Review and Advances in Neurological Therapeutics (2021). Functional disorders

Abstract

We reviewed treatments for headaches (migraine and cluster headaches) and epilepsy, mainly published in 2021. Headache is the most common neurological disorder and the third leading cause of disability worldwide. Recently, calcitonin gene–related peptide (CGRP) has been highlighted for its role in the pathophysiology of migraine headaches. Therefore, since 2021, monoclonal anti–CGRP antibodies have been approved in Japan. They have been shown to improve the frequency of headache attacks compared with placebo or previous medications. Furthermore, they did not show significant adverse effects in the clinical trials. In addition to these antibodies, a selective 5–HT1F receptor agonist (ditans) was also approved in 2021 and was shown to resolve pain in the acute phase of migraine.

Recently, one study showed a difference in survival between patients treated with enzyme–inducing antiseizure medications and lamotrigine or levetiracetam for post–stroke epilepsy. These results can be due to the increased metabolism of drugs used in secondary prevention after stroke or directly associated with markers of vascular diseases, such as lipid abnormalities. The mechanistic target of rapamycin (mTOR) is a ubiquitous regulator of cell metabolism, growth, proliferation, and survival. Pathogenic variants of genes associated with mTOR cause epilepsy or neurodevelopmental disorders, such as tuberous sclerosis. In addition, focal cortical dysplasia type II results from somatic brain mutations of mTOR pathway activators. Therefore, substances associated with mTOR can be therapeutically used to treat drug–resistant seizures.