDDCT myelography was considered useful to target the treatment of the leak. CONCLUSIONS Based on our experience, DDDCT provided sufficient spatial and temporal resolution to pinpoint fast CSF leaks and it may be considered to localize posterolateral dural defects.
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Affiliation(s)
- Federico Cagnazzo
- Neuroradiology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Răzvan Alexandru Radu
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucarest, Romania
| | - Francesca Rapido
- Anesthesiology and Critical Care Medicine, Montpellier University Hospital, Gui de Chauliac, Montpellier, France
| | - Julien Fendeleur
- Anesthesiology and Critical Care Medicine, Montpellier University Hospital, Gui de Chauliac, Montpellier, France
| | - Mahmoud Charif
- Neurorology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Lucas Corti
- Neurorology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Nicolas Lonjon
- Neurosurgical Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Anne Ducros
- Neurorology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
| | - Vincent Costalat
- Neuroradiology Department, Montpellier University Hospital, Gui-de-Chauliac, Montpellier, France
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Lange KS, Choi SY, Ling YH, Chen SP, Mawet J, Duflos C, Lee MJ, Ducros A, Wang SJ, Pezzini A. Reversible cerebral Vasoconstriction syndrome intERnational CollaborativE (REVERCE) network: Study protocol and rationale of a multicentre research collaboration. Eur Stroke J 2023; 8:1107-1113. [PMID: 37329287 PMCID: PMC10683719 DOI: 10.1177/23969873231182207] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023] Open
Abstract
INTRODUCTION Reversible cerebral vasoconstriction syndrome (RCVS) is a rare, but increasingly recognised cerebrovascular condition with an estimated annual age-standardised incidence of approximately three cases per million. Knowledge about risk factors and triggering conditions and information about prognosis and optimal treatment in these patients are limited. METHODS The REversible cerebral Vasoconstriction syndrome intERnational CollaborativE (REVERCE) project aims to elucidate the epidemiological and clinical characteristics of RCVS by collecting individual patient data from four countries (France, Italy, Taiwan and South Korea) in the setting of a multicentric study. All patients with a diagnosis of definite RCVS will be included. Data on the distribution of risk factors and triggering conditions, imaging data, neurological complications, functional outcome, risk of recurrent vascular events and death and finally the use of specific treatments will be collected. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and geographical region of residence. ETHICS AND DISSEMINATION Ethical approval for the REVERCE study will be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of clinical and epidemiological characteristics of RCVS patients.
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Affiliation(s)
- Kristin Sophie Lange
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin, Berlin, Germany
- Department of Neurology, CHU Montpellier, Gui de Chauliac Hospital, Montpellier, France
| | - So Youn Choi
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yu-Hsiang Ling
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jérôme Mawet
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, Department of Public Health, CHU Montpellier, Montpellier University, Montpellier, France
| | - Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Anne Ducros
- Department of Neurology, CHU Montpellier, Gui de Chauliac Hospital, Montpellier, France
- Charles Coulomb Laboratory, CNRS UMR5221, Montpellier University, Montpellier, France
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
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Espanol A, Lerebours F, Calviere L, Bonneville F, Ducros A, Larrue V, Gollion C. Silent brain infarct in migraine: Systematic review and meta-analysis. Rev Neurol (Paris) 2023:S0035-3787(23)01011-1. [PMID: 37743182 DOI: 10.1016/j.neurol.2023.05.003] [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: 01/10/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND While migraine, particularly migraine with aura, is a recognized risk factor for ischemic stroke, the association of migraine with silent brain infarction is a matter of debate, as studies on this topic have yielded conflicting results. METHODS A systematic review of the literature was conducted of studies reporting migraine and silent brain infarction, assessed by magnetic resonance imaging, between January 1980 and April 2022, by consulting Medline and Embase databases. Studies with a control group were included in a meta-analysis of population-based studies. An exploratory meta-analysis of both population-based and clinical-based studies was further performed to test the association between migraine with aura and silent brain infarction. RESULTS A total of 2,408 articles were identified, among which 24 were included in the systematic review and 10 in the meta-analysis. The meta-analysis of population-based studies showed no association of migraine with silent brain infarction (odds ratio (OR)=1.32 [95% CI 0.92;1.90], P=0.13) and migraine with aura with silent brain infarction (OR=1.56 [0.74;3.30], P=0.24). However, in the exploratory meta-analysis of population-based and clinical-based studies, migraine with aura was significantly associated with silent brain infarction (OR=1.91 [1.02;3.59], P=0.04) and to silent cerebellar infarcts (OR=2.57 [1.01;6.56], P=0.05). CONCLUSION In this updated systematic review and meta-analysis of population-based studies, migraine and migraine with aura were not associated with silent brain infarction.
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Affiliation(s)
- A Espanol
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - F Lerebours
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - L Calviere
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - F Bonneville
- Inserm, ToNIC, Toulouse NeuroImaging Center, University of Toulouse III, Toulouse, France; Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - A Ducros
- Department of Neurology, University Hospital of Montpellier, Montpellier, France
| | - V Larrue
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - C Gollion
- Department of Neurology, University Hospital of Toulouse, Toulouse, France; Inserm, ToNIC, Toulouse NeuroImaging Center, University of Toulouse III, Toulouse, France.
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Oukhai F, Domigo V, Benzakoun J, Wolff M, Ducros A, Mas JL, Calvet D. Case report: Meningitis: a cause of reversible cerebral vasoconstriction syndrome? Front Neurol 2023; 14:1143215. [PMID: 37545713 PMCID: PMC10400005 DOI: 10.3389/fneur.2023.1143215] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/21/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headache and reversible cerebral arteries vasoconstriction. The pathophysiology remains unclear, but many triggers were reported. Case reports We reported two cases of patients with meningitis who developed RCVS confirmed by brain imaging. They presented clinical and CSF features of meningitis that are suspected to be infectious, but no agent was identified. Headache and artery irregularities were resolved with the improvement of CSF. Conclusion These cases suggest that in the context of meningitis, modification or atypical headaches should lead to brain imaging to rule out RCVS. We hypothesized that CSF inflammation may trigger cerebral arteries vasoconstriction.
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Affiliation(s)
- Fida Oukhai
- Neurology Department, Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Université de Paris, Federation Hospitalo-Universitaire (FHU) NeuroVasc, Paris, France
| | - Valérie Domigo
- Neurology Department, Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Université de Paris, Federation Hospitalo-Universitaire (FHU) NeuroVasc, Paris, France
- INSERM 1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Joseph Benzakoun
- INSERM 1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
- Radiology Department, Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Michel Wolff
- Neuro Intensive Care Unit, Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Anne Ducros
- Neurology Department, Gui de Chauliac Hospital, Centre Hospitalier Universitaire (CHU) de Montpellier, Montpellier, France
| | - Jean-Louis Mas
- Neurology Department, Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Université de Paris, Federation Hospitalo-Universitaire (FHU) NeuroVasc, Paris, France
- INSERM 1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - David Calvet
- Neurology Department, Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Université de Paris, Federation Hospitalo-Universitaire (FHU) NeuroVasc, Paris, France
- INSERM 1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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Lange KS, Tuloup G, Duflos C, Gobron C, Burcin C, Corti L, Roos C, Ducros A, Mawet J. Complications of reversible cerebral vasoconstriction syndrome in relation to age. J Neurol 2023:10.1007/s00415-023-11708-z. [PMID: 37052670 DOI: 10.1007/s00415-023-11708-z] [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: 03/07/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Reversible cerebral vasoconstriction syndrome (RCVS) has a heterogenous clinical and radiological presentation. We investigated whether RCVS complications vary according to age. PATIENTS AND METHODS In a pooled French cohort of 345 patients with RCVS, we assessed (1) rates of clinical and radiological complications, and (2) the functional outcome at 3 months according to age as a continuous variable, and in young patients aged ≤ 49 years versus those aged ≥ 50 years. The Commission Nationale Informatique et Liberté and the local ethics committee approved this study (registration number: 202100733). RESULTS The risk for any focal deficit and for any brain lesion were independently associated with increasing age (OR 1.4, 95% CI 1.1-1.8; p = 0.014, and OR 1.6, 95% CI 1.2-2.1; p < 0.001, respectively). Subtypes of brain lesions independently associated with increasing age were subarachnoid haemorrhage (OR 1.7, 95% CI 1.3-2.3; p < 0.001) and intracerebral haemorrhage (OR 1.5, 95% CI 1.1-2.2; p = 0.023). Frequency of cervical artery dissections peaked at age 30-39, and young age was independently associated with cervical artery dissections (OR 13.6, 95% CI 2.4-76.6; p = 0.003). Age had no impact on the functional outcome, with a modified Rankin scale score of 0-1 in > 96% of patients. CONCLUSION Age seems to influence rates and types of complications of RCVS, with young age being associated with cervical artery dissections, and increasing age with haemorrhagic complications. If confirmed in larger prospective studies, recognition of age-specific patterns might help to guide clinical management and to identify complications in cases of RCVS and vice versa.
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Affiliation(s)
- Kristin Sophie Lange
- Department of Neurology, CHU Montpellier, Gui de Chauliac Hospital, Montpellier, France.
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany.
- Department of Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Gabrielle Tuloup
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
- Department of Neurology, CHU Caen-Normandie, Caen, France
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, Department of Public Health, CHU Montpellier, Montpellier University, Montpellier, France
| | - Claire Gobron
- Department of Clinical Physiology, APHP, Lariboisière-St Louis Hospitals, DMU DREAM, 75010, Paris, France
| | - Cécilia Burcin
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Lucas Corti
- Department of Neurology, CHU Montpellier, Gui de Chauliac Hospital, Montpellier, France
| | - Caroline Roos
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Anne Ducros
- Department of Neurology, CHU Montpellier, Gui de Chauliac Hospital, Montpellier, France
- Charles Coulomb Laboratory, CNRS UMR5221, Montpellier University, Montpellier, France
| | - Jérôme Mawet
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
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Grangeon L, Lange KS, Waliszewska-Prosół M, Onan D, Marschollek K, Wiels W, Mikulenka P, Farham F, Gollion C, Ducros A. Genetics of migraine: where are we now? J Headache Pain 2023; 24:12. [PMID: 36800925 PMCID: PMC9940421 DOI: 10.1186/s10194-023-01547-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/07/2023] [Indexed: 02/21/2023] Open
Abstract
Migraine is a complex brain disorder explained by the interaction of genetic and environmental factors. In monogenic migraines, including familial hemiplegic migraine and migraine with aura associated with hereditary small-vessel disorders, the identified genes code for proteins expressed in neurons, glial cells, or vessels, all of which increase susceptibility to cortical spreading depression. The study of monogenic migraines has shown that the neurovascular unit plays a prominent role in migraine. Genome-wide association studies have identified numerous susceptibility variants that each result in only a small increase in overall migraine risk. The more than 180 known variants belong to several complex networks of "pro-migraine" molecular abnormalities, which are mainly neuronal or vascular. Genetics has also highlighted the importance of shared genetic factors between migraine and its major co-morbidities, including depression and high blood pressure. Further studies are still needed to map all of the susceptibility loci for migraine and then to understand how these genomic variants lead to migraine cell phenotypes.
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Affiliation(s)
- Lou Grangeon
- grid.41724.340000 0001 2296 5231Neurology Department, CHU de Rouen, Rouen, France
| | - Kristin Sophie Lange
- grid.6363.00000 0001 2218 4662Neurology Department, Charité – Universitätsmedizin Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin, Berlin, Germany
| | - Marta Waliszewska-Prosół
- grid.4495.c0000 0001 1090 049XDepartment of Neurology, Wrocław Medical University, Wrocław, Poland
| | - Dilara Onan
- grid.14442.370000 0001 2342 7339Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Karol Marschollek
- grid.4495.c0000 0001 1090 049XDepartment of Neurology, Wrocław Medical University, Wrocław, Poland
| | - Wietse Wiels
- grid.8767.e0000 0001 2290 8069Department of Neurology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Petr Mikulenka
- grid.412819.70000 0004 0611 1895Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Fatemeh Farham
- grid.411705.60000 0001 0166 0922Headache Department, Iranian Centre of Neurological Researchers, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Cédric Gollion
- grid.411175.70000 0001 1457 2980Neurology Department, CHU de Toulouse, Toulouse, France
| | - Anne Ducros
- Neurology Department, CHU de Montpellier, 80 avenue Augustin Fliche, 34295, Montpellier, France.
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Lanteri-Minet M, Ducros A, Francois C, Olewinska E, Nikodem M, Dupont-Benjamin L. Effectiveness of onabotulinumtoxinA (BOTOX®) for the preventive treatment of chronic migraine: A meta-analysis on 10 years of real-world data. Cephalalgia 2022; 42:1543-1564. [PMID: 36081276 PMCID: PMC9693763 DOI: 10.1177/03331024221123058] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND This meta-analysis evaluated the real-world effectiveness of onabotulinumtoxinA (BOTOX®), the first preventive treatment FDA-approved specifically for chronic migraine in 2010. METHODS We systematically reviewed onabotulinumtoxinA observational data in chronic migraine published between 1 January 2010 and 31 March 2021. Random-effects models evaluated available data for primary and secondary endpoints defined in onabotulinumtoxinA pivotal trials at approximately 24 weeks and 52 weeks. RESULTS Of the 44 full-text eligible studies (29 prospective; 13 retrospective; 2 other), seven evaluated change from baseline (mean[confidence interval]) at ∼24 weeks and ∼52 weeks, respectively, for onabotulinumtoxinA in: number of headache days/month: (-10.64 [-12.31, -8.97]; -10.32 [-14.92, -5.73]); number of days of acute headache pain medication intake per month (-7.40 [-13.04, -1.77]; overlapping CIs at 52 weeks); total Headache Impact Test-6 score (-11.70 [-13.86, -9.54]); -11.80 [14.70, -8.90]); and Migraine-Specific Quality-of-Life v2.1 score (MSQ; 23.60 [CI: 21.56, 25.64]; 30.90 [CI: 28.29, 33.51]). At ∼24 weeks onabotulinumtoxinA showed total Migraine Disability Assessment score of 44.74 [28.50, 60.99] and ≥50% reduction in migraine days response rate of 46.57% [29.50%, 63.65%]. A sensitivity analysis at study-end suggested durability of onabotulinumtoxinA effectiveness on MSQ. CONCLUSION The meta-analysis reflecting real-world practice broadly corroborated with evidence from pivotal and long-term open-label studies of onabotulinumtoxinA in chronic migraine preventive treatment.
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Affiliation(s)
- Michel Lanteri-Minet
- Pain Department and FHU InovPain, Côte Azur University, Centre Hospitalier Universitaire de Nice, Nice, France
- INSERM U1107 Migraine and Trigeminal Pain, Auvergne University, Clermont-Ferrand, France
| | - Anne Ducros
- Neurology Department, Gui de Chauliac Hospital, Montpellier, France
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Sacco S, Lampl C, Amin FM, Braschinsky M, Deligianni C, Uludüz D, Versijpt J, Ducros A, Gil-Gouveia R, Katsarava Z, Martelletti P, Ornello R, Raffaelli B, Boucherie DM, Pozo-Rosich P, Sanchez-Del-Rio M, Sinclair A, Maassen van den Brink A, Reuter U. European Headache Federation (EHF) consensus on the definition of effective treatment of a migraine attack and of triptan failure. J Headache Pain 2022; 23:133. [PMID: 36224519 PMCID: PMC9555163 DOI: 10.1186/s10194-022-01502-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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] [Received: 08/03/2022] [Accepted: 09/21/2022] [Indexed: 12/01/2022] Open
Abstract
Background Triptans are migraine-specific acute treatments. A well-accepted definition of triptan failure is needed in clinical practice and for research. The primary aim of the present Consensus was to provide a definition of triptan failure. To develop this definition, we deemed necessary to develop as first a consensus definition of effective treatment of an acute migraine attack and of triptan-responder. Main body The Consensus process included a preliminary literature review, a Delphi round and a subsequent open discussion. According to the Consensus Panel, effective treatment of a migraine attack is to be defined on patient well-being featured by a) improvement of headache, b) relief of non-pain symptoms and c) absence of adverse events. An attack is considered effectively treated if patient’s well-being, as defined above, is restored within 2 hours and for at least 24 hours. An individual with migraine is considered as triptan-responder when the given triptan leads to effective acute attack treatment in at least three out of four migraine attacks. On the other hand, an individual with migraine is considered triptan non-responder in the presence of failure of a single triptan (not matching the definition of triptan-responder). The Consensus Panel defined an individual with migraine as triptan-resistant in the presence of failure of at least 2 triptans; triptan refractory, in the presence of failure to at least 3 triptans, including subcutaneous formulation; triptan ineligibile in the presence of an acknowledged contraindication to triptan use, as specified in the summary of product characteristics. Conclusions The novel definitions can be useful in clinical practice for the assessment of acute attack treatments patients with migraine. They may be helpful in identifying people not responding to triptans and in need for novel acute migraine treatments. The definitions will also be of help in standardizing research on migraine acute care. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01502-z.
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Affiliation(s)
- Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, L'Aquila, Italy.
| | - Christian Lampl
- Department of Neurology, Headache Medical Center at the Konventhospital BHB Linz, Linz, Austria
| | - Faisal Mohammad Amin
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark.,Department of Neurorehabilitation/Traumatic Brain Injury, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mark Braschinsky
- Department of Neurology, Institute of Clinical Medicine, University of Tartu; Headache Clinic, Department of Neurology, Tartu University Hospital, Tartu, Estonia
| | - Christina Deligianni
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Derya Uludüz
- Department of Neurology Istanbul Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Jan Versijpt
- Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair, Ziekenhuis Brussel, Brussels, Belgium
| | - Anne Ducros
- Neurology Department, CHU de Montpellier Charles Coulomb Laboratory, Montpellier University, Montpellier, France
| | - Raquel Gil-Gouveia
- Neurology Department, Hospital da Luz Headache Center, Hospital da Luz, Lisbon, Portugal.,Center for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Zaza Katsarava
- Christian Hospital, Unna, Germany.,University of Duisburg-Essen, Essen, Germany
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, L'Aquila, Italy
| | - Bianca Raffaelli
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Deirdre M Boucherie
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Medicine, Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Alexandra Sinclair
- Institute of Metabolism and Sytems Research, University of Birmingham, Birmingham, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Universitätsmedizin Greifswald, Greifswald, Germany
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10
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Beltramone M, Redon S, Fernandes S, Ducros A, Avouac A, Donnet A. The teaching of headache medicine in France: A questionnaire-based study. Headache 2022; 62:1177-1186. [PMID: 36200808 PMCID: PMC9828409 DOI: 10.1111/head.14395] [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] [Received: 01/13/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The treatment of patients with headache represents an important part of a neurologist's activity. It requires sufficient training for neurology residents. In France, residents in neurology can complete this training by attending specialized consultations or by participating in a postgraduate training program called "Diplôme Inter-Universitaire Migraine et Céphalées" (DIUMC). OBJECTIVE The objective of this cross-sectional study was to investigate the French residents' knowledge in headache medicine and the impact of different types of training in headache medicine that are available in France. METHODS An anonymous survey was carried out among 548 French residents in neurology. RESULTS The questionnaires of 121 residents (22.1%) were analyzed. Among them, 54.5% (66/121) had no complementary training apart from the internship (Group 1), 21.5% (26/121) had attended only specialized consultations (Group 2), and 24% (29/121) had participated in the DIUMC (Group 3). There was no difference between all groups regarding the knowledge of the prevalence of primary or chronic headaches. There was almost no difference between the groups in the management of episodic migraine. In contrast, the management of tension-type headache and chronic headache was better known by residents of Group 3 than residents of Group 1. In these two diseases, residents of Group 3 offered prophylactic treatment more often. Almost 29% of the residents (35/121) had read the French guidelines for the diagnosis and management of migraine. In Group 3, residents had read them significantly more often (1.6% in Group 1, 38.5% in Group 2 and 62.1% in Group 3, p < 0.001). CONCLUSION This study shows the lack of knowledge among French neurology residents regarding headache medicine. It highlights the interest of specific training programs that could improve the practical and theoretical knowledge of future neurologists.
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Affiliation(s)
- Marion Beltramone
- Department of Evaluation and Treatment of PainFHU INOVPAIN, CHU Timone, AP‐HMMarseilleFrance
| | - Sylvain Redon
- Department of Evaluation and Treatment of PainFHU INOVPAIN, CHU Timone, AP‐HMMarseilleFrance
| | - Sara Fernandes
- Service d'Epidémiologie et d'Economie de la Santé, Unité de Recherche Clinique, Direction de la Recherche en SantéAix Marseille Univ, APHM, Hôpital de la TimoneMarseilleFrance
| | - Anne Ducros
- Neurology DepartmentCHU de MontpellierMontpellierFrance
| | - Alexandre Avouac
- Department of Evaluation and Treatment of PainFHU INOVPAIN, CHU Timone, AP‐HMMarseilleFrance
| | - Anne Donnet
- Department of Evaluation and Treatment of PainFHU INOVPAIN, CHU Timone, AP‐HMMarseilleFrance,INSERM U‐1107, CHU de Clermont‐FerrandClermont‐FerrandFrance
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11
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Hirtz C, Adam G, Raposo N, Fabre N, Ducros A, Calviere L, Rousseau V, Albucher JF, Olivot JM, Bonneville F, Viguier A. Diagnostic utility of T2*-weighted GRE in migraine with aura attack. The cortical veins sign. Cephalalgia 2022; 42:730-738. [PMID: 35301873 DOI: 10.1177/03331024221076484] [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: 11/16/2022]
Abstract
OBJECTIVE To evaluate the frequency, distribution, and clinical associations of the dilated appearance of cerebral cortical veins, termed cortical veins sign on T2*-weighted gradient recalled-echo (T2*-GRE) in the acute setting of migraine with aura attack in adult patients. METHODS We conducted a retrospective analysis of 60 consecutive patients admitted for acute neurological symptoms with a final diagnosis of migraine with aura (42%) or probable migraine with aura (58%) who underwent emergency brain magnetic resonance imaging and 60 non-migrainous control adults. The cortical veins sign was defined as a marked hypo-intensity and/or an apparent increased diameter of at least one cortical vein. We examined the prevalence, the spatial distribution, and the associations of cortical veins sign with clinical characteristics of migraine with aura. RESULTS We detected the cortical veins sign in 25 patients (42%) with migraine with aura, compared to none in the control group (p < 0.0001). The spatial distribution of cortical veins sign was characterised by the predominantly bilateral and posterior location. Presence of cortical veins sign was associated with increased severity of aura (p = 0.05), and shorter delay to MRI (p = 0.02). CONCLUSION In the setting of acute neurological symptoms, the presence of cortical veins sign is frequent in patients with migraine with aura and can be detected with good reliability. This imaging marker may help clinicians identify underlying migraine with aura.
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Affiliation(s)
- Chloe Hirtz
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Gilles Adam
- Department of Neuroradiology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Nicolas Raposo
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Nelly Fabre
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Anne Ducros
- Department of Neurology, Gui de Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Lionel Calviere
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Vanessa Rousseau
- Department of Pharmacovigilence and Pharmaco-epidemiology, Toulouse University, Toulouse, France
| | - Jean François Albucher
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Jean-Marc Olivot
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Fabrice Bonneville
- Department of Neuroradiology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Alain Viguier
- Department of Neurology, 36760Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
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12
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Boitet R, de Gaalon S, Ducros A. Sindrome da vasocostrizione cerebrale reversibile. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)45780-6] [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: 10/19/2022] Open
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13
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Moisset X, Demarquay G, Ducros A. Systematic Review and Meta-analysis of Acute Treatments for Episodic Migraine in Adults. JAMA 2021; 326:1636-1637. [PMID: 34698790 DOI: 10.1001/jama.2021.14063] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Xavier Moisset
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Anne Ducros
- Department of Neurology, CHU de Montpellier, Montpellier, France
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14
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Riant F, Roos C, Roubertie A, Barbance C, Hadjadj J, Auvin S, Baille G, Beltramone M, Boulanger C, Cahn A, Cata F, Cheuret E, Cuvellier JC, Defo A, Demarquay G, Donnet A, Gaillard N, Massardier E, Guy N, Lamoureux S, Le Moigno L, Lucas C, Ratiu D, Redon S, Rey C, Thauvin C, Viallet F, Tournier-Lasserve E, Ducros A. Hemiplegic Migraine Associated With PRRT2 Mutations: A Clinical and Genetic Study. Neurology 2021; 98:e51-e61. [PMID: 34649875 DOI: 10.1212/wnl.0000000000012947] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE PRRT2 variants have been reported in a few cases of patients with hemiplegic migraine. To clarify the role of PRRT2 in familial hemiplegic migraine, we studied this gene in a large cohort of affected probands. METHODS PRRT2 was analyzed in 860 probands with hemiplegic migraine and PRRT2 mutations were identified in 30 probands. Genotyping of relatives identified a total of 49 persons with mutations whose clinical manifestations were detailed. RESULTS PRRT2 mutations were found in 12 of 163 probands previously tested negative for CACNA1A, ATP1A2 and SCN1A mutations, and in 18 of 697 consecutive probands screened simultaneously on the four genes. In this second group, pathogenic variants were found in 105 subjects, mostly in ATP1A2 (42%), followed by CACNA1A (26%), PRRT2 (17%) and SCN1A (15%). The PRRT2 mutations included seven distinct variants, five of which already described in persons with paroxysmal kinesigenic dyskinesia, and two new variants. Eight probands had a deletion of the whole PRRT2 gene.Among the 49 PRRT2 mutated patients, 26 had pure hemiplegic migraine, 16 had hemiplegic migraine associated with another manifestation: epilepsy (8), learning disabilities (5), hypersomnia (4) or abnormal movement (3). Three patients had epilepsy without migraine, two had paroxysmal kinesigenic dyskinesia without migraine, and one was asymptomatic. CONCLUSION PRRT2 should be regarded as the fourth autosomal dominant gene for hemiplegic migraine, and screened in any affected patient, together with the three other main genes. Further studies are needed to understand how the same loss of function PRRT2 mutations can lead to a wide range of neurologic phenotypes including paroxysmal movement disorder, epilepsy, learning disabilities, sleep disorder and hemiplegic migraine.
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Affiliation(s)
- Florence Riant
- Service de Génétique Moléculaire, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris, France .,INSERM UMR-S1141, Université Paris, France
| | - Caroline Roos
- Emergency Headache Centre, Lariboisière Hospital, Paris, France
| | - Agathe Roubertie
- INM, Univ Montpellier, INSERM, CHU Montpellier, Département de Neuropédiatrie, Montpellier, France
| | - Cécile Barbance
- Service de Génétique Moléculaire, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Jessica Hadjadj
- Service de Génétique Moléculaire, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Stéphane Auvin
- Service de Neurologie Pédiatrique, Hôpital Robert Debré, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Guillaume Baille
- Service de Neurologie et Pathologie du Mouvement, CHRU de Lille, Lille, France
| | - Marion Beltramone
- Pain Department, FHU INNOVPAIN, Hôpital La Timone, Marseille, France
| | - Cécile Boulanger
- Equipe Douleur et Soins Palliatifs Pédiatriques, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Alice Cahn
- Service de Neuropédiatrie, Centre Hospitalier d'Arras, Arras, France
| | - Florina Cata
- Service de Pédiatrie - Néonatologie du CH Remiremont, Remiremont, France
| | - Emmanuel Cheuret
- Service de Neurologie Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse,France
| | | | - Antoine Defo
- Service de Neuropédiatrie, CH de Cayenne, Guyane Française
| | - Genevieve Demarquay
- Department of Neurology, Hospices Civils de Lyon, Lyon, and Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), INSERM U1028, CNRS UMR5292, Lyon
| | - Anne Donnet
- Pain Department, FHU INNOVPAIN, Hôpital La Timone, Marseille, France
| | - Nicolas Gaillard
- Neurology Department, Montpellier University Hospital, Montpellier, France
| | | | - Nathalie Guy
- Service de Neurologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sylvie Lamoureux
- Service de Pédiatrie, Centre Hospitalier d'Avignon, Avignon, France
| | - Laurence Le Moigno
- Service de Pédiatrie et Unité d'Urgence Pédiatrique, Centre Hospitalier de Cornouaille, Quimper, France
| | - Christian Lucas
- Centre d'Evaluation et de Traitement de la Douleur dans le service de Neurochirurgie, CHU de Lille, Lille, France
| | - Diana Ratiu
- Service de Neurologie Centre Hospitalier de Narbonne, Narbonne, France
| | - Sylvain Redon
- Pain Department, FHU INNOVPAIN, Hôpital La Timone, Marseille, France
| | - Caroline Rey
- Service de Neurologie Vasculaire, CHU Timone, Marseille, France
| | - Christel Thauvin
- Centre de Génétique et Centre de Référence des Anomalies du Développement et Syndromes Malformatifs de l'Interrégion Est, Centre Hospitalier Universitaire Dijon, France
| | - François Viallet
- Département de Neurologie, Centre Hospitalier Intercommunal d'Aix-Pertuis, Aix-en-Provence, France
| | - Elisabeth Tournier-Lasserve
- Service de Génétique Moléculaire, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris, France.,INSERM UMR-S1141, Université Paris, France
| | - Anne Ducros
- Neurology Department, Montpellier University Hospital, Montpellier, France.,Charles Coulomb Laboratory, UMR 5221 CNRS-UM, Montpellier University, Montpellier, France
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Affiliation(s)
- A Donnet
- Hôpital La Timone, 264, rue Saint-Pierre, 13007 Marseille, France.
| | - A Ducros
- Service neurologie, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Marseille, France
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16
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Patel SD, Topiwala K, Otite Oliver F, Saber H, Panza G, Mui G, Liebeskind DS, Saver JL, Alberts M, Ducros A. Outcomes Among Patients With Reversible Cerebral Vasoconstriction Syndrome: A Nationwide United States Analysis. Stroke 2021; 52:3970-3977. [PMID: 34470494 DOI: 10.1161/strokeaha.121.034424] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Reversible cerebral vasoconstriction syndrome (RCVS) is a well-established cause of stroke, but its demographics and outcomes have not been well delineated. METHODS Analysis of the United States Nationwide Inpatient Sample database (2016-2017) to characterize the frequency of hospitalizations for RCVS, demographic features, inpatient mortality, and discharge outcomes. RESULTS During the 2-year study period, 2020 patients with RCVS were admitted to Nationwide Inpatient Sample hospitals, representing 0.02 cases per 100 000 national hospitalizations. The mean age at admission was 47.6 years, with 85% under 65 years of age, and 75.5% women. Concomitant neurological diagnoses during hospitalization included ischemic stroke (17.1%), intracerebral hemorrhage (11.0%), subarachnoid hemorrhage (32.7%), seizure disorders (6.7%), and reversible brain edema (13.6%). Overall, 70% of patients were discharged home, 29.7% discharged to a rehabilitation facility or nursing home and 0.3% died before discharge. Patient features independently associated with the poor outcome of discharge to another facility or death were advanced age (odds ratio [OR], 1.04 [95% CI, 1.03-1.04]), being a woman (OR, 2.45 [1.82-3.34]), intracerebral hemorrhage (OR, 2.91 [1.96-4.31]), ischemic stroke (OR, 5.72 [4.32-7.58]), seizure disorders (OR, 2.61 [1.70-4.00]), reversible brain edema (OR, 6.26 [4.41-8.89]), atrial fibrillation (OR, 2.97 [1.83-4.81]), and chronic kidney disease (OR, 3.43 [2.19-5.36]). CONCLUSIONS Projected to the entire US population, >1000 patients with RCVS are hospitalized each year, with the majority being middle-aged women, and about 300 required at least some rehabilitation or nursing home care after discharge. RCVS-related inpatient mortality is rare.
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Affiliation(s)
- Smit D Patel
- Neurology Department, University of Connecticut/Hartford Hospital (S.D.P., G.M., M.A.)
| | - Karan Topiwala
- Neurology Department, University of Minnesota, Minneapolis (K.T.)
| | - Fadar Otite Oliver
- Neurology Department, State University of New York (SUNY) Upstate Medical University, Syracuse, NY (F.O.O.)
| | - Hamidreza Saber
- Neurology Department, University of California of Los Angelos (H.S., D.S.L., J.L.S.)
| | - Gregory Panza
- Department of Research, Hartford Hospital, CT (G.P.)
| | - Gracia Mui
- Neurology Department, University of Connecticut/Hartford Hospital (S.D.P., G.M., M.A.)
| | - David S Liebeskind
- Neurology Department, University of California of Los Angelos (H.S., D.S.L., J.L.S.)
| | - Jeffrey L Saver
- Neurology Department, University of California of Los Angelos (H.S., D.S.L., J.L.S.)
| | - Mark Alberts
- Neurology Department, University of Connecticut/Hartford Hospital (S.D.P., G.M., M.A.)
| | - Anne Ducros
- Neurology Department, Montpellier University Hospital, France (A.D.).,Laboratory Charles Coulomb UMR 5221 CNRS-UM, Montpellier University, France (A.D.)
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17
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Lange KS, Forster O, Mawet J, Tuloup G, Burcin C, Corti L, Duflos C, Roos C, Ducros A. Type of headache at onset and risk for complications in reversible cerebral vasoconstriction syndrome. Eur J Neurol 2021; 29:130-137. [PMID: 34390103 DOI: 10.1111/ene.15064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In a recent Italian study, 30% of patients with reversible cerebral vasoconstriction syndrome (RCVS) presented without thunderclap headache (TCH), and tended to present more severe forms of RCVS than patients with TCH. We aimed to analyze the risk for complications of RCVS in patients with and without TCH at onset. METHODS In a pooled cohort of 345 French patients with RCVS, we compared patients with and without TCH at onset regarding rates of neurological complications, and the functional outcome at 3 months. RESULTS As compared to the 281 patients with TCH at onset, the 64 patients without TCH had a higher risk for any neurological complication (61% vs. 24%, OR 4.9, 95% CI 2.8-8.7, p < 0.001). The association was strongest for cervical artery dissections (28% vs. 5%, OR 8.1, 95% CI 3.7-17.6, p < 0.001), followed by posterior reversible encephalopathy syndrome (17% vs. 3%, OR 7.1, 95% CI 2.7-18.4, p < 0.001), seizures (9% vs. 2.5%, OR 4.1, 95% CI 1.3-12.5, p = 0.019), and subarachnoid hemorrhage (41% vs. 16%, OR 3.5, 95% CI 1.9-6.3, p < 0.001). In multivariable analysis, the risk for any neurological complication remained significantly elevated in the absence of TCH (OR 3.5, 95% CI 1.8-6.8, p < 0.001). The functional outcome was equal in both groups, with a modified Rankin scale score of 0-1 in ≥90% of patients. CONCLUSIONS Absence of TCH at onset might predict a higher risk of complications in RCVS. Our results warrant further multicentric studies to prove this finding.
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Affiliation(s)
- Kristin Sophie Lange
- Department of Neurology, CHU Montpellier, Hospital Gui de Chauliac, Montpellier, France.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,Department of Neurology I Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Ophélie Forster
- Department of Neurology, CHU Montpellier, Hospital Gui de Chauliac, Montpellier, France
| | - Jérôme Mawet
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Cécilia Burcin
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Lucas Corti
- Department of Neurology, CHU Montpellier, Hospital Gui de Chauliac, Montpellier, France
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, Department of Medical Information, CHU Montpellier, Montpellier University, Montpellier, France
| | - Caroline Roos
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Anne Ducros
- Department of Neurology, CHU Montpellier, Hospital Gui de Chauliac, Montpellier, France.,Charles Coulomb Laboratory, CNRS UMR5221, Montpellier University, Montpellier, France
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Eigenbrodt AK, Ashina H, Khan S, Diener HC, Mitsikostas DD, Sinclair AJ, Pozo-Rosich P, Martelletti P, Ducros A, Lantéri-Minet M, Braschinsky M, Del Rio MS, Daniel O, Özge A, Mammadbayli A, Arons M, Skorobogatykh K, Romanenko V, Terwindt GM, Paemeleire K, Sacco S, Reuter U, Lampl C, Schytz HW, Katsarava Z, Steiner TJ, Ashina M. Diagnosis and management of migraine in ten steps. Nat Rev Neurol 2021; 17:501-514. [PMID: 34145431 PMCID: PMC8321897 DOI: 10.1038/s41582-021-00509-5] [Citation(s) in RCA: 152] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 02/05/2023]
Abstract
Migraine is a disabling primary headache disorder that directly affects more than one billion people worldwide. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a European panel of experts to develop a ten-step approach to the diagnosis and management of migraine. Each step was established by expert consensus and supported by a review of current literature, and the Consensus Statement is endorsed by the European Headache Federation and the European Academy of Neurology. In this Consensus Statement, we introduce typical clinical features, diagnostic criteria and differential diagnoses of migraine. We then emphasize the value of patient centricity and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. In addition, we provide recommendations for evaluating treatment response and managing treatment failure. Lastly, we discuss the management of complications and comorbidities as well as the importance of planning long-term follow-up.
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Affiliation(s)
- Anna K Eigenbrodt
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina Khan
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Dimos D Mitsikostas
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra J Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
- Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Anne Ducros
- Neurology Department, Montpellier University Hospital, Montpellier, France
| | - Michel Lantéri-Minet
- Departement d'Evaluation et Traitement de la Douleur, Centre Hospitalo-Universitaire de Nice, Nice, France
| | | | | | - Oved Daniel
- Headache & Facial Pain Clinic, Laniado Medical Center, Netanya, Israel
| | - Aynur Özge
- Department of Neurology, Mersin University Medical Faculty, Mersin, Turkey
| | - Ayten Mammadbayli
- Department of Neurology, Azerbaijan State Medical University, Baku, Azerbaijan
| | - Mihails Arons
- Department of Anesthesiology and Intensive Care, P. Stradins University, Riga, Latvia
| | | | | | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Lampl
- Headache Medical Center, Seilerstaette Linz, Linz, Austria
- Department of Geriatric Medicine, Ordensklinikum Linz, Linz, Austria
| | - Henrik W Schytz
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Zaza Katsarava
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
- EVEX Medical Corporation, Tbilisi, Georgia
- Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Division of Brain Sciences, Imperial College London, London, UK
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia.
- Danish Knowledge Center on Headache Disorders, Glostrup, Denmark.
- Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan.
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Demarquay G, Moisset X, Lantéri-Minet M, de Gaalon S, Donnet A, Giraud P, Guégan-Massardier E, Lucas C, Mawet J, Roos C, Valade D, Ducros A. Revised guidelines of the French Headache Society for the diagnosis and management of migraine in adults. Part 1: Diagnosis and assessment. Rev Neurol (Paris) 2021; 177:725-733. [PMID: 34340812 DOI: 10.1016/j.neurol.2021.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022]
Abstract
The French Headache Society proposes updated French guidelines for the management of migraine. The first part of these recommendations is focused on the diagnosis and assessment of migraine. First, migraine needs to be precisely diagnosed according to the currently validated criteria of the International Classification of Headache Disorders, 3d version (ICHD-3). Migraine-related disability has to be assessed and we suggest to use the 6 questions of the headache impact test (HIT-6). Then, it is important to check for risk factors and comorbidities increasing the risk to develop chronic migraine, especially frequency of headaches, acute medication overuse and presence of depression. We suggest to use a migraine calendar and the Hospital Anxiety and Depression scale (HAD). It is also necessary to evaluate the efficacy and tolerability of current migraine treatments and we suggest to systematically use the self-administered Migraine Treatment Optimization Questionnaire (M-TOQ) for acute migraine treatment. Finally, a treatment strategy and a follow-up plan have to be proposed. Guidelines for pharmacological and non-pharmacological treatments are presented in the second and third part of the recommendations.
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Affiliation(s)
- G Demarquay
- Neurological hospital, Lyon, Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, Lyon, France.
| | - X Moisset
- Neuro-Dol, Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Clermont-Ferrand, France
| | - M Lantéri-Minet
- Pain Department and FHU InovPain, CHU Nice - Côte Azur Université, Nice, France
| | - S de Gaalon
- Department of Neurology, Laënnec Hospital, CHU de Nantes, Nantes, France
| | - A Donnet
- Centre d'évaluation et de traitement de la douleur, FHU INOVPAIN, hôpital de La Timone, Marseille, France
| | - P Giraud
- Department of Neurology, Annecy Genevois Hospital, Annecy, France
| | | | - C Lucas
- Centre d'Evaluation et de Traitement de la Douleur, Service de Neurochirurgie, Hôpital Salengro, CHU de Lille, Lille, France
| | - J Mawet
- Emergency Headache Center (Centre d'Urgences Céphalées), Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - C Roos
- Emergency Headache Center (Centre d'Urgences Céphalées), Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - D Valade
- Department of Neurosurgery, Pitié-Sapêtrière Hospital, Paris, France
| | - A Ducros
- Department of Neurology, Gui de Chauliac Hospital, CHU Montpellier, University of Montpellier, 34000 Montpellier, France
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Demarquay G, Mawet J, Guégan-Massardier E, de Gaalon S, Donnet A, Giraud P, Lantéri-Minet M, Lucas C, Moisset X, Roos C, Valade D, Ducros A. Revised guidelines of the French headache society for the diagnosis and management of migraine in adults. Part 3: Non-pharmacological treatment. Rev Neurol (Paris) 2021; 177:753-759. [PMID: 34340809 DOI: 10.1016/j.neurol.2021.07.009] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 01/16/2023]
Abstract
The French Headache Society proposes updated French guidelines for the management of migraine. This article presents the third part of the guidelines, which is focused on the non-pharmacological treatment of migraine, including physical exercise, dietary supplements and plants, diets, neuromodulation therapies, acupuncture, behavioral interventions and mindfulness therapy, patent foramen ovale closure and surgical nerve decompression.
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Affiliation(s)
- G Demarquay
- Inserm U1028, CNRS UMR5292, Neuroscience Research Center (CRNL), Neurological hospital, Lyon, France.
| | - J Mawet
- Department of Neurology, Emergency Headache Center (Centre d'urgences céphalées), Lariboisière Hospital, AP-HP, Paris, France
| | | | - S de Gaalon
- Department of Neurology, Laënnec Hospital, CHU de Nantes, Nantes, France
| | - A Donnet
- FHU INOVPAIN, centre d'évaluation et de traitement de la douleur, hôpital de La Timone, Marseille, France
| | - P Giraud
- Department of Neurology, Annecy-Genevois Hospital, Annecy, France
| | - M Lantéri-Minet
- Pain Department and FHU InovPain, CHU de Nice, Côte Azur Université, Nice, France
| | - C Lucas
- Service de neurochirurgie, centre d'évaluation et de traitement de la douleur, CHRU de Lille, hôpital Salengro, Lille, France
| | - X Moisset
- Inserm, Neuro-Dol, Université Clermont Auvergne, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - C Roos
- Department of Neurology, Emergency Headache Center (Centre d'urgences céphalées), Lariboisière Hospital, AP-HP, Paris, France
| | - D Valade
- Department of Neurosurgery, Hopital Pitié-Sapêtrière, Paris, France
| | - A Ducros
- Department of Neurology, Gui-de-Chauliac Hospital, CHU de Montpellier, University of Montpellier, 34000 Montpellier, France
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21
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Ducros A, de Gaalon S, Roos C, Donnet A, Giraud P, Guégan-Massardier E, Lantéri-Minet M, Lucas C, Mawet J, Moisset X, Valade D, Demarquay G. Revised guidelines of the French headache society for the diagnosis and management of migraine in adults. Part 2: Pharmacological treatment. Rev Neurol (Paris) 2021; 177:734-752. [PMID: 34340810 DOI: 10.1016/j.neurol.2021.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/21/2022]
Abstract
The French Headache Society proposes updated French guidelines for the management of migraine. This article presents the second part of the guidelines, which is focused on the pharmacological treatment of migraine, including both the acute treatment of attacks and the prophylaxis of episodic migraine as well as chronic migraine with and without medication overuse. The specific situations that can be encountered in women with migraine are also discussed, including pregnancy, menstrual migraine, contraception and hormonal replacement therapy.
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Affiliation(s)
- A Ducros
- Department of neurology, Gui-de-Chauliac hospital, CHU Montpellier, university of Montpellier, 34000 Montpellier, France
| | - S de Gaalon
- Department of neurology, Laënnec hospital, CHU de Nantes, Nantes, France
| | - C Roos
- Emergency headache center (centre d'urgences céphalées), department of neurology, Lariboisière hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - A Donnet
- Centre d'évaluation et de traitement de la douleur, FHU INOVPAIN, hôpital de La Timone, Marseille, France
| | - P Giraud
- Department of neurology, Annecy Genevois hospital, Annecy, France
| | | | - M Lantéri-Minet
- Pain department, FHU InovPain, CHU Nice Côte Azur université, Nice, France
| | - C Lucas
- Centre d'évaluation et de traitement de la douleur, service de neurochirurgie, hôpital Salengro, CHRU de Lille, Lille, France
| | - J Mawet
- Emergency headache center (centre d'urgences céphalées), department of neurology, Lariboisière hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - X Moisset
- Neuro-Dol, université Clermont Auvergne, CHU de Clermont-Ferrand, INSERM, Clermont-Ferrand, France
| | - D Valade
- Department of neurosurgery, hôpital Pitié-Sapêtrière, Paris, France
| | - G Demarquay
- Neurological hospital, Lyon, neuroscience research center (CRNL), INSERM U1028, CNRS UMR5292, Lyon, France.
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22
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Sacco S, Lampl C, Maassen van den Brink A, Caponnetto V, Braschinsky M, Ducros A, Little P, Pozo-Rosich P, Reuter U, Ruiz de la Torre E, Sanchez Del Rio M, Sinclair AJ, Martelletti P, Katsarava Z. Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance. J Headache Pain 2021; 22:39. [PMID: 34006218 PMCID: PMC8130435 DOI: 10.1186/s10194-021-01252-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/03/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND New treatments are currently offering new opportunities and challenges in clinical management and research in the migraine field. There is the need of homogenous criteria to identify candidates for treatment escalation as well as of reliable criteria to identify refractoriness to treatment. To overcome those issues, the European Headache Federation (EHF) issued a Consensus document to propose criteria to approach difficult-to-treat migraine patients in a standardized way. The Consensus proposed well-defined criteria for resistant migraine (i.e., patients who do not respond to some treatment but who have residual therapeutic opportunities) and refractory migraine (i.e., patients who still have debilitating migraine despite maximal treatment efforts). The aim of this study was to better understand the perceived impact of resistant and refractory migraine and the attitude of physicians involved in migraine care toward those conditions. METHODS We conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care. RESULTS There were 277 questionnaires available for analysis. A relevant proportion of participants reported that patients with resistant and refractory migraine were frequently seen in their clinical practice (49.5% for resistant and 28.9% for refractory migraine); percentages were higher when considering only those working in specialized headache centers (75% and 46% respectively). However, many physicians reported low or moderate confidence in managing resistant (8.1% and 43.3%, respectively) and refractory (20.7% and 48.4%, respectively) migraine patients; confidence in treating resistant and refractory migraine patients was different according to the level of care and to the number of patients visited per week. Patients with resistant and refractory migraine were infrequently referred to more specialized centers (12% and 19%, respectively); also in this case, figures were different according to the level of care. CONCLUSIONS This report highlights the clinical relevance of difficult-to-treat migraine and the presence of unmet needs in this field. There is the need of more evidence regarding the management of those patients and clear guidance referring to the organization of care and available opportunities.
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Affiliation(s)
- Simona Sacco
- Neuroscience section - Department of Biotechnological and Applied Clinical Sciences and (Edificio Coppito 2), University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy.
- Regional Referral Headache Center of the Abruzzo Region, ASL Avezzano-Sulmona-L'Aquila, L'Aquila, Italy.
| | - Christian Lampl
- Department of Neurology, Headache Medical Centre Linz, Hospital Barmherzige Brüder, Centre of Integrative Medicine (ZiAM) Ordensklinikum Linz, Linz, Austria
| | - Antoinette Maassen van den Brink
- Division of Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Valeria Caponnetto
- Neuroscience section - Department of Biotechnological and Applied Clinical Sciences and (Edificio Coppito 2), University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
- Regional Referral Headache Center of the Abruzzo Region, ASL Avezzano-Sulmona-L'Aquila, L'Aquila, Italy
| | - Mark Braschinsky
- Headache Clinic, Department of Neurology, Tartu University Clinics, Tartu, Estonia
| | - Anne Ducros
- Headache Unit, Neurology Department, Montpellier University Hospital and Montpellier University, Montpellier, France
| | - Patrick Little
- European Migraine & Headache Alliance (EMHA), Brussels, Belgium
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Department de Medicina, Universitat Autònoma de Barcelona, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Uwe Reuter
- Charité Universitätsmedizin Berlin, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Alexandra J Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Regional Referral Headache Center of the Lazio Region, Sant'Andrea Hospital, Rome, Italy
| | - Zaza Katsarava
- Christian Hospital, Unna, Germany
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- EVEX Medical Corporation, Tbilisi, Georgia
- IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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23
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Donnet A, Ducros A, Radat F, Allaf B, Chouette I, Lanteri-Minet M. Severe migraine and its control: A proposal for definitions and consequences for care. Rev Neurol (Paris) 2021; 177:924-934. [PMID: 33810839 DOI: 10.1016/j.neurol.2020.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/28/2020] [Revised: 11/19/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Abstract
Currently many patients with severe migraine do not receive appropriate treatment and are never referred to specialist headache centres. On the other hand, specialist headache centres are frequently attended by patients whose migraines could be managed adequately in the community. One reason for this may be the absence of standardised definitions of migraine severity and control and of a treatment algorithm for orientating difficult-to-treat patients to specialist headache centres. Based on a review of the relevant literature and consensus meetings, proposals have been made for these items. We propose that migraine should be considered severe if headache frequency is at least eight migraine days per month or, if headaches are less frequent, the HIT-6 score is ≥60 or ≥50% of headaches require complete interruption of activity. The proposed definition of migraine control is defined on the basis of appropriate response to acute headache therapy and to preventative therapy. A treatment algorithm is proposed to assess migraine control regularly and to adapt therapy accordingly. These proposals may contribute to developing and testing strategies for management of severe disease with appropriate and effective preventive treatment strategies. With the anticipated introduction of new possibilities for migraine prevention in the near future, the time is ripe for a holistic approach to migraine management.
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Affiliation(s)
- Anne Donnet
- Centre d'évaluation et de traitement de la douleur, CHU de la Timone, Marseille, France; Neuro-Dol Inserm U1107, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Anne Ducros
- Service de Neurologie, CHU Gui de Chauliac, Montpellier, France
| | - Françoise Radat
- Unité de traitement de la douleur chronique, CHU de Bordeaux, Bordeaux, France
| | | | | | - Michel Lanteri-Minet
- Neuro-Dol Inserm U1107, Université Clermont Auvergne, Clermont-Ferrand, France; Département d'évaluation et de traitement de la douleur CHU de Nice, FHU InovPain Université Côte Azur, Nice, France.
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24
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Benali A, Moynier M, Dargazanli C, Deverdun J, Cagnazzo F, Mourand I, Bonafe A, Arquizan C, Derraz I, Menjot de Champfleur N, Molino F, Ducros A, Le Bars E, Costalat V. Mechanical Thrombectomy in Nighttime Hours: Is There a Difference in 90-Day Clinical Outcome for Patients with Ischemic Stroke? AJNR Am J Neuroradiol 2021; 42:530-537. [PMID: 33478943 DOI: 10.3174/ajnr.a6997] [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: 05/04/2020] [Accepted: 10/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Few data are available regarding the influence of the timing of ischemic stroke management, such as daytime and nighttime hours, on the delay of mechanical thrombectomy, the effectiveness of revascularization, and clinical outcomes. We aimed to investigate whether admission during nighttime hours could impact the clinical outcome (mRS at 90 days) of patients with acute ischemic stroke treated by mechanical thrombectomy. MATERIALS AND METHODS We retrospectively analyzed 169 patients (112 treated during daytime hours and 57 treated during nighttime hours) with acute ischemic stroke in the anterior cerebral circulation. The main outcome was the rate of patients achieving functional independence at 90 days (mRS ≤2), depending on admission time. RESULTS In patients admitted during nighttime hours, the rate of mRS ≤ 2 at 90 days was significantly higher (51% versus 35%, P = .05) compared with those admitted in daytime hours. Patients in daytime and nighttime hours were comparable regarding admission and treatment characteristics. However, patients in nighttime hours tended to have a higher median NIHSS score at admission (P = .08) and to be younger (P = .08), especially among the mothership group (P = .09). The multivariate logistic regression analysis confirmed that patients in nighttime hours had better functional outcomes at 90 days than those in daytime hours (P = .018; 95% CI, 0.064-0.770; OR = 0.221). CONCLUSIONS In a highly organized stroke care network, mechanical thrombectomy is quite effective in the nighttime hours among acute ischemic stroke presentations. Unexpectedly, we found that those patients achieved favorable clinical outcomes more frequently than those treated during daytime hours. Larger series are needed to confirm these results.
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Affiliation(s)
- A Benali
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - M Moynier
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - C Dargazanli
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - J Deverdun
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - F Cagnazzo
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - I Mourand
- Neurology (I.M., C.A., A.D.), Gui de Chauliac Hospital, Montpellier, France
| | - A Bonafe
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - C Arquizan
- Neurology (I.M., C.A., A.D.), Gui de Chauliac Hospital, Montpellier, France
| | - I Derraz
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - N Menjot de Champfleur
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - F Molino
- Department of Physics (F.M.), Charles Coulomb Laboratory, Montpellier, France
| | - A Ducros
- Neurology (I.M., C.A., A.D.), Gui de Chauliac Hospital, Montpellier, France
| | - E Le Bars
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
| | - V Costalat
- From the Departments of Neuroradiology (A.B., M.M., C.D., J.D., F.C., A.B., I.D., N.M.d.C., E.L.B., V.C.)
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25
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Chen SP, Chang YA, Chou CH, Juan CC, Lee HC, Chen LK, Wu PC, Wang YF, Fuh JL, Lirng JF, Ducros A, Huang HD, Wang SJ. Circulating microRNAs Associated With Reversible Cerebral Vasoconstriction Syndrome. Ann Neurol 2020; 89:459-473. [PMID: 33314303 DOI: 10.1002/ana.25965] [Citation(s) in RCA: 20] [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] [Received: 08/20/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the significance of circulating micro RNAs (miRNAs) in the pathogenesis of reversible cerebral vasoconstriction syndrome (RCVS). METHODS We prospectively recruited 3 independent cohorts of patients with RCVS and age-matched and sex-matched controls in a single medical center. Next-generation small RNA sequencing followed by quantitative polymerase chain reaction (PCR) was used to identify and validate differentially expressed miRNAs, which was cross-validated in migraine patients in ictal stage or interictal stage. Computational analysis was used to predict the target genes of miRNAs, followed by in vitro functional analysis. RESULTS We identified a panel of miRNAs including miR-130a-3p, miR-130b-3p, let-7a-5p, let-7b-5p, and let-7f-5p that well differentiated patients with RCVS from controls (area under the receiver operating characteristics curve [AUC] was 0.906, 0.890, and 0.867 in the 3 cohorts, respectively). The abundance of let-7a-5p, let-7b-5p, and let-7f-5p, but not miR-130a-3p nor miR-130b-3p, was significantly higher in patients with ictal migraine compared with that of controls and patients with interictal migraine. Target prediction and pathway enrichment analysis suggested that the transforming growth factor-β signaling pathway and endothelin-1 responsible for vasomotor control might link these miRNAs to RCVS pathogenesis, which was confirmed in vitro by transfecting miRNAs mimics or incubating the patients' cerebrospinal fluid (CSF) in 3 different vascular endothelial cells. Moreover, miR-130a-3p was associated with imaging-proven disruption of the blood-brain barrier (BBB) in patients with RCVS and its overexpression led to reduced transendothelial electrical resistance (ie, increased permeability) in in vitro human BBB model. INTERPRETATION We identified the circulating miRNA signatures associated with RCVS, which may be functionally linked to its headache, BBB integrity, and vasomotor function. ANN NEUROL 2021;89:459-473.
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Affiliation(s)
- Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-An Chang
- Department of Biological Science and Technology, National Chiao Tung University, HsinChu, Taiwan
| | - Chih-Hung Chou
- Department of Biological Science and Technology, National Chiao Tung University, HsinChu, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao Tung University, HsinChu, Taiwan
| | - Chi-Chang Juan
- Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Chen Lee
- Department and Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Luen-Kui Chen
- Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Chun Wu
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Feng Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jiing-Feng Lirng
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Anne Ducros
- Neurology Department, Montpellier University Hospital, Montpellier, France.,Charles Coulomb Laboratory (L2C), UMR5221CNRS, Montpellier University, Montpellier, France
| | - Hsien-Da Huang
- Department of Biological Science and Technology, National Chiao Tung University, HsinChu, Taiwan.,School of Life and Health Sciences, The Chinese University of Hong Kong, Shenzhen, China.,Warshel Institute for Computational Biology, The Chinese University of Hong Kong, Shenzhen, China
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Affiliation(s)
- Anne Ducros
- Department of Neurology, Gui de Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier 34000, France.
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Ayrignac X, Zagroun C, Coget A, Azakri S, Menjot de Champfleur N, Montcriol AL, Labauge P, Mourand I, Ducros A, Daïen V, Arquizan C. Acute retinal arterial ischaemia: silent brain infarcts prevalence and short‐term recurrence. Eur J Neurol 2020; 27:2517-2522. [DOI: 10.1111/ene.14485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- X. Ayrignac
- Département de Neurologie CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - C. Zagroun
- Département d’Ophtalmologie CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - A. Coget
- Département de Neuroradiologie CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - S. Azakri
- Département de Neurologie CHU Montpellier INSERM Univ Montpellier Montpellier France
| | | | - A. L. Montcriol
- Département d’Ophtalmologie CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - P. Labauge
- Département de Neurologie CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - I. Mourand
- Département de Neurologie CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - A. Ducros
- Département de Neurologie CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - V. Daïen
- Département d’Ophtalmologie CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - C. Arquizan
- Département de Neurologie CHU Montpellier INSERM Univ Montpellier Montpellier France
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Sacco S, Braschinsky M, Ducros A, Lampl C, Little P, van den Brink AM, Pozo-Rosich P, Reuter U, de la Torre ER, Sanchez Del Rio M, Sinclair AJ, Katsarava Z, Martelletti P. European headache federation consensus on the definition of resistant and refractory migraine : Developed with the endorsement of the European Migraine & Headache Alliance (EMHA). J Headache Pain 2020; 21:76. [PMID: 32546227 PMCID: PMC7296705 DOI: 10.1186/s10194-020-01130-5] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [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] [Received: 02/28/2020] [Accepted: 05/25/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Despite advances in the management of headache disorders, some patients with migraine do not experience adequate pain relief with acute and preventive treatments. It is the aim of the present document to provide a definition of those migraines which are difficult-to-treat, to create awareness of existence of this group of patients, to help Healthcare Authorities in understanding the implications, and to create a basis to develop a better pathophysiological understanding and to support further therapeutic advances. MAIN BODY Definitions were established with a consensus process using the Delphi method. Patients with migraine with or without aura or with chronic migraine can be defined as having resistant migraine and refractory migraine according to previous preventative failures. Resistant migraine is defined by having failed at least 3 classes of migraine preventatives and suffer from at least 8 debilitating headache days per month for at least 3 consecutive months without improvement; definition can be based on review of medical charts. Refractory migraine is defined by having failed all of the available preventatives and suffer from at least 8 debilitating headache days per month for at least 6 consecutive months. Drug failure may include lack of efficacy or lack of tolerability. Debilitating headache is defined as headache causing serious impairment to conduct activities of daily living despite the use of pain-relief drugs with established efficacy at the recommended dose and taken early during the attack; failure of at least two different triptans is required. CONCLUSIONS We hope, that the updated EHF definition will be able to solve the conflicts that have limited the use of definitions which have been put forward in the past. Only with a widely accepted definition, progresses in difficult-to-treat migraine can be achieved. This new definition has also the aim to increase the understanding of the impact of the migraine as a disease with all of its social, legal and healthcare implications. It is the hope of the EHF Expert Consensus Group that the proposed criteria will stimulate further clinical, scientific and social attention to patients who suffer from migraine which is difficult-to-treat.
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Affiliation(s)
- Simona Sacco
- Neuroscience section - Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy. .,Regional Referral Headache Center of the Abruzzo region, ASL Avezzano-Sulmona-L'Aquila, L'Aquila, Italy.
| | - Mark Braschinsky
- Headache Clinic, Department of Neurology, Tartu University Clinics, Tartu, Estonia
| | - Anne Ducros
- Headache Unit, Neurology Department, Montpellier University Hospital and Montpellier University, Montpellier, France
| | - Christian Lampl
- Department of Neurology, Headache Medical Centre Linz, Hospital Barmherzige Brüder, Centre of Integrative Medicine (ZiAM) Ordensklinikum Linz, Linz, Austria
| | - Patrick Little
- European Migraine & Headache Alliance (EMHA), Hendrik Ido Ambacht, The Netherlands
| | - Antoinette Maassen van den Brink
- Division of Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Uwe Reuter
- Charité Universitätsmedizin Berlin, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Alexandra J Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Zaza Katsarava
- Evangelical Hospital Unna, Unna, Germany.,Departmentof Neurology, University of Duisburg-Essen, Essen, Germany.,EVEX Medical Corporation, Tbilisi, Georgia.,IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.,Regional Referral Headache Center of the Lazio region, Sant'Andrea Hospital, Rome, Italy
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Taieb G, Gaillard N, Dargazanli C, Ducros A. Early and late infratentorial haemorrhages sharing a common mechanism: Answer. J Clin Neurosci 2020. [DOI: 10.1016/j.jocn.2020.01.001] [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: 10/25/2022]
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Boitet R, de Gaalon S, Duflos C, Marin G, Mawet J, Burcin C, Roos C, Fiedler U, Bousser MG, Ducros A. Long-Term Outcomes After Reversible Cerebral Vasoconstriction Syndrome. Stroke 2020; 51:670-673. [DOI: 10.1161/strokeaha.119.027703] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
We aimed to further investigate the long-term outcomes after reversible cerebral vasoconstriction syndrome (RCVS).
Methods—
A longitudinal follow-up study was conducted in 173 RCVS patients.
Results—
Of the 172 patients who completed a mean follow-up of 9.2±3.3 years, 10 had a recurrent RCVS that was benign in all. Independent predictors of relapse were having a history of migraine and having exercise as a trigger for thunderclap headache during initial RCVS. After new delivery, the rate of postpartum RCVS was 9%.
Conclusions—
Overall, long-term outcome after RCVS is excellent.
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Affiliation(s)
- Rosalie Boitet
- From the Neurology Department (R.B., A.D.), Montpellier University Hospital, France
| | - Solène de Gaalon
- Neurology Department, Nantes University Hospital, France (S.d.G.)
| | - Claire Duflos
- Department of Medical Information (C.D., G.M.), Montpellier University Hospital, France
| | - Grégory Marin
- Department of Medical Information (C.D., G.M.), Montpellier University Hospital, France
| | - Jérôme Mawet
- Emergency Headache Centre (J.M., C.B., C.R., U.F.), Lariboisière Hospital, Assistance Publique–Hôpitaux de Paris, France
| | - Cécilia Burcin
- Emergency Headache Centre (J.M., C.B., C.R., U.F.), Lariboisière Hospital, Assistance Publique–Hôpitaux de Paris, France
| | - Caroline Roos
- Emergency Headache Centre (J.M., C.B., C.R., U.F.), Lariboisière Hospital, Assistance Publique–Hôpitaux de Paris, France
| | - Ursula Fiedler
- Emergency Headache Centre (J.M., C.B., C.R., U.F.), Lariboisière Hospital, Assistance Publique–Hôpitaux de Paris, France
| | - Marie-Germaine Bousser
- Neurology Department (M.-G.B.), Lariboisière Hospital, Assistance Publique–Hôpitaux de Paris, France
| | - Anne Ducros
- From the Neurology Department (R.B., A.D.), Montpellier University Hospital, France
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Taieb G, Gaillard N, Dargazanli C, Ducros A. Early and late infratentorial haemorrhages sharing a common mechanism. J Clin Neurosci 2020. [DOI: 10.1016/j.jocn.2019.11.042] [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: 10/25/2022]
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Boitet R, Gaillard N, Bendiab E, Corti L, Roos C, Reynes J, Costalat V, Arquizan C, Ducros A. Concomitant reversible cerebral vasoconstriction syndrome and transient global amnesia. J Neurol 2019; 267:390-394. [PMID: 31650256 DOI: 10.1007/s00415-019-09594-5] [Citation(s) in RCA: 8] [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: 08/06/2019] [Revised: 10/07/2019] [Accepted: 10/18/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reversible cerebral vasoconstriction syndrome (RCVS) is a common cause of thunderclap headache (TCH), mainly recurrent, sometimes associated with seizures and/or neurological deficit. Association with amnesia is exceptional. We report a case series of RCVS concomitant with transient global amnesia (TGA) and propose pathophysiologic hypotheses. METHODS We retrospectively reviewed clinical and radiological features of patients diagnosed with confirmed concomitant RCVS and TGA between 2012 and 2018 in two specialized institutions. RESULTS Two women aged 67 and 53, and a 64-year-old man had a first thunderclap headache triggered by an acute emotional stress, rapidly followed by TGA. Amnesia resolved within a few hours and RCVS was proven for all, with complete resolution of vasospasms within 3 months. All three patients had excellent outcome. CONCLUSIONS RCVS and TGA can occur simultaneously, which suggests common mechanisms such as aberrant responses to physical or emotional stress and cerebral vasoconstriction.
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Affiliation(s)
- Rosalie Boitet
- Neurology Department, Montpellier University Hospital, Montpellier, France
| | - Nicolas Gaillard
- Neurology Department, Montpellier University Hospital, Montpellier, France. .,Neurology Department, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
| | - Eddine Bendiab
- Neurology Department, Montpellier University Hospital, Montpellier, France
| | - Lucas Corti
- Neurology Department, Montpellier University Hospital, Montpellier, France
| | - Caroline Roos
- Emergency Headache Centre, Lariboisière Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Jacques Reynes
- Infectious and Tropical Diseases Department, Montpellier University Hospital, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Caroline Arquizan
- Neurology Department, Montpellier University Hospital, Montpellier, France
| | - Anne Ducros
- Neurology Department, Montpellier University Hospital, Montpellier, France
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Ducros A. Reversible cerebral vasoconstriction syndrome. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.073] [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: 11/25/2022]
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Coulette S, Renard D, Lehmann S, Raposo N, Arquizan C, Charif M, Thouvenot E, Wacongne A, Viguier A, Bonneville F, Allou T, Boukriche Y, Chiper L, Blanchet Fourcade G, Gabelle A, Ducros A, Duflos C, Labauge P, Menjot de Champfleur N, Ayrignac X. A Clinico-Radiological Study of Cerebral Amyloid Angiopathy-Related Inflammation. Cerebrovasc Dis 2019; 48:38-44. [DOI: 10.1159/000502832] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/20/2019] [Indexed: 11/19/2022] Open
Abstract
Objective: To describe the clinico-radiological features and long-term prognosis in patients with cerebral amyloid angiopathy-related inflammation (CAA-ri). Methods: Twenty-eight CAA-ri patients were recruited retrospectively from 6 neurological centers. We recorded the clinico-radiological and biological data, at baseline and during follow-up. Baseline characteristics associated with relapse risk and prognosis were assessed. Results: Five patients had pathologically confirmed CAA-ri whereas 23 had probable (n = 21) or possible (n = 2) CAA-ri. The mean age was 72 years; main clinical symptoms included confusion (54%), hemiparesis (36%), and aphasia (29%). Cerebral MRI disclosed a brain parenchymal lesion (89%), which was usually multifocal (82%) and bilateral (89%). It was associated with gadolinium enhancement (84%), small ischemic lesions (39%), cortical superficial siderosis (CSS; 50%), and a high number of microbleeds (mean 240 ± 277). An isolated leptomeningeal involvement was observed in 3 patients with pathological confirmation. Despite a favorable initial evolution after treatment, we observed a 42% risk of relapse, mostly within the first year (83%). After a mean follow-up of 2 years, 29% died and 25% had a marked disability. Disseminated CSS was associated with death. Conclusion: Despite an apparently favorable initial evolution, CAA-ri is characterized by a poor prognosis. Diagnostic criteria should consider patients with isolated leptomeningeal involvement.
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Boitet R, De Gaalon S, Duflos C, Marin G, Mawet J, Burcin C, Roos C, Fiedler U, Bousser MG, Ducros A. Récidive à long terme du syndrome de vasoconstriction cérébral réversible : suivi prospectif de 173 patients. Rev Neurol (Paris) 2019. [DOI: 10.1016/j.neurol.2019.01.311] [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: 11/24/2022]
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Benali A, Moynier M, Dargazanli C, Deverdun J, Costalat V, Le Bars E, Ducros A. La prise en charge endovasculaire de l’infarctus cérébral ischémique de nuit impacte-t-elle la récupération fonctionnelle à 3 mois ? J Neuroradiol 2019. [DOI: 10.1016/j.neurad.2019.01.066] [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: 10/27/2022]
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Benali A, Chaptal T, Deverdun J, Champfleur NMD, Molino F, Le Bars E, Ducros A. Comparaison du volume ischémique lésionnel évalué sur la séquence EPI et sur la séquence RESOLVE à la phase aiguë chez le patient victime d’un Infarctus cérébral. J Neuroradiol 2019. [DOI: 10.1016/j.neurad.2019.01.013] [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: 10/27/2022]
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de Boysson H, Parienti JJ, Mawet J, Arquizan C, Boulouis G, Burcin C, Naggara O, Zuber M, Touzé E, Aouba A, Bousser MG, Pagnoux C, Ducros A. Primary angiitis of the CNS and reversible cerebral vasoconstriction syndrome. Neurology 2018; 91:e1468-e1478. [DOI: 10.1212/wnl.0000000000006367] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/13/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectivesTo further improve the distinction between primary angiitis of the CNS (PACNS) and reversible cerebral vasoconstriction syndrome (RCVS).MethodsWe compared 2 large French cohorts of patients with PACNS (n = 110, retrospectively and prospectively enrolled) and RCVS (n = 173, prospectively enrolled).ResultsPatients with RCVS were predominantly female (p < 0.0001), with migraines (p < 0.0001), and were more often exposed to vasoactive substances (p < 0.0001) or postpartum (p = 0.002) than patients with PACNS. Headache, especially thunderclap headache, was more frequent in RCVS (both p < 0.0001). Thunderclap headache was absent in only 6% of patients with RCVS and was mainly recurrent (87%) and provoked (77%) mostly by sexual intercourse, exertion, or emotion. All other neurologic symptoms (motor deficit, seizure, cognitive disorder, or vigilance impairment, all p < 0.0001) were more frequent in PACNS. At admission, brain CT or MRI was abnormal in all patients with PACNS and in 31% of patients with RCVS (p < 0.0001). Acute ischemic stroke was more frequent in PACNS than in RCVS (p < 0.0001). Although intracerebral hemorrhage was more frequent in PACNS (p = 0.006), subarachnoid hemorrhage and vasogenic edema predominated in RCVS (p = 0.04 and p = 0.01, respectively). Multiple small deep infarcts, extensive deep white matter lesions, tumor-like lesions, or multiple gadolinium-enhanced lesions were observed only in PACNS, whereas cervical artery dissection was found only in RCVS.ConclusionsOur study confirms that careful analysis of clinical context, headache features, and patterns of brain lesions can distinguish PACNS and RCVS within the first few days of admission in most cases. However, diagnosis remains challenging in a few cases.
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Ducros A. Présentation du Club céphalées & migraines. Rev Neurol (Paris) 2018. [DOI: 10.1016/j.neurol.2018.02.068] [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: 10/17/2022]
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Abstract
Background Migraine with brainstem aura is defined as a migraine with aura including at least two of the following symptoms: dysarthria, vertigo, tinnitus, hypacusis, diplopia, ataxia and/or decreased level of consciousness. Aim The aim of this study is to review data coming from clinical observations and functional mapping that support the role of the cerebral cortex in the initiation of brainstem aura symptoms. Results Vertigo can result from a vestibular cortex dysfunction, while tinnitus and hypacusis can originate within the auditory cortex. Diplopia can reflect a parieto-occipital involvement. Dysarthria can be caused by dysfunctions located in precentral gyri. Ataxia can reflect abnormal processing of vestibular, sensory, or visual inputs by the parietal lobe. Alteration of consciousness can be caused by abnormal neural activation within specific consciousness networks that include prefrontal and posterior parietal cortices. Conclusion Any symptom of so-called brainstem aura can originate within the cortex. Based on these data, we suggest that brainstem aura could have a cortical origin. This hypothesis would explain the co-occurrence of typical and brainstem aura during attacks and would fit with the theory of cortical spreading depression. We propose that migraine with brainstem aura should be classified as a typical migraine aura.
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Affiliation(s)
- Geneviève Demarquay
- 1 Department of Neurology, Hospices Civils de Lyon, Lyon, France.,2 Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), INSERM U1028, CNRS UMR5292, Lyon, France
| | - Anne Ducros
- 3 Department of Neurology, Montpellier University Hospital, France.,4 Medical School of Montpellier University (UM), France
| | | | - François Mauguiere
- 1 Department of Neurology, Hospices Civils de Lyon, Lyon, France.,5 Lyon Neuroscience Research Center (CRNL), Neuropain team, INSERM U1028, CNRS UMR5292, Lyon, France.,6 Lyon 1 University, Lyon, France
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Sherlaw W, McColl K, Ducros A. The ethics of true collaboration between children with ASD, their families and education and health professionals. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw167.042] [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: 11/14/2022] Open
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Abstract
We report a patient with headaches meeting the criteria of chronic paroxysmal hemicrania, as defined by the International Headache Society classification. Headaches were fully responsive to indomethacin during the first 3 months of treatment but recurred when daily doses were lowered. Investigations revealed a macroprolactinoma. Headaches stopped after cabergoline treatment. This report further suggests that patients with paroxysmal hemicrania should be investigated for pituitary abnormalities.
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Affiliation(s)
- M Sarov
- Emergency Headache Centre, Lariboisière Hospital, Paris, France
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Mawet J, Debette S, Bousser MG, Ducros A. The Link Between Migraine, Reversible Cerebral Vasoconstriction Syndrome and Cervical Artery Dissection. Headache 2016; 56:645-56. [PMID: 27016026 DOI: 10.1111/head.12798] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Headache is the common thread of migraine, reversible cerebral vasoconstriction syndrome (RCVS) and cervical artery dissection (CeAD), three medical conditions that otherwise appear to be very different. However, epidemiological, clinical and genetic data suggest that these conditions share common and complex features and are, at least partly, linked. The purpose of this manuscript is to review existing evidence for an association between migraine, RCVS and CeAD and discuss the potential underlying mechanisms.
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Affiliation(s)
- Jérôme Mawet
- Emergency Headache Center, Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, Paris, France (J. Mawet)
| | - Stéphanie Debette
- Institut National de la Santé et de la Recherche Médicale (INSERM) U897 Epidemiology and Biostatistics and Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S. Debette)
| | - Marie-Germaine Bousser
- Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, Paris, France (M.-G. Bousser)
| | - Anne Ducros
- Department of Neurology, Montpellier University Hospital and Montpellier University, Montpellier, France (A. Ducros)
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Affiliation(s)
- Valérie Wolff
- Department of Neurology; Stroke Unit, Strasbourg University Hospital; Strasbourg France
- EA3072, Federation of Translational Medicine of Strasbourg, University of Strasbourg; Strasbourg France
| | - Anne Ducros
- Department of Neurology; Montpellier University Hospital; Montpellier France
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Affiliation(s)
- Anne Ducros
- Department of Neurology; Montpellier University Hospital, and Montpellier University; Montpellier France (A. Ducros)
| | - Valérie Wolff
- Stroke Unit, Department of Neurology; Strasbourg University Hospital; Strasbourg France (V. Wolff)
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Debette S, Compter A, Labeyrie MA, Uyttenboogaart M, Metso TM, Majersik JJ, Goeggel-Simonetti B, Engelter ST, Pezzini A, Bijlenga P, Southerland AM, Naggara O, Béjot Y, Cole JW, Ducros A, Giacalone G, Schilling S, Reiner P, Sarikaya H, Welleweerd JC, Kappelle LJ, de Borst GJ, Bonati LH, Jung S, Thijs V, Martin JJ, Brandt T, Grond-Ginsbach C, Kloss M, Mizutani T, Minematsu K, Meschia JF, Pereira VM, Bersano A, Touzé E, Lyrer PA, Leys D, Chabriat H, Markus HS, Worrall BB, Chabrier S, Baumgartner R, Stapf C, Tatlisumak T, Arnold M, Bousser MG. Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. Lancet Neurol 2015; 14:640-54. [PMID: 25987283 DOI: 10.1016/s1474-4422(15)00009-5] [Citation(s) in RCA: 256] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 02/26/2015] [Accepted: 03/20/2015] [Indexed: 12/27/2022]
Abstract
Spontaneous intracranial artery dissection is an uncommon and probably underdiagnosed cause of stroke that is defined by the occurrence of a haematoma in the wall of an intracranial artery. Patients can present with headache, ischaemic stroke, subarachnoid haemorrhage, or symptoms associated with mass effect, mostly on the brainstem. Although intracranial artery dissection is less common than cervical artery dissection in adults of European ethnic origin, intracranial artery dissection is reportedly more common in children and in Asian populations. Risk factors and mechanisms are poorly understood, and diagnosis is challenging because characteristic imaging features can be difficult to detect in view of the small size of intracranial arteries. Therefore, multimodal follow-up imaging is often needed to confirm the diagnosis. Treatment of intracranial artery dissections is empirical in the absence of data from randomised controlled trials. Most patients with subarachnoid haemorrhage undergo surgical or endovascular treatment to prevent rebleeding, whereas patients with intracranial artery dissection and cerebral ischaemia are treated with antithrombotics. Prognosis seems worse in patients with subarachnoid haemorrhage than in those without.
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Affiliation(s)
- Stéphanie Debette
- Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France; Inserm U897, Bordeaux University, France.
| | - Annette Compter
- Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Marc-Antoine Labeyrie
- Department of Neuroradiology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France
| | - Maarten Uyttenboogaart
- Departments of Neurology and Radiology, University Medical Centre Groningen, Groningen, Netherlands
| | - Tina M Metso
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | | | | | - Stefan T Engelter
- Department of Neurology and Stroke Centre, University Hospital of Basel, Basel, Switzerland; Neurorehabilitation Unit, University Centre for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, Basel, Switzerland
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, Brescia University Hospital, Brescia, Italy
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland
| | - Andrew M Southerland
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Olivier Naggara
- Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Center Hospitalier Sainte-Anne, DHU Neurovasc Paris Sorbonne, Paris, France
| | - Yannick Béjot
- Department of Neurology, Dijon University Hospital, Dijon, France
| | - John W Cole
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anne Ducros
- Department of Neurology, Gui de Chauliac Hospital, Montpellier I University, Montpellier, France
| | - Giacomo Giacalone
- Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele, Milano, Italy
| | | | - Peggy Reiner
- Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France
| | - Hakan Sarikaya
- Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland; Department of Neurology, University Hospital of Zürich, Zürich, Switzerland
| | - Janna C Welleweerd
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Gert Jan de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Leo H Bonati
- Department of Neurology and Stroke Centre, University Hospital of Basel, Basel, Switzerland
| | - Simon Jung
- Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Vincent Thijs
- Department of Neurosciences, Experimental Neurology, Laboratory of Neurobiology, KU Leuven University of Leuven, Leuven, Belgium; VIB-Vesalius Research Center, Leuven, Belgium; Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Juan J Martin
- Department of Neurology, Sanatorio Allende, Cordoba, Argentina
| | - Tobias Brandt
- Clinics for Neurologic Rehabilitation, Kliniken Schmieder, Heidelberg, Germany
| | | | - Manja Kloss
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Tohru Mizutani
- Department of Neurosurgery, Showa University, Tokyo, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | | | - Vitor M Pereira
- Division of Neuroradiology, Department of Medical Imaging, and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Anna Bersano
- Cerebrovascular Disease Unit, IRCCS Foundation C Besta Neurological Institute, Milan, Italy
| | - Emmanuel Touzé
- Université Caen Basse Normandie, Inserm U919, Department of Neurology, CHU Côte de Nacre, Caen, France
| | - Philippe A Lyrer
- Department of Neurology and Stroke Centre, University Hospital of Basel, Basel, Switzerland
| | - Didier Leys
- Department of Neurology, Lille University Hospital, Lille, France
| | - Hugues Chabriat
- Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Bradford B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Stéphane Chabrier
- French Centre for Paediatric Stroke and EA3065, Saint-Etienne University Hospital, Saint-Etienne, France
| | | | - Christian Stapf
- Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Marcel Arnold
- Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Marie-Germaine Bousser
- Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France
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Affiliation(s)
- Anne Ducros
- Department of Neurology, Neuroscience Head and Neck Clinic, Montpellier University Hospital, and the University of Montpellier, Montpellier, France
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Ducros A, Biousse V. Headache arising from idiopathic changes in CSF pressure. Lancet Neurol 2015; 14:655-68. [DOI: 10.1016/s1474-4422(15)00015-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/17/2015] [Accepted: 03/24/2015] [Indexed: 12/24/2022]
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Bourvis N, Franc J, Szatmary Z, Chabriat H, Crassard I, Ducros A. Reversible cerebral vasoconstriction syndrome in the context of recent cerebral venous thrombosis: Report of a case. Cephalalgia 2015; 36:92-7. [PMID: 25944816 DOI: 10.1177/0333102415584359] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 04/05/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Reversible cerebral constriction syndrome and cerebral venous thrombosis are two rare conditions. Reversible cerebral constriction syndrome affects the cerebral arteries and the pathology is still largely unknown. To date, no physiological link with cerebral venous thrombosis has been reported. CASE RESULTS We report here the case of a 24-year-old woman who presented a reversible cerebral constriction syndrome in the setting of a cerebral venous thrombosis. Cerebral venous thrombosis had developed in her left lateral venous sinus, within the stent placed one year before, in order to treat an idiopathic intracranial hypertension. DISCUSSION The co-occurrence of cerebral venous thrombosis and reversible cerebral constriction syndrome in the same patient raises the issue of a potential link between them. We discuss the potential common trigger factors in this case: recent hormonal therapy; intracranial hypotension iatrogenically induced by lumbar puncture.
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Affiliation(s)
- Nadège Bourvis
- Neurology Department, Lariboisière Hospital, Paris, France Headache Emergency Centre, Lariboisière Hospital, Paris, France
| | - Julie Franc
- Neuroradiology Department, Lariboisière Hospital, Paris, France
| | - Zoltan Szatmary
- Neuroradiology Department, Lariboisière Hospital, Paris, France
| | | | | | - Anne Ducros
- Neurology Department, Lariboisière Hospital, Paris, France Headache Emergency Centre, Lariboisière Hospital, Paris, France
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