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Di Marco S, Pilati L, Torrente A, Maccora S, Santangelo A, Cosentino G, Correnti E, Raieli V, Fierro B, Brighina F. Pediatric Migraine and Visual Cortical Excitability: A Prospective Observational Study with Sound-Induced Flash Illusions. Children (Basel) 2024; 11:394. [PMID: 38671611 PMCID: PMC11049238 DOI: 10.3390/children11040394] [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] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024]
Abstract
The pathophysiological mechanisms underlying migraine are more difficult to investigate in children than in the adult population. Abnormal cortical excitability turns out to be one of the most peculiar aspects of migraine, accounting for the manifestations of migraine attacks. Recently, visual cortical excitability has been explored effectively in adult migraineurs with a technique based on cross-modal audio-visual illusions (with sound-induced flash illusions (SIFIs) being reduced in migraineurs compared to non-migraineur subjects). On such a basis, in this study, we investigated visual cortical excitability in children with migraine using SIFIs using combinations of visual and sound stimuli presented randomly. We evaluated 26 children with migraine without aura and 16 healthy children. Migraineurs did not differ from the age-matched healthy subjects regarding fission or fusion illusions but perceived more flashes in trials of multiple flashes with or without beeps. The higher number of SIFIs in migraineur children compared to adults may be due to a greater propensity of visual stimulation to be driven by auditory stimuli (i.e., acoustic dominance). The increased ability to perceive flashes reveals a hyperfunctional visual cortex, demonstrating that the use of SIFIs is a valid tool for assessing visual cortical responsiveness even in pediatric migraine.
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Affiliation(s)
- Salvatore Di Marco
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), University of Palermo, 90127 Palermo, Italy; (S.D.M.); (L.P.); (A.T.); (S.M.); (B.F.); (F.B.)
- Neurology and Stroke Unit, P.O. “S. Antonio Abate”, 91016 Trapani, Italy
| | - Laura Pilati
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), University of Palermo, 90127 Palermo, Italy; (S.D.M.); (L.P.); (A.T.); (S.M.); (B.F.); (F.B.)
- Neurology and Stroke Unit, P.O. “S. Antonio Abate”, 91016 Trapani, Italy
| | - Angelo Torrente
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), University of Palermo, 90127 Palermo, Italy; (S.D.M.); (L.P.); (A.T.); (S.M.); (B.F.); (F.B.)
| | - Simona Maccora
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), University of Palermo, 90127 Palermo, Italy; (S.D.M.); (L.P.); (A.T.); (S.M.); (B.F.); (F.B.)
- Neurology Unit, ARNAS Civico di Cristina and Benfratelli Hospitals, 90127 Palermo, Italy
| | - Andrea Santangelo
- Pediatrics Department, AOUP Santa Chiara Hospital, 56126 Pisa, Italy;
| | - Giuseppe Cosentino
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy;
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Edvige Correnti
- Child Neurology and Psychiatry Unit—ISMEP, “G. Di Cristina” Children’s Hospital—ARNAS Civico, 90127 Palermo, Italy;
| | - Vincenzo Raieli
- Child Neurology and Psychiatry Unit—ISMEP, “G. Di Cristina” Children’s Hospital—ARNAS Civico, 90127 Palermo, Italy;
| | - Brigida Fierro
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), University of Palermo, 90127 Palermo, Italy; (S.D.M.); (L.P.); (A.T.); (S.M.); (B.F.); (F.B.)
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), University of Palermo, 90127 Palermo, Italy; (S.D.M.); (L.P.); (A.T.); (S.M.); (B.F.); (F.B.)
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D’Agnano D, Lo Cascio S, Correnti E, Raieli V, Sciruicchio V. A Narrative Review of Visual Hallucinations in Migraine and Epilepsy: Similarities and Differences in Children and Adolescents. Brain Sci 2023; 13:643. [PMID: 37190608 PMCID: PMC10136509 DOI: 10.3390/brainsci13040643] [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: 03/13/2023] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023] Open
Abstract
Since the earliest descriptions of the simple visual hallucinations in migraine patients and in subjects suffering from occipital lobe epilepsy, several important issues have arisen in recognizing epileptic seizures of the occipital lobe, which often present with symptoms mimicking migraine. A detailed quantitative and qualitative clinical scrutiny of timing and characteristics of visual impairment can contribute to avoiding mistakes. Differential diagnosis, in children, might be challenging because of the partial clinical, therapeutic, and pathophysiological overlaps between the two diseases that often coexist. Ictal elementary visual hallucinations are defined by color, shape, size, location, movement, speed of appearance and duration, frequency, and associated symptoms and their progression. The evaluation of the distinctive clinical features of visual aura in migraine and visual hallucinations in occipital epilepsy could contribute to understanding the pathogenetic mechanisms of these two conditions. This paper aims to critically review the available scientific evidence on the main clinical criteria that address diagnosis, as well as similarities and differences in the pathophysiological mechanisms underlying the visual impairment in epilepsy and migraine.
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Affiliation(s)
- Daniela D’Agnano
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Salvatore Lo Cascio
- Child Neuropsychiatry Unit Department, Pro.MI.S.E. “G. D’Alessandro, University of Palermo, 90100 Palermo, Italy
| | - Edvige Correnti
- Child Neuropsychiatry Department, ISMEP, ARNAS Civico, 90100 Palermo, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Department, ISMEP, ARNAS Civico, 90100 Palermo, Italy
| | - Vittorio Sciruicchio
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
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Manzo ML, Reina F, Correnti E, D'Aiuto F, D'Agnano D, Santangelo A, Vetri L, Santangelo G, Maniscalco L, Tripi G, Sciruicchio V, Raieli V. Evolution of Pediatric Migraine Patients Admitted at an Emergency Department after a 10-Year Follow-Up. J Clin Med 2023; 12:jcm12072475. [PMID: 37048559 PMCID: PMC10095507 DOI: 10.3390/jcm12072475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/12/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Despite its high prevalence, the clinical course of pediatric migraine has not been fully understood, and previous studies present conflicting results. We present here the findings of a 10-year follow-up study involving children with severe migraine pain admitted to our emergency department. Furthermore, all studies were carried out on selected outpatient clinical case studies. Our aim was to evaluate a population of migraine children admitted to an emergency department because of increased severity or frequency of pain or even because of very anxious parents concerning their child's headache in order to describe their long-term outcomes, whether it differed from that of outpatient populations and to identify possible predictors of prognosis. METHODS We recruited 80 subjects with migraine headaches (mean age 8 years with a range of 4-14 years, 50% females), attending the baseline examination of a population admitted for a headache to the Emergency Department in the first half year of 2012. Of the 80 subjects, 48 (60%) were eligible for follow-up in 2022. We included in our study only patients diagnosed with migraine, according to the diagnostic criteria of the International Classification of Headache Disorders. All were contacted by telephone, and a semi-structured questionnaire was provided to them by email. The association between several possible prognostic factors (gender, familiar neurologic disorders, prenatal and perinatal disorders, social activities, sleep disorders, etc.) and the long-term persistence of migraine headaches were explored using logistic regression analysis. RESULTS Of 48 subjects with migraine headaches at baseline, 31 (65%) had persistent migraine, and 17 (35%) experienced remission. The preliminary results showed that the presence of neurologic disorders in parents (p < 0.01-odds ratio 9.34 (2.53-41.64) and sleep disorders (p < 0.01-odds ratio 13.18 (2.25-252.74) significantly predicted the 10-year persistence of migraine headaches, while the other considered predictors were found not to influence prognosis. CONCLUSIONS To our knowledge, this was the first study conducted on a selected pediatric population upon admission to the emergency room. Our study suggests that a population of pediatric migraine selected for admission to the emergency department also shows a favorable long-term prognosis, like the studies conducted in the outpatient sample. Familial neurological comorbidity and sleep disorders were unfavorable factors for predicting good outcomes.
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Affiliation(s)
- Maria Laura Manzo
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Federica Reina
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Edvige Correnti
- Child Neuropsychiatry Department, ISMEP-ARNAS Civico, 90100 Palermo, Italy
| | | | - Daniela D'Agnano
- Children Epilepsy and EEG Center, PO, San Paolo ASL, 70132 Bari, Italy
| | - Andrea Santangelo
- Pediatrics Department, AOUP Santa Chiara Hospital, 56126 Pisa, Italy
| | - Luigi Vetri
- Oasi Research Institute IRCCS, 94018 Troina, Italy
| | | | - Laura Maniscalco
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Gabriele Tripi
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | | | - Vincenzo Raieli
- Child Neuropsychiatry Department, ISMEP-ARNAS Civico, 90100 Palermo, Italy
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Correnti E, Lo Cascio S, Cernigliaro F, Rossi R, D'Agnano D, Grasso G, Pellegrino A, Lauria B, Santangelo A, Santangelo G, Tripi G, Versace A, Sciruicchio V, Raieli V. Idiopathic Non-Dental Facial Pain Syndromes in Italian Children: A Clinical Case Series. Life (Basel) 2023; 13:life13040861. [PMID: 37109390 PMCID: PMC10144764 DOI: 10.3390/life13040861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/08/2023] [Accepted: 03/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes characterized by painful attacks involving the orofacial structures. They may be summarily subdivided into two great categories: (1) orofacial pain mainly attributed to dental disorders such as dentoalveolar and myofascial orofacial pain or temporomandibular joint (TM) pain; (2) orofacial pain mainly attributed to non-dental pain as neuralgias, facial localization of primary headaches or idiopathic orofacial pain. The second group is uncommon, often described by single case reports, can often show overlapping symptoms with the first group, and represents a clinical challenge, carrying the risk of undervaluation and possibly invasive odontoiatric treatment. We aimed to describe a clinical pediatric series of non-dental orofacial pain and better to underline some topographic and clinical features associated with them. We retrospectively collected the data of children admitted to our headache centers (Bari, Palermo, Torino) from 2017 to 2021. Our inclusion criterion was the presence of non-dental orofacial pain following the topographic criteria of 3° International Classification of Headache Disorders (ICHD-3), and exclusion criteria included the pain syndromes attributed to the dental disorders and pain syndromes due to the secondary etiologies Results. Our sample comprised 43 subjects (23/20 M/F, in the range of ages 5-17). We classified them int: 23 primary headaches involving the facial territory during attacks, 2 facial trigeminal autonomic cephalalgias, 1 facial primary stabbing headache, 1 facial linear headache, 6 trochlear migraines, 1 orbital migraine 3 red ear syndrome and 6 atypical facial pain. All patients described debilitating pain for intensity (moderate/severe), 31 children had episodic attacks, and 12 had continuous pain. Almost all received drugs for acute treatment (less than 50% were satisfied), and some received non-pharmacological treatment associated with drug therapy Conclusion. Although rare OFP can occur in pediatric age, it can be debilitating if unrecognized and untreated, affecting the psychophysical well-being of young patients. We highlight the specific characteristics of the disorder for a more correct and earlier identification during the diagnostic process, already difficult in pediatric age, and to define the approach and possible treatment to prevent negative outcomes in adulthood.
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Affiliation(s)
- Edvige Correnti
- Child Neuropsychiatry Department, ISMEP, ARNAS Civico, 90100 Palermo, Italy
| | - Salvatore Lo Cascio
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Federica Cernigliaro
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Roberta Rossi
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Daniela D'Agnano
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Giulia Grasso
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Annamaria Pellegrino
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Barbara Lauria
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Andrea Santangelo
- Pediatrics Department, AOUP Santa Chiara Hospital, 56126 Pisa, Italy
| | | | - Gabriele Tripi
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Antonella Versace
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Vittorio Sciruicchio
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Department, ISMEP, ARNAS Civico, 90100 Palermo, Italy
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Lo Cascio S, Correnti E, D’Agostino S, Capizzi M, Marino A, Meli R, Lo Nobile S, Raieli V. Cranial Autonomic Symptoms and Migraine: What Relationship and What Meaning? A Review. J Integr Neurosci 2022; 21:166. [DOI: 10.31083/j.jin2106166] [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] [Received: 06/23/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 11/07/2022] Open
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Reina F, Marino A, Martina Nocera G, Capizzi M, D'Amico A, Correnti E, Pitino R, Buffa D, Raieli V. Sneezing as conversion disorder: Different faces of the same fragility. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119748] [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: 11/28/2022]
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Calì F, Elia M, Vinci M, Vetri L, Correnti E, Trapolino E, Roccella M, Vanadia F, Romano V. Are Mutations in the DHRS9 Gene Causally Linked to Epilepsy? A Case Report. ACTA ACUST UNITED AC 2020; 56:medicina56080387. [PMID: 32752300 PMCID: PMC7466289 DOI: 10.3390/medicina56080387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/01/2020] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 11/16/2022]
Abstract
The DHRS9 gene is involved in several pathways including the synthesis of allopregnanolone from progesterone. Allopregnanolone is a positive modulator of gamma aminobutyric acid (GABA) action and plays a role in the control of neuronal excitability and seizures. Whole-exome sequencing performed on a girl with an early onset epilepsy revealed that she was a compound heterozygote for two novel missense mutations of the DHRS9 gene likely to disrupt protein function. No previous studies have reported the implication of this gene in epilepsy. We discuss a new potential pathogenic mechanism underlying epilepsy in a child, due to a defective progesterone pathway.
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Affiliation(s)
- Francesco Calì
- Oasi Research Institute-IRCCS, 94018 Troina, Italy; (F.C.); (M.V.); (L.V.)
| | - Maurizio Elia
- Oasi Research Institute-IRCCS, 94018 Troina, Italy; (F.C.); (M.V.); (L.V.)
- Correspondence: ; Tel.: +39-0935-936111; Fax: +39-0935-653327
| | - Mirella Vinci
- Oasi Research Institute-IRCCS, 94018 Troina, Italy; (F.C.); (M.V.); (L.V.)
| | - Luigi Vetri
- Oasi Research Institute-IRCCS, 94018 Troina, Italy; (F.C.); (M.V.); (L.V.)
- Department of Sciences for Health Promotion and Mother and Child Care G. D’Alessandro, University of Palermo, 90127 Palermo, Italy;
| | - Edvige Correnti
- Department of Sciences for Health Promotion and Mother and Child Care G. D’Alessandro, University of Palermo, 90127 Palermo, Italy;
| | - Emanuele Trapolino
- Child Neuropsichiatry Unity, ISMEP-G. di Cristina Hospital-Arnas Civico, 90134 Palermo, Italy; (E.T.); (F.V.)
| | - Michele Roccella
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy;
| | - Francesca Vanadia
- Child Neuropsichiatry Unity, ISMEP-G. di Cristina Hospital-Arnas Civico, 90134 Palermo, Italy; (E.T.); (F.V.)
| | - Valentino Romano
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, 90128 Palermo, Italy;
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Pavone V, Dones P, Giordano S, Parisi E, Correnti E, Drago F, Messina LM, Plicato G, Rocchitelli L, Vanadia F. A rare case of pediatric Epstein-Barr Virus-associated encephalitis. Gazz Med Ital - Arch Sci Med 2019. [DOI: 10.23736/s0393-3660.18.03957-8] [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: 11/08/2022]
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Raieli V, Correnti E, Sandullo A, Romano M, Marchese F, Loiacono C, Brighina F. Effectiveness of a digital platform for sharing knowledge on headache management: a two-year experience. Funct Neurol 2019; 33:51-55. [PMID: 29633697 PMCID: PMC5901942 DOI: 10.11138/fneur/2018.33.1.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
It is crucial that all headache specialists receive adequate training. Considering the unsatisfactory results obtained with standard updating courses and the growing need for continuing professional education, a digital platform was developed as a training tool. The platform has been active since 1 October 2014. It is readily accessible to doctors by free registration. Users have access to all the material available on the platform, which includes scientific articles, e-books, presentations and images. Users can share their own material and clinical cases directly. At the time of this study, the platform had 37 users. In the second year following its launch 316 files were downloaded and five discussions were started. These saw 22 contributions. Fifteen of the 37 members did not perform any action on the platform. In total, 74 files were uploaded in the second year of activity, but 90% of the contributions came from a very small group of users. There were no significant differences in use of the platform between members of the Italian Society for the Study of Headache and other specialists. Even though the platform appears to be an easily accessible, interactive and inexpensive instrument, the higher number of downloads than uploads suggests that it is used passively.
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Affiliation(s)
| | | | | | - Marcello Romano
- Neurology Dept.- Cervello, Villa Sofia Ospedali Riuniti, Palermo, Italy
| | | | | | - Filippo Brighina
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Italy
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Raieli V, Loiacono C, Messina LM, Correnti E, Brighina F. Is a digital platform useful in headache training? A 4-year Italian experience. Neurol Sci 2018; 39:2223-2224. [PMID: 30121838 DOI: 10.1007/s10072-018-3540-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 08/14/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Vincenzo Raieli
- ARNAS Civico Palermo, via dei Benedettini 1, UO NPI- P.O. Di Cristina, 90100, Palermo, Italy.
| | - Carmela Loiacono
- Child Neuropsychiatry School, University of Palermo, Palermo, Italy
| | | | - Edvige Correnti
- Child Neuropsychiatry School, University of Palermo, Palermo, Italy
| | - Filippo Brighina
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
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Rubio-Beltrán E, Correnti E, Deen M, Kamm K, Kelderman T, Papetti L, Vigneri S, MaassenVanDenBrink A, Edvinsson L. PACAP38 and PAC 1 receptor blockade: a new target for headache? J Headache Pain 2018; 19:64. [PMID: 30088106 PMCID: PMC6081277 DOI: 10.1186/s10194-018-0893-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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: 06/05/2018] [Accepted: 07/24/2018] [Indexed: 12/21/2022] Open
Abstract
Pituitary adenylate cyclase activating polypeptide-38 (PACAP38) is a widely distributed neuropeptide involved in neuroprotection, neurodevelopment, nociception and inflammation. Moreover, PACAP38 is a potent inducer of migraine-like attacks, but the mechanism behind this has not been fully elucidated. Migraine is a neurovascular disorder, recognized as the second most disabling disease. Nevertheless, the antibodies targeting calcitonin gene-related peptide (CGRP) or its receptor are the only prophylactic treatment developed specifically for migraine. These antibodies have displayed positive results in clinical trials, but are not effective for all patients; therefore, new pharmacological targets need to be identified. Due to the ability of PACAP38 to induce migraine-like attacks, its location in structures previously associated with migraine pathophysiology and the 100-fold selectivity for the PAC1 receptor when compared to VIP, new attention has been drawn to this pathway and its potential role as a novel target for migraine treatment. In accordance with this, antibodies against PACAP38 (ALD 1910) and PAC1 receptor (AMG 301) are being developed, with AMG 301 already in Phase II clinical trials. No results have been published so far, but in preclinical studies, AMG 301 has shown responses comparable to those observed with triptans. If these antibodies prove to be effective for the treatment of migraine, several considerations should be addressed, for instance, the potential side effects of long-term blockade of the PACAP (receptor) pathway. Moreover, it is important to investigate whether these antibodies will indeed represent a therapeutic advantage for the patients that do not respond the CGRP (receptor)-antibodies. In conclusion, the data presented in this review indicate that PACAP38 and PAC1 receptor blockade are promising antimigraine therapies, but results from clinical trials are needed in order to confirm their efficacy and side effect profile.
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Affiliation(s)
- Eloisa Rubio-Beltrán
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Edvige Correnti
- Department of Child Neuropsychiatry, University of Palermo, Palermo, Italy
| | - Marie Deen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Katharina Kamm
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Tim Kelderman
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Laura Papetti
- Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simone Vigneri
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo; Pain Medicine Unit, Santa Maria Maddalena Hospital, Occhiobello, Italy
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lars Edvinsson
- Department of Internal Medicine, Institute of Clinical Sciences, Lund University, Lund, Sweden
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Deen M, Correnti E, Kamm K, Kelderman T, Papetti L, Rubio-Beltrán E, Vigneri S, Edvinsson L, Maassen Van Den Brink A. Blocking CGRP in migraine patients - a review of pros and cons. J Headache Pain 2017; 18:96. [PMID: 28948500 PMCID: PMC5612904 DOI: 10.1186/s10194-017-0807-1] [Citation(s) in RCA: 189] [Impact Index Per Article: 27.0] [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: 07/26/2017] [Accepted: 09/14/2017] [Indexed: 02/02/2023] Open
Abstract
Migraine is the most prevalent neurological disorder worldwide and it has immense socioeconomic impact. Currently, preventative treatment options for migraine include drugs developed for diseases other than migraine such as hypertension, depression and epilepsy. During the last decade, however, blocking calcitonin gene-related peptide (CGRP) has emerged as a possible mechanism for prevention of migraine attacks. CGRP has been shown to be released during migraine attacks and it may play a causative role in induction of migraine attacks. Here, we review the pros and cons of blocking CGRP in migraine patients. To date, two different classes of drugs blocking CGRP have been developed: small molecule CGRP receptor antagonists (gepants), and monoclonal antibodies, targeting either CGRP or the CGRP receptor. Several trials have been conducted to test the efficacy and safety of these drugs. In general, a superior efficacy compared to placebo has been shown, especially with regards to the antibodies. In addition, the efficacy is in line with other currently used prophylactic treatments. The drugs have also been well tolerated, except for some of the gepants, which induced a transient increase in transaminases. Thus, blocking CGRP in migraine patients is seemingly both efficient and well tolerated. However, CGRP and its receptor are abundantly present in both the vasculature, and in the peripheral and central nervous system, and are involved in several physiological processes. Therefore, blocking CGRP may pose a risk in subjects with comorbidities such as cardiovascular diseases. In addition, long-term effects are still unknown. Evidence from animal studies suggests that blocking CGRP may induce constipation, affect the homeostatic functions of the pituitary hormones or attenuate wound healing. However, these effects have so far not been reported in human studies. In conclusion, this review suggests that, based on current knowledge, the pros of blocking CGRP in migraine patients exceed the cons.
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Affiliation(s)
- Marie Deen
- Danish Headache Center, Department of Neurology, Rigshospitalet, Copenhagen, Denmark.
| | - Edvige Correnti
- Department of Child Neuropsychiatry, University of Palermo, Palermo, Italy
| | - Katharina Kamm
- Department of Neurology, University Hospital, LMU, Munich, Germany
| | - Tim Kelderman
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Laura Papetti
- Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Eloisa Rubio-Beltrán
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simone Vigneri
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo; Advanced Algology Research and Pain Medicine Unit, Santa Maria Maddalena Hospital, Occhiobello, Italy
| | - Lars Edvinsson
- Department of Internal Medicine, Institute of Clinical Sciences, Lund University, Lund, Sweden
| | - Antoinette Maassen Van Den Brink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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