2017 Volume 33 Issue 4 Pages 546-549
We reviewed major bibliographic references pertaining to headache (migraine and cluster headache) and epilepsy treatments, which were predominantly published in 2015.
Calcitonin gene–related peptide (CGRP) plays a major role in the pathophysiology of migraine headaches. In 2014, the results of phase II clinical studies of two CGRP antibodies, LY2951742 and ALD403, were reported, and both antibodies demonstrated efficacy. TEV–48125, administered by subcutaneous injection every 28 days, seemed to be tolerable and effective, thus supporting its further development for preventive treatment of chronic migraine in a phase III trial. As these CGRP antibodies have high tolerability and cause few serious adverse reactions, they are expected to serve as the next generation of prophylactic drugs for migraine. A study demonstrated that simvastatin plus vitamin D was effective for preventing headaches in adults with episodic migraines. Given the ability of statins to repair endothelial dysfunction, this economical approach may also reduce the increased risk of vascular diseases among migraineurs. An open–label observational cohort study included patients with cluster headaches (11 chronic, 8 episodic), including 7 who were refractory to drug treatment. A device, known as the gamma–core, was used to treat and prevent individual attacks. Ten patients reduced their acute use of high–flow oxygen therapy by 55% and 9 reduced their triptan use by 48%. The prophylactic use of the device resulted in substantial reduction in the estimated mean attack frequency from 4.5/24h to 2.6/24h after treatment.
Over the last year, several epilepsy studies published might soon influence our clinical decisions. A unique study this year was a clinical trial of bumetanide for the treatment of seizures in neonates with hypoxic–ischemic encephalopathy. Fourteen infants were included in the study ; they received bumetanide doses of 0.05mg/kg to 0.3mg/kg, together with phenobarbital. Eleven survived, but none had outcomes that met efficacy criteria.
