Anti-CGRP and anti-CGRP receptor monoclonal antibodies as antimigraine agents. Potential differences in safety profile postulated on a pathophysiological basis
Publication date: Available online 21 April 2019Source: PeptidesAuthor(s): Giuseppe Tringali, Pierluigi NavarraAbstractCalcitonin gene-related peptide (CGRP), is a peptide neurotransmitter with potent vasodilating properties. CGRP is believed to play a primary role in the pathogenesis of migraine. As such, CGRP and its receptors are obvious druggable targets for novel anti-migraine agents. While the development of small-molecule CGRP receptor antagonists started first, none of these agents is yet available in clinical practice. Conversely, both anti-CGRP and anti-CGRP receptor monoclonal antibodies (mABs) completed clinical development, and the first representatives of these 2 classes are available on the market. MABs are approved for prevention of migraine attacks in chronic or episodic migraine, involving long-term treatments. In light of the physiological role exerted by CGRP in the regulation of vascular tone, the potential risks of a long-term inhibition of CGRP functions raised diffuse concerns. These concerns were correctly addressed by the anti-CGRP receptor mABs erenumab with a 5-year open-label clinical trial; however, this study is currently ongoing and results are not yet available, leaving some uncertainty on the profile of erenumab long-term safety. Similar concerns can be raised with direct anti-CGRP mABs, which entrap the peptide preventing receptor activation. However, evidence exists that plasma CGRP is detectable in patients chronically treated with anti-CG...
We present a series of four adult sickle-cell patients who developed PRES. The association of hypertension, renal failure, and immunosuppressants in sickle cell patients may play a role in the development of PRES in this patient population. It is unclear if SC patients have a higher frequency of PRES predisposing factors than the general population or if SC is an independent risk factor for PRES. Despite this limitation, the presence of acute neurological status changes in adult SC patients should trigger suspicion for PRES as management and outcome may be altered.
Publication date: Available online 22 August 2019Source: Journal of Clinical NeuroscienceAuthor(s): Yu Chiang, Hung-Jung Wang, Cheng-Yu ChenAbstractLeukoencephalopathy, cerebral calcifications, and cysts (LCC) is an extremely rare neurological disease, also known as Labrune syndrome. The disease more commonly affects children and young adults and the characteristic triple imaging findings are leukoencephalopathy, calcifications and multiple cysts, presenting with a variety of supra- and infratentorial symptoms but lacking for extra-neurological manifestations. Coats plus syndrome and cerebroretinal microangiopathy with cal...
ConclusionsThis study evaluated the efficacy characteristics of seven kinds of triptans and their different dosage forms. The present findings provide necessary quantitative information for migraine medication guidelines.
CONCLUSION: Patients with IBS in Germany are likely not receiving sufficient diag- nostic evaluation in conformity with the relevant guidelines. The high prevalence of comorbid mental disorders and other pain syndromes implies that the complaints of patients with IBS need to be more comprehensively evaluated and treated. PMID: 31431234 [PubMed - in process]
In conclusion, PACAP27 induced headache and dilated extracerebral arteries (>5 h) and slightly constricted MCA in healthy volunteers. Post hoc analysis of PACAP38 data compared with PACAP27 showed that PACAP isoforms dilates MMA with significantly different magnitude.
Sagittal imbalance in the cervical spine is a major cause of neck pain, headache, fatigue, and disability. While parameters such as C2-C7 lordosis and C2-C7 sagittal vertical axis have been extensively studied, they do not fully characterize cervical sagittal balance. T1 is an important new parameter of both cervical as well as global spinal sagittal balance. However, the T1 superior end plate can be difficult to visualize on standard lateral radiographs due to overlying anatomical structures. C7 slope has therefore been proposed as a potential substitute for T1 slope when the T1 superior end plate is not well visualized.
Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): The Lancet
Dr Neil Long Funtabulously Frivolous Friday Five 291 It's Friday. Boggle your brain with FFFF challenge and some old fashioned trivia. Funtabulously Frivolous Friday Five 291
Headache is one of the most common pain symptoms in childhood having a negative impact on many aspects of the lives of affected children, both short-term and long-term. Therefore, it is important to document s...
To identify structural changes in the brain regions of patients with vestibular migraine (VM) so as to better understand its pathophysiology.