2021 年 38 巻 5 号 p. 744-747
We reviewed treatments for headaches (migraine and cluster headaches) and epilepsy, mainly published in 2020. Headache is the most common neurological disorder and the third leading cause of disability worldwide. Recently, Calcitonin gene–related peptide (CGRP) has been shed light on because of its role in the pathophysiology of migraine headaches. In 2020, the monoclonal anti–CGRP antibodies were approved in Japan. They were shown to improve the frequency of headache attacks compared to the placebo or previous medications. Furthermore, they did not show significant adverse effects in the clinical trials. Other than these antibodies, selective 5–HT1F receptor agonist (ditans) or CGRP antagonists (gepants) are also under clinical trials. Cluster headache is one of the most painful disorders. Although the precise protocols were not determined, one study showed that the gradual decrement protocols of prednisolone improve the frequency of headache attacks.
Recently, the number of patients with epilepsy in the elderly has been gradually increasing because of the aging society. Since the cause of late–onset epilepsy was mainly cerebrovascular diseases and dementia, the cross–talks between epilepsy and dementia were reported. Patients with Alzheimer's disease had a 6–times higher odds ratio of complications of seizures. Meanwhile, cognitive functions of minimal cognitive impairment cases with epileptic seizures worsened compared to those without epileptic seizures. Autoimmune encephalitis is one of the crucial causes of late–onset epilepsy. However, autoimmune encephalitis such as anti LGI1 antibody–associated encephalitis was often misdiagnosed because it mimics epilepsy or dementia. It responses to immunological treatments like methylprednisone pulse or IVIg.
Other advances were reported below. 1) The use of continuous electroencephalogram (cEEG) was revealed to improve the prognosis of critical care patients. As a result, the American Clinical Neurophysiology Society recommended its use to diagnose nonconvulsive seizures in the neuro–intensive care unit. 2) Oromucosal solution containing the active substance midazolam was approved in Japan to treat prolonged, acute convulsive seizures in children and adolescents less than 18 years of age. 3) The treatment with responsive neurostimulation (RNS) in the USA was shown to provide significant reductions in the frequency of focal onset seizures through 9 years of follow–up. In addition, there could be longer–term neuromodulatory effects of neurostimulation that resulted in continued improvement in outcomes.
