In the last years, the hypothesis that cortical hyperexcitability may play a role in the physiopathology of migraine led to the therapeutic use of some antiepileptic drugs. To evaluate the efficacy of levetiracetam as prophylactic treatment for migraine without aura in elderly patients. We performed a small open-label trial treating 13 elderly patients(8F 5M) mean age 64.7 years (SD 3.4), range 60-72 years affected by migraine without aura (ICDH '04 criteria). The mean age of disease was 21.3 years (SD13.4) range 2-45 years. At baseline: the frequency of attacks was 12.2/month (SD 5.9), range 6-25; the mean number of drugs for acute attacks was 12.6 (SD 6.5) tablets/month. All patients took concomitant medication for other chronic diseases. After recruitment Levetiracetam 500 mg/die was administered for 1 week and 1000 mg/die for six months. The basal frequency of attack was 12,2 (SD 5.9) and 8,3 (SD 4.9), 4,1 (SD2.6), 1,3 (SD1.4) after 1, 3 and 6 months respectively [P=0.079; P<0.0001; P<0.0001].The basal value of intaking drugs for acute attacks was 12,6 (SD 6.5) and 6,7 (SD 4.3), 2,8 (SD 2.2), 1,4 (SD1.7) after 1, 3 and six months respectively [P=0.012; P<0.0001; P<0.0001](T-test analysis). Levetiracetam was well tolerated (7 patients complained somnolence, lack of concentration and gastralgia but none patient withdrew the study). In our study levetiracetam showed a good efficacy in frequency and intensity reduction of headache attack and showed a very good tolerability despite all elderly patients took drugs for concomitant diseases.
The relationship between genetic polymorphisms and migraine as a cause of an increased risk of thrombotic disorders development is still debated In this respect, factor V Leiden, factor V (H1299R), prothrombin G20210A, factor XIII (V34L), β-fibrinogen, MTHFR (C677T), MTHFR (A1298C), APO E, PAI-1, HPA-1 and ACE I/D seem to play a determinant role in vascular diseases related to migraine. The present review analyzes both the incidence of the above genetic vascular mutations in migraineurs and the most re-cent developments related to genetic polymorphisms and migraine.
Genetic factors that increase susceptibility to oxidative stress, endothelial disfunction and, possibly, stroke include angiotensin-converting enzyme gene deletion polymorphism (ACE-DD) and the methylentetrahydropholate reductase (MTHFR) C677-TT polymorphism. The relationship of ACE-DD genotype to ischemic stroke and cardiovascular disease is controversial, but it has been independently linked to lacunar infarction, in the absence of carotid atheroma. Lea et al. (2005) reported that the ACE DD genotype acts in combination with the MTHFR T/T genotype to increase migraine susceptibility, with the greatest effect in those with aura. The "TT" polymorphism is also associated with an increased risk of migraine with aura, independent of other cardiovascular risk factors. The aim of our study was to evaluate the incidence of ACE and MTHFR genes polymorphisms in a consecutive series of migrainous patients and of patients affected by myocardial infarction. We studied a series of 103 migrainous patients (1), whose age was between 13 and 75 years (81 suffering from migraine without aura, MwA, 9 from migraine with aura, MWA, 13 from mixed forms MwA-MWA, according to ICHD-II 2004 criteria) and of 336 patients (2) suffering from ischaemic cardiopathy (myocardial infarction, MI). The analysis, based on Polymerase Chain Reaction (PCR) and on reverse-hybridization, showed as follows: MTHFR (C677T): 60 patients (58%) (1) and 186 (56%) (2) were heterozygous; 9 patients (9%) (1) and 54 (16%) (2) were mutated. The result of 1 patient (2) was unknown. MTHFR (A1298C): 54 patients (52%) (1) and 146 (44%) (2) were heterozygous, 7 patients (7%) (1) and 33 (10%) (2) were mutated. The result of 1 patient (2) was unknown. ACE (evaluated on 101 patients (1) and 245 (2)): 45 patients (43%) (1) and 133 (54%) (2) had an ID genotype; 42 (41%) (1) and 87 (36%) (2) had a DD genotype. The results of our study confirm the high incidence in the genetic polymorphisms ACE and MTHFR in migraineuse. These data are confirmed in the sample of patients affected by myocardial infarction. This gives evidence of a strong relationship between migraine and major vascular diseases and let us hypothesize an important role of ACE and MTHFR system in the pathogenetic model of migraine for its capability to interfere with the endothelial regulation tone. Once an effective role in the genesis of migraine and in the increased risk of migrainous patients to evolve into an ischemic pathology has been obviously assigned to this genetic mutation, future researches must aim through wider and more controlled casistics also to clarify the role that drugs acting on these systems may have on the resolution of these diseases.
Introduction: It is estimated that 46 million people in the world live with dementia and it is estimated that this number will increase 3-fold by 2050, being a leading cause of disability worldwide and major welfare and economic problem. The aging of the general population increase these problems, especially in regions, such as Cilento (Southern Italy), where we can register higher longevity. Preserving cognitive health is one of the most important aims of the current research, also through the identification of possible preventative life-style strategies. Recent meta-analyses suggest that low serum vitamin D concentrations could be associated with Alzheimer's disease (AD) and cognitive impairment. The specific role of Vitamin D, however, is still controversial. There is a growing evidence of high rates of vitamin D deficiency in the elderly and there is still much uncertainty about the cause of AD and other forms of dementia. On the other hand, there is no definitive evidence is not conclusive and vitamin D could be involved in many other physiological and pathological mechanisms. Objective: Our aim is to investigate vitamin D serum levels in a small preliminary sample of AD patients from the Cilento area. Materials and Methods: Patients were recruited from the AD centre of the San Luca Hospital, in Vallo della Lucania (SA). We enrolled 25 consecutive patients, 13 women, and 12 men. The mean age was 78.5±8.3 years, the mean duration of the disease was 3.5±1.8 years. The average school-age of the patients was 6.1 +/- 3.5 years, the average disease age was 6.3 +/- 1.7 years, the average basal Mini-Mental Score Examination (MMSE) score was 17.6 +/- 3.6. We determined serum 25-hydroxyvitamin D (25[OH]D) in 25 consecutive AD patients. Results: The mean vitamin D serum level was 17.9+7.9 UI/ml, denoting a state of insufficiency. Among our 25 patients, only 3 had serum level above 30 UI/ml; most patients (17 out of 25) showed serum level among 10 and 30 UI, while in 5 patients, serum level was less than 10 UI. Conclusion: Our preliminary data showed that Vitamin D deficiency was, in our patients, independently associated with AD, even in a special population, high rate of centenarians, like Cilento people. However, our preliminary study has different limitations. The vitamin D deficiency has been evaluated through a single time-point of measurement (or in different periods of the year), that may be susceptible to bias. Even the differences in age and level of education should be taken into consideration. Nevertheless, these data in the Cilento region are original (there are no similar reports to our knowledge). However, our results confirm the necessity of other study, and this result is an important opportunity to introduce a modifiable risk fact and, consequently, a new treatment for AD.
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