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Acetazolamide improves cerebral hemodynamics in CADASIL.

Li Huang1, Qidong Yang, Le Zhang

  • 1Department of Neurology, Xiangya Hospital of Central South University, Hunan Province, Changsha, 410008, China. huangl200903@126.com

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Acetazolamide (ACZ) treatment significantly improved cerebral blood flow and CO2 reactivity in CADASIL patients. This 24-week study suggests ACZ is a promising therapy for enhancing cerebral hemodynamics in this hereditary cerebrovascular disease.

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Area of Science:

  • Neurology
  • Vascular Biology
  • Pharmacology

Background:

  • Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a genetic cerebrovascular disorder.
  • Acetazolamide (ACZ), a carbonic anhydrase inhibitor, is known to increase cerebral blood flow (CBF).
  • Previous research indicates ACZ may improve cerebral perfusion in CADASIL patients, even in compromised areas.

Purpose of the Study:

  • To evaluate the efficacy and safety of a 24-week Acetazolamide (ACZ) treatment in CADASIL patients.
  • To determine if chronic ACZ administration can improve cerebral hemodynamics in individuals with CADASIL.
  • To assess the impact of ACZ on cerebral blood flow velocity and CO2-induced cerebrovascular reactivity.

Main Methods:

  • Sixteen CADASIL patients received daily Acetazolamide (ACZ) at 250 mg for 24 weeks.
  • Transcranial Doppler sonography (TCD) was used to measure middle cerebral artery mean blood flow velocity (MFV) and CO2-induced cerebrovascular reactivity (CVR).
  • Measurements were taken before and after the 24-week treatment period.

Main Results:

  • ACZ treatment led to a significant increase in resting middle cerebral artery mean blood flow velocity (MFV).
  • Cerebrovascular reactivity (CVR) to CO2 significantly improved post-treatment.
  • A significant decrease in the pulsatility index (PI) was observed, indicating improved cerebrovascular compliance.

Conclusions:

  • This study provides the first evidence that Acetazolamide (ACZ) therapy effectively increases cerebral blood flow (CBF) in CADASIL patients.
  • ACZ treatment significantly enhances cerebrovascular reactivity (CVR) in individuals with CADASIL.
  • The findings suggest that ACZ is a viable therapeutic option for managing cerebral hemodynamics in CADASIL.