Cycling multisensory changes in migraine: more than a headache
Purpose of review
Research on migraine usually focuses on the headache; however, accumulating evidence suggests that migraine not only changes the somatosensory system for nociception (pain), but also the other modalities of perception, such as visual, auditory or tactile sense. More importantly, the multisensory changes exist beyond the headache (ictal) phase of migraine and show cyclic changes, suggesting a central generator driving the multiple sensory changes across different migraine phases. This review summarizes the latest studies that explored the cyclic sensory changes of migraine.
Recent findings
Consi...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: HEADACHE: Edited by Messoud Ashina Source Type: research
Triggers of migraine: where do we stand?
Purpose of review
In this review, we illustrate and discuss the recent findings regarding the epidemiology and pathophysiology of migraine triggers and their implications in clinical practice.
Recent findings
Data from the literature suggest that individual triggers fail to provoke migraine attack in experimental settings. It is therefore possible that more triggers acting in combination are needed to induce an attack by promoting some degree of brain dysfunction and thus increasing the vulnerability to migraine. Caution is however needed, because some of the factors rated as triggers by the patients may actuall...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: HEADACHE: Edited by Messoud Ashina Source Type: research
Therapies targeting CGRP signaling for medication overuse headache
Purpose of review
Medication overuse headache (MOH) affects more than 60 million individuals worldwide causing enormous personal and social burden. Only repurposed drugs are available for MOH that share limited evidence for efficacy. The preclinical data suggesting that activation of the calcitonin gene-related peptide (CGRP) pathway is involved in headache chronification along with clinical evidence that monoclonal antibodies targeting CGRP (anti-CGRP mAbs) have good efficacy in preventing chronic migraine, triggered this review that aims to summarize the current data on the effectiveness and safety of mAbs against CG...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: HEADACHE: Edited by Messoud Ashina Source Type: research
Is calcitonin gene-related peptide a reliable biochemical marker of migraine?
Purpose of review
The aim of this study was to provide an overview of clinical studies on calcitonin gene-related peptide (CGRP) measurements in body fluids of migraine patients and to discuss the validity of CGRP measurement as a clinical biomarker of migraine.
Recent findings
Several studies have reported increased CGRP levels in venous blood, saliva and tear fluid of migraine patients compared with healthy controls and in migraine patients during attacks compared with the interictal state, suggesting that CGRP may be a feasible biomarker of migraine. However, the findings of studies investigating CGRP levels ...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: HEADACHE: Edited by Messoud Ashina Source Type: research
From basic mechanisms to therapeutic perspectives in cluster headache
Purpose of review
The pathophysiological understanding of cluster headache has evolved significantly over the past years. Although it is now well known that the trigeminovascular system, the parasympathetic system and the hypothalamus play important roles in its pathomechanism, we increasingly understand the functional role several neurotransmitters and hormones play in the communication between these structures.
Recent findings
This work will give an overview of the current understanding of the role of calcitonin gene-related peptide, vasoactive intestinal peptide, pituitary adenylate cyclase-activating peptide...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: HEADACHE: Edited by Messoud Ashina Source Type: research
Functional MRI in migraine
Purpose of review
The underlying mechanisms of migraine are complex and heterogenous. Advances in neuroimaging techniques during the past few decades have contributed to our understanding of migraine pathophysiology. Brain function in migraine patients has been widely explored using functional MRI (fMRI). This review will highlight the major fMRI findings that characterize the different phases of migraine.
Recent findings
The migraine attack starts with hypothalamic hyperexcitability and early reorganization of the common ascending pain and central trigeminovascular pathways. Moreover, the visual cortex becomes ...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: HEADACHE: Edited by Messoud Ashina Source Type: research
Multiple sclerosis in the era of COVID-19: disease course, DMTs and SARS-CoV2 vaccinations
Purpose of review
As of January 21st 2022, over 340 million are confirmed cases of coronavirus disease 2019 (COVID-19), including nearly 5.6 million deaths. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is neurotropic and affects the neural parenchyma through direct viral invasion from the nasal mucosa and postinfectious cytokine storm. Further challenges of SARS-CoV-2 infection are nowadays linked to variants of concern. Multiple sclerosis is an inflammatory and progressive degenerative disorder of the central nervous system commonly affecting young adults and potentially generating irreversible disabil...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Hans-Peter Hartung Source Type: research
Promoting exogenous repair in multiple sclerosis: myelin regeneration
Purpose of the review
Despite the significant progress in the development of disease-modifying treatments for multiple sclerosis (MS), repair of existing damage is still poorly addressed. Current research focuses on stem cell-based therapies as a suitable alternative or complement to current drug therapies.
Recent findings
Myelin damage is a hallmark of multiple sclerosis, and novel approaches leading to remyelination represent a promising tool to prevent neurodegeneration of the underlying axon. With increasing evidence of diminishing remyelination capacity of the MS brain with ageing and disease progression, e...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Hans-Peter Hartung Source Type: research
Endogenous clues promoting remyelination in multiple sclerosis
Purpose of review
The introduction some 30 years ago of β-interferon, followed by a panel of immunomodulators and immunosuppressants has led to a remarkable improvement in the management of multiple sclerosis (MS) patients. Despite these noticeable progresses, which lower the number of relapses and thereby ameliorate patients’ quality of life, preventing long-term progression of disability is still an unmet need, highlighting the necessity to develop therapeutic strategies aimed at repairing demyelinated lesions and protecting axons from degeneration. The capacity of human brain to self-regenerate demyelinated lesio...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Hans-Peter Hartung Source Type: research
Microglia in multiple sclerosis – pathogenesis and imaging
Purpose of review
Microglia normally protects the central nervous system (CNS) against insults. However, their persistent activation in multiple sclerosis (MS) contributes to injury. Here, we review microglia activation in MS and their detection using positron emission tomography (PET).
Recent findings
During lesion evolution and the progression of MS, microglia activity may contribute to neurotoxicity through the release of pro-inflammatory cytokines, reactive oxidative species, proteases and glutamate. A means to detect and monitor microglia activation in individuals living with MS is provided by positron emis...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Hans-Peter Hartung Source Type: research
Progression in multiple sclerosis – a long-term problem
Purpose of review
Disability progression in multiple sclerosis (MS) is strongly linked to central nervous system (CNS)-specific pathological processes that occur throughout all disease stages, but that become clinically evident in later phases of the disease. We here discuss current views and concepts for targeting progressive MS.
Recent findings
Detailed clinical assessment of MS patients has identified an even closer entanglement of relapse-remitting and progressive disease, leading to novel concepts such as ‘progression independent of relapse activity’. Evolving clinical concepts together with a focus on ...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Hans-Peter Hartung Source Type: research
Fluid phase biomarkers in multiple sclerosis
We present a new approach to search for biomarkers involving extracellular RNA, particularly microRNA (miRNA), and small extracellular vesicles. MiRNA represents an important molecular mechanism influencing gene expression, including those involved in MS pathogenesis and extracellular vesicles transfer multiple cargo, including myelin molecules from parental cells of central nervous system to the long-distance targets.
Summary
MiRNAs which control gene expression in cells involved in autoimmune processes in MS as well as extracellular vesicles transferring myelin content might generate a new promising categories of ...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Hans-Peter Hartung Source Type: research
MRI and laboratory monitoring of disease-modifying therapy efficacy and risks
Purpose of review
Increasingly, therapeutic strategy in multiple sclerosis (MS) is informed by imaging and laboratory biomarkers, in addition to traditional clinical factors. Here, we review aspects of monitoring the efficacy and risks of disease-modifying therapy (DMT) with both conventional and emerging MRI and laboratory measures.
Recent findings
The adoption of consensus-driven, stable MRI acquisition protocols and artificial intelligence-based, quantitative image analysis is heralding an era of precision monitoring of DMT efficacy. New MRI measures of compartmentalized inflammation, neuro-degeneration and r...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Hans-Peter Hartung Source Type: research
Interrogating large multiple sclerosis registries and databases: what information can be gained?
Purpose of review
Although substantial progress has been made in understanding the natural history of multiple sclerosis (MS) and the development of new therapies, many questions concerning disease behavior and therapeutics remain to be answered. Data generated from real-world observational studies, based on large MS registries and databases and analyzed with advanced statistical methods, are offering the scientific community answers to some of these questions that are otherwise difficult or impossible to address. This review focuses on observational studies published in the last 2 years designed to compare the effecti...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Hans-Peter Hartung Source Type: research
New drugs for multiple sclerosis: new treatment algorithms
Purpose of review
To discuss recent changes in the multiple sclerosis (MS) treatment algorithm and to present therapies currently in MS clinical trials.
Recent findings
High efficacy disease modifying therapies are optimally beneficial when used in the early, inflammatory phase of MS. Bruton's tyrosine kinase has emerged as an important therapeutic target for both relapsing and progressive forms of MS. Multiple therapies targeting remyelination failed to provide conclusive evidence of broad therapeutic benefit; however, more targeted approaches offer hope that myelin repair might be achieved resulting in specifi...
Source: Current Opinion in Neurology - June 1, 2022 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Hans-Peter Hartung Source Type: research
