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Familial hemiplegic migraine treated by sodium valproate and lamotrigine
Nadine Pelzer1, Anine H Stam1, Johannes A Carpay2
1Department of Neurology, Leiden University Medical Center, the Netherlands.
Background:
Familial hemiplegic migraine (FHM) is a rare monogenic subtype of migraine with aura that includes motor auras. Prophylactic treatment of FHM often has marginal effects and involves a trial-and-error strategy based on therapeutic guidelines for non-hemiplegic migraine and on case reports in FHM.
Methods:
We assessed the response to prophylactic medication in an FHM family and sequenced the FHM2 ATP1A2 gene in all available relatives.
Results:
A novel p.Met731Val ATP1A2 mutation was identified. Attack frequency was reduced significantly with sodium valproate monotherapy (n = 1) and attacks ceased completely with a combination of sodium valproate and lamotrigine (n = 2).
Conclusions:
We report dramatic prophylactic effects of sodium valproate and lamotrigine in an FHM2 family, making these drugs worth considering in the treatment of other FHM patients.
Insights
Sodium valproate and lamotrigine showed significant success in preventing familial hemiplegic migraine (FHM) attacks. This study highlights their potential as effective prophylactic treatments for FHM patients.
Area of Science:
- Neurology
- Genetics
- Pharmacology
Background:
- Familial hemiplegic migraine (FHM) is a rare genetic migraine subtype characterized by motor auras.
- Current prophylactic treatments for FHM often yield limited results, necessitating a trial-and-error approach.
Purpose of the Study:
- To evaluate the efficacy of prophylactic medications in a family with FHM.
- To identify genetic mutations associated with FHM in the studied family.
Main Methods:
- Assessed prophylactic medication response within an FHM family.
- Sequenced the ATP1A2 gene in FHM2 patients to identify mutations.
Main Results:
- A novel p.Met731Val mutation in the ATP1A2 gene was identified.
- Sodium valproate monotherapy significantly reduced FHM attack frequency in one patient.
- A combination of sodium valproate and lamotrigine completely halted attacks in two patients.
Conclusions:
- Sodium valproate and lamotrigine demonstrated substantial prophylactic effects in an FHM2 family.
- These medications warrant consideration for treating other patients with FHM.
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