特集 神経疾患治療の進歩2016
機能性疾患の治療の進歩
キーワード:
migraine,
calcitonin gene–related peptide receptor antagonists,
genetic study,
cluster headache,
epilepsy
2018 年 34 巻 5 号 p. 538-542
詳細
2018 年 34 巻 5 号 p. 538-542
We reviewed major bibliographic references pertaining to headache (migraine and cluster headache) and epilepsy treatments, which were predominantly published in 2016. Headache is the most common neurological disorder and the third leading cause of disability worldwide. Calcitonin gene–related peptide (CGRP) plays a major role in the pathophysiology of migraine headaches. In 2016, most migraine preventive studies of the monoclonal anti–CGRP antibodies are now in phase 3. AMG 334 leave no doubt that, unlike current preventive treatments, short–term tolerability is very good. On the other hand, TEV–48125 has been proven safety and tolerability for chronic migraine only in phase 2b. In present, further development of TEV–48125 for the preventive treatment of chronic migraine in a phase 3 trial. Migraine with aura has been consistently associated with increased risk of stroke. Both migraine and CAD have a strong genetic determination, and recent genome–wide association studies have identified risk variants for each.
Cluster headache is one of the most painful disorders. There have been reports on the effectiveness of sphenopalatine ganglion (SPG) stimulation in patients with medically refractory, chronic cluster headache. In this study, SPG stimulation is an effective acute therapy in 45% of patients, offering sustained effectiveness over 24 months of observation.
Genetic study is regarded important in the treatment of epilepsy. Carbamazepine–induced SJS–TEN is strongly associated with the HLA B*1502 allele. SJS–TEN did not develop in any of the HLA–B*1502–negative subjects receiving carbamazepine. Therefore, the HLA B*1502 allele was shown to be a biomarker for carbamazepine–induced SJS–TEN. Hemispheric surgery has been proven to be an effective treatment for patients with medically intractable epilepsy. However temporal plus epilepsy, characterized by a primary temporal lobe epileptogenic zone extending to neighbored regions, there are surgery failures. So, there are necessary for sufficient preoperative examinations.
